The clinical (ir)relevance of opioid-induced immune suppression

Current Opinion in Anaesthesiology

Volumn 23, Issue 5, 2010, Pages 588-592

  Rittner, Heike L ^a   Roewer, Norbert ^a   Brack, Alexander ^a  

^a UNIVERSITY HOSPITAL WÜRZBURG   (Germany)

Author keywords

immune suppression; infection; intensive care; opioids

Indexed keywords

17 METHYLNALTREXONE; ALCOHOL; ALVIMOPAN; BENZODIAZEPINE DERIVATIVE; FENTANYL; HYDROMORPHONE; KETOCONAZOLE; MORPHINE; NALOXONE; OPIATE; OXYCODONE; PLACEBO; REMIFENTANIL; SUFENTANIL;

ANALGESIA; BURN; CANCER SURGERY; CHRONIC PAIN; CLINICAL TRIAL; COLON RESECTION; DIGESTIVE SYSTEM CANCER; DIVERTICULOSIS; ENTERITIS; EPIDURAL ANESTHESIA; HEART SURGERY; HUMAN; IMMUNOMODULATION; INFECTION RISK; INFECTIOUS COMPLICATION; INTENSIVE CARE; INTENSIVE CARE UNIT; LAPAROSCOPY; LOW DRUG DOSE; OUTCOME ASSESSMENT; PNEUMONIA; POSTOPERATIVE COMPLICATION; POSTOPERATIVE PAIN; PRIORITY JOURNAL; RESPIRATORY TRACT INFECTION; REVIEW; SEDATION; SEPSIS; STREPTOCOCCUS PNEUMONIAE; SYSTEMIC THERAPY; URINARY TRACT INFECTION; WITHDRAWAL SYNDROME; WOUND INFECTION;

ACUTE DISEASE; ANALGESICS, OPIOID; ANIMALS; CROSS INFECTION; HUMANS; IMMUNOSUPPRESSION; INTENSIVE CARE UNITS; OPIOID-RELATED DISORDERS; PAIN, POSTOPERATIVE; RECEPTORS, OPIOID; SURGICAL WOUND INFECTION;

EID: 77956467141     PISSN: 09527907     EISSN: None     Source Type: Journal    
DOI: 10.1097/ACO.0b013e32833c345a     Document Type: Review

References (30)

