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Are There Opportunities to Decrease Nosocomial Infection by Choice of Analgesic Regimen?
Evidence for Immunity and Pain Interactions
Kathleen B. Weatherstone, MD;
Linda S. Franck, PhD, RN, RGN, RSCN;
Nigel J. Klein, MBBS, MRCP, PhD, FRCPCH
Arch Pediatr Adolesc Med. 2003;157:1108-1114.
Background Interactions suggest that anesthetic and analgesic strategies could be used to modulate immune function and reduce nosocomial infection in critically ill pediatric patients. However, this theory has yet to be adequately tested.
Objective To present the evidence for interactions between nociceptive and immune pathways.
Data Sources The MEDLINE database and hand searches of the English-language biomedical literature for the 1985-2003 period.
Data Synthesis Substantial evidence exists for numerous bidirectional relationships between nociceptive and immune pathways. Some studies suggest that surgical pain and stress may alter immune function in adults. Limited evidence indicates that anesthetic and analgesic immunomodulation may boost immune function to prevent nosocomial infection. However, unique aspects of immune function maturation and neurodevelopment must be considered.
Conclusion Research is urgently needed to determine if the interactions between nociceptive and immune function pathways in critically ill infants and children are similar to those in adults and if host defenses can be enhanced by optimal anesthetic and analgesic strategies.
From the Department of Pediatrics, University of Kansas School of Medicine, Kansas City (Dr Weatherstone); and the Centre for Nursing and Allied Health Professionals Research (Dr Franck) and Department of Infectious Disease and Microbiology (Dr Klein), Institute of Child Health and Great Ormond Street Hospital for Children, London, England.
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