Effects of different anesthesia and analgesia on cellular immunity and cognitive function of patients after surgery for esophageal cancer.

Background: The study intends to analyze influences of different anesthesia and analgesia on cellular immune and cognitive functions of patients undergoing thoracotomy for esophageal cancer (EsC).

Methods: Patients undergoing thoracotomy for EsC were divided into four groups: Group A (received general anesthesia [GA]) and postoperative intravenous analgesia); B (received GA and postoperative epidural analgesia); C (received GA combined with thoracic epidural anesthesia [TEA]) and postoperative intravenous analgesia); D (received GA combined with TEA and postoperative epidural analgesia). The T-lymphocyte subsets were determined at 30 min before anesthesia induction (T0), 2 h after skin incision (T1), and at 4 h (T2), 24 h (T3), and 48 h (T4) after operation. Besides, visual analogue scale (VAS) and mini-mental state examination (MMSE) were assessed.

Results: The percentage of CD3⁺ and CD4⁺ cells in groups B and C were higher than group A from T1 to T3. The ratio of CD4⁺/CD8⁺ in group B and C were higher than in group A at T3. Compared with group A, group D had increased percentages of CD3⁺ and CD4⁺ from T1 to T4, and elevated ratio of CD4⁺/CD8⁺ from T2 to T4 VAS scores were lower and MMSE scores were higher in groups B, C, and D than in group A, and group D had relatively lower VAS and higher MMSE scores as compared to group B.

Conclusions: The intraoperative general anesthesia combined with thoracic epidural anesthesia and postoperative epidural analgesia may reduce adverse effect on cellular immune and cognitive functions of patients undergoing thoracotomy for EsC.