1. Feng P, Truant AL, Meissler JJ Jr, et al. Morphine withdrawal lowers host defense to enteric bacteria: spontaneous sepsis and increased sensitivity to oral Salmonella enterica serovar Typhimurium infection. Infect Immun 2006; 74:5221-5226.
2. Wang J, Barke RA, Charboneau R, Roy S. Morphine impairs host innate immune response and increases susceptibility to Streptococcus pneumoniae lung infection. J Immunol 2005; 174:426-434.
3. Wang J, Barke RA, Charboneau R, et al. Morphine induces defects in early response of alveolar macrophages to Streptococcus pneumoniae by modulating TLR9-NF-kappa B signaling. J Immunol 2008; 180:3594-3600.
4. Qaseem A, Snow V, Fitterman N, et al. Risk assessment for and strategies to reduce perioperative pulmonary complications for patients undergoing noncardiothoracic surgery: a guideline from the American College of Physicians. Ann Intern Med 2006; 144:575-580.
5. Ma J, Wang J, Wan J, et al. Morphine disrupts interleukin-23 (IL-23)/IL-17- mediated pulmonary mucosal host defense against Streptococcus pneumoniae infection. Infect Immun 2010; 78:830-837.
6. El Solh AA, Bhora M, Pineda L, Dhillon R. Nosocomial pneumonia in elderly patients following cardiac surgery. Respir Med 2006; 100:729-736.
7. Spies C, Eggers V, Szabo G, et al. Intervention at the level of the neuroendocrine- immune axis and postoperative pneumonia rate in long-term alcoholics. Am J Respir Crit Care Med 2006; 174:408-414.
8. Noel JK, Fahrbach K, Estok R, et al. Minimally invasive colorectal resection outcomes: short-term comparison with open procedures. J Am Coll Surg 2007; 204:291-307.
9. Wu CL, Cohen SR, Richman JM, et al. Efficacy of postoperative patientcontrolled and continuous infusion epidural analgesia versus intravenous patient-controlled analgesia with opioids: a meta-analysis. Anesthesiology 2005; 103:1079-1088.
10. Popping DM, Elia N, Marret E, et al. Protective effects of epidural analgesia on pulmonary complications after abdominal and thoracic surgery: a meta-analysis. Arch Surg 2008; 143:990-1000.
11. Ahlers O, Nachtigall I, Lenze J, et al. Intraoperative thoracic epidural anaesthesia attenuates stress-induced immunosuppression in patients undergoing major abdominal surgery. Br J Anaesth 2008; 101:781-787.
12. Volk T, Schenk M, Voigt K, et al. Postoperative epidural anesthesia preserves lymphocyte, but not monocyte, immune function after major spine surgery. Anesth Analg 2004; 98:1086-1092.
13. Dellinger RP, Levy MM, Carlet JM, et al. Surviving Sepsis Campaign: international guidelines for management of severe sepsis and septic shock: 2008. Crit Care Med 2008; 36:296-327.
14. Schwacha MG, McGwin G Jr, Hutchinson CB, et al. The contribution of opiate analgesics to the development of infectious complications in burn patients. Am J Surg 2006; 192:82-86.
15. Anand KJ, Hall RW, Desai N, et al. Effects of morphine analgesia in ventilated preterm neonates: primary outcomes from the NEOPAIN randomised trial. Lancet 2004; 363:1673-1682.
16. Bhandari V, Bergqvist LL, Kronsberg SS, et al. Morphine administration and short-term pulmonary outcomes among ventilated preterm infants. Pediatrics 2005; 116:352-359.
17. Kress JP, Pohlman AS, O'Connor MF, Hall JB. Daily interruption of sedative infusions in critically ill patients undergoing mechanical ventilation. N Engl J Med 2000; 342:1471-1477.
18. Girard TD, Kress JP, Fuchs BD, et al. Efficacy and safety of a paired sedation and ventilator weaning protocol for mechanically ventilated patients in intensive care (Awakening and Breathing Controlled trial): a randomised controlled trial. Lancet 2008; 371:126-134.
19. Quenot JP, Ladoire S, Devoucoux F, et al. Effect of a nurse-implemented sedation protocol on the incidence of ventilator-associated pneumonia. Crit Care Med 2007; 35:2031-2036.
20. Feng P, Meissler JJ Jr, Adler MW, Eisenstein TK. Morphine withdrawal sensitizes mice to lipopolysaccharide: elevated TNF-alpha and nitric oxide with decreased IL-12. J Neuroimmunol 2005; 164 (1-2):57-65.
21. Feng P, Wilson QM, Meissler JJ Jr, et al. Increased sensitivity to Salmonella enterica serovar Typhimurium infection in mice undergoing withdrawal from morphine is associated with suppression of interleukin-12. Infect Immun 2005; 73:7953-7959.
22. Nseir S, Hoel J, Grailles G, et al. Remifentanil discontinuation and subsequent intensive care unit-acquired infection: a cohort study. Crit Care 2009; 13:R60.
23. Rittirsch D, Hoesel LM, Ward PA. The disconnect between animal models of sepsis and human sepsis. J Leukoc Biol 2007; 81:137-143.
24. Meissner W, Dohrn B, Reinhart K. Enteral naloxone reduces gastric tube reflux and frequency of pneumonia in critical care patients during opioid analgesia. Crit Care Med 2003; 31:776-780.
25. Jaeger K, Scheinichen D, Heine J, et al. Remifentanil, fentanyl, and alfentanil have no influence on the respiratory burst of human neutrophils in vitro. Acta Anaesthesiol Scand 1998; 42:1110-1113.
26. Welters ID, Menzebach A, Goumon Y, et al. Morphine suppresses complement receptor expression, phagocytosis, and respiratory burst in neutrophils by a nitric oxide and mu(3) opiate receptor-dependent mechanism. J Neuroimmunol 2000; 111 (1-2):139-145.
27. Webster L, Jansen JP, Peppin J, et al. Alvimopan, a peripherally acting muopioid receptor (PAM-OR) antagonist for the treatment of opioid-induced bowel dysfunction: results from a randomized, double-blind, placebocontrolled, dose-finding study in subjects taking opioids for chronic noncancer pain. Pain 2008; 137:428-440.
28. Thomas J, Karver S, Cooney GA, et al. Methylnaltrexone for opioidinduced constipation in advanced illness. N Engl J Med 2008; 358: 2332-2343.
29. Rittner HL, Brack A, Stein C. Pain and the immune system. Br J Anaesth 2008; 101:40-44.
30. Altman DG, Bland JM. Absence of evidence is not evidence of absence. BMJ 1995; 311:485.