Vispārējās un reģionālās anestēzijas saistība ar beta-herpesvīrusu aktivāciju un imunoloģiskajām izmaiņām ilgstošās mikrovaskulārās brīvā lēvera operācijās

Beta-herpesvirus 6 (HHV-6) and beta-herpesvirus 7 (HHV-7) are ubiquitous immunomodulating viruses that after primary infection remain in the form of persistent infection throughout the life. There are a wide variety of studies trying to find and evaluate the role of infection of these herpesviruses in the development of various chronical diseases. Unfortunately, the final answer to this question is still not found. Probably it is linked to the broad distribution and different mechanisms of interference with the host organism of these viruses. The aim of this study was to explore use of two different methods of anaesthesia – general and regional – for prolonged microvascular free flap surgery and their relationship with HHV-6 and HHV-7 activation and changes of cellular immunity in order to find the optimal anaesthetic technique for microvascular free flap surgeries. Qualitative and quantitative polymerase chain reactions (PCR) were carried out to detect presence of viral genomic sequences, infection activity stage, and viral load. The expression level of cytokines was detected by enzyme-linked immunosorbent assay – ELISA, subpopulations of immunocompetent cells’ – analysed by Becton Dickinson (USA) laser flow cytofluorimeter. The results showed that prolonged microvascular free flap surgery, performed under general anaesthesia, causes a significant impact on the cellular immune response. Microvascular free flap surgeries performed under general anaesthesia were associated with significant activation of HHV-7 infection, while microvascular free flap surgeries performed under regional anaesthesia were not significantly associated with activation of HHV-6 or HHV-7 infection. Microvascular free flap surgeries performed under general anaesthesia supress the effector phase cellular immune response while microvascular free flap surgeries performed under regional anaesthesia preserve active immune response. Short operations, irrespective of the anaesthetic technique used, are not related to activation of HHV-6 or HHV-7 and changes in the number of immune cells. After prolonged microvascular free flap surgeries neither active, nor latent/persistent HHV-6 and HHV-7 infection does affect the post-operative period course and outcome of surgery. In individual cases, as evidenced by our clinical case of neurofibromatosis, the impact of active HHV-6 and HHV-7 infection on the postoperative period course and surgical outcome could not be excluded.