Perioperative effects of anesthesia and surgery on inflammation-coagulation interaction

Background: The extent of perioperative cross-talk between coagulation and inflammatory markers depends on the type of surgery and anesthesia. Methods: After obtaining ethical committee approval and patients' written informed consents, 68 patients aged 25–65 years of either sex, ASA physical status I–II were randomly assigned to one of four equal groups: Open or Laparoscopic cholecystectomy groups anesthetized with either Isoflurane (IO or IL groups) or Sevoflurane (SO or SL groups) in order to assess coagulation, anticoagulation, fibrinolytic and inflammatory markers preoperatively, immediately postoperative, 24 and 72 hours after surgery. Results: In all groups, prothrombin concentration significantly reduced while prothrombin time, partial thromboplastin time and international normalized ratio significantly increased (P < 0.05) postoperatively. Coagulation markers including; soluble platelet selectin, von Willebrand factor, thrombin antithrombin complex, D-dimer, as well as inflammatory markers including; high sensitivity C-reactive protein, interleukin- 1 beta and interleukin-6 showed significant (P < 0.05) postoperative elevation. Plasminogen and anticoagulation markers including; antithrombin, protein C and S significantly reduced (P < 0.05) in all groups. Coagulation and inflammatory markers were significantly higher while plasminogen and anticoagulation markers were significantly lower in open than laparoscopic groups and after isoflurane than sevoflurane anesthesia (P < 0.05). Correlations between coagulation and inflammatory markers were observed postoperatively. Conclusions: Laparoscopic surgery under sevoflurane anesthesia was associated with less hypercoagulability than open surgery under isoflurane anesthesia probably mediated through inflammatory response.