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Correspondence |
Kobe, Japan
To the Editor:
Anesthesia and surgery inhibit several neutrophil functions1 involved in antibacterial host defence mechanisms. Pirenzepine (a muscarinic receptor antagonist) and omeprazole, lansoprazole, and rabeprazole (proton pump inhibitors) are administered peri-operatively for prophylaxis against aspiration pneumonitis or stress ulceration.2–4 Critically ill patients, potentially immunocompromised, often receive these gastric protective agents for the same purpose. This is why, after institutional approvement and informed consent, we assessed chemotaxis, phagocytosis, and superoxide (O2-) and hydrogen peroxide (H2O2) production of neutrophils isolated from 12 healthy adult volunteers in the presence of pirenzepine, omeprazole, lansoprazole, or rabeprazole at clinically relevant concentrations, four times, and ten times these concentrations, according to methods described previously.5 We also measured intracellular calcium ion ([Ca++]i) concentrations and O2- and H2O2 production by the xanthine- xanthine oxidase system. Although pirenzepine, omeprazole, and lansoprazole had no effect on neutrophil chemotaxis, phagocytosis, O2- and H2O2 production, and the stimulant-induced elevation of [Ca++]i, rabeprazole inhibited these functions/responses in a dose-dependent manner (Figure
). Rabeprazole impaired chemotaxis at clinically relevant concentrations. All drugs failed to scavenge O2- and H2O2 generated by an acellular system. Inhibition of calcium mobilization may have contributed, in part, to reduction of neutrophil function by rabeprazole. Thus, rabeprazole could be beneficial in non-septic patients with systemic inflammation or multiple organ failure. On the other hand, pirenzepine, omeprazole, and lansoprazole may not interfere with neutrophil function in infectious or septic patients. Further in vivo studies are required to assess the clinical effects of these gastric protectors on neutrophil function.
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References
1 Khan FA, Kamal RS, Mithani CH, Khurshid M. Effect of general anaesthesia and surgery on neutrophil function. Anaesthesia 1995; 50: 769–75.[Medline]
2
Maekawa N, Nishina K, Mikawa K, Shiga M, Obara H. Comparison of pirenzepine, ranitidine, and pirenzepine-ranitidine combination for reducing preoperative gastric fluid acidity and volume in children. Br J Anaesth 1998; 80: 53–7.
3 Nishina K, Mikawa K, Maekawa N, Takao Y, Shiga M, Obara H. A comparison of lansoprazole, omeprazole, and ranitidine for reducing preoperative gastric secretion in adult patients undergoing elective surgery. Anesth Analg 1996; 82: 832–6.[Abstract]
4
Nishina K, Mikawa K, Takao Y, Shiga M, Maekawa N, Obara H. A comparison of rabeprazole, lansoprazole, and ranitidine for improving gastric fluid property in adults undergoing elective surgery. Anesth Analg 2000; 90: 717–21.
5 Nishina K, Akamatsu H, Mikawa K, et al. The inhibitory effects of thiopental, midazolam, and ketamine on human neutrophil functions. Anesth Analg 1998; 86: 159–65.[Abstract]
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