الفهرس 
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Abstract
Introduction: A good knowledge about immunological effects of anaesthetic agents and related perioperative interventions on immunologically normal patients and immunocompromised would serve in improvement of patient safety and preoperative outcome. Intraoperative anaphylaxis is the most severe immune mediated reaction associated with anesthesia leading to severe morbidity and mortality, so immediate recognition and management are vital to prevent death. Diagnosis of preoperative anaphylaxis relies on history and physical examination, while retrospective diagnosis is based on serologