الفهرس 
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Abstract
Background: Surgical trauma elicits a complex response that involves an interplay between the neuroendocrine, cardiovascular, immune and inflammatory systems. This response may be self limited or may progress to multiple organ dysfunction syndrome. Cytokines are key mediators in the inflammatory response. Release of many pro- and antiinflammatory cytokines occurs in the local damaged tissue from both endothelial cells and recruited inflammatory cells. IL-6 is a proinflammatory cytokine that mediates the hepatic induction of many acute phase proteins. IL-6 effects are controlled and regulated by antiinflammatory cytokines including IL-10. Aim of work: Anesthesia may induce immunomodulation with attenuation of the acute phase response after prolonged abdominal surgery. Whether this attenuation is in favor of inhalational or total intravenous anesthesia is still a subject of debate. This study was designed to test the hypothesis that patients subjected to prolonged abdominal surgery with either K-M-F total intravenous anesthesia or isoflurane inhalational anesthesia may reveal a deferential effect on the acute phase response. Methods: This prospective randomized study was carried out on patients submitted for radical cystectomy and bladder substitution in Mansoura Urology & Nephrology Center. The study protocol was approved by the hospital research ethics committee and a written informed consent was obtained. All patients were ASA I, II, aged 30 – 60 years of both sex were included. Exclusion criteria were patients with endocrinal or inflammatory disorders, patients receiving corticosteroids, anti-inflammatory drugs, chemotherapy, blood transfusion, albumin or psychotic therapy. 62 patients were allocated by computer generated randomization into two groups of 31 patients each; TIVA group: received total intravenous anesthesia with ketamine-midazolam-fentanyl (K-M-F TIVA). Isoflurane group: receive isoflurane inhalational anesthesia. Results: K-M-F total intervenous anesthesia demonstrated more stable haemodynamic as regard the rough indicators (HR and MPB) changes. Also less visual analogue score was exhibited with K-M-F group. These findings were in coorderance with the significant increase in CRP and fibrinogen observed with the isoflurane group when compared with K-M-F group. CRP increased significantly on the first postoperative day while fibrinogen increase was detected in the third postoperative day. Total leucocytic count demonstrated a significant increase in the first and third postoperative days in the isoflurane group. IL-6, IL-10, Hb level and albumin showed a comparable results when both groups were compared. Conclusion: K-M-F total intravenous anesthesia could attenuate the acute phase protein response, possibly due to the superior analgesic and antinocipective effect of K-M-F anesthesia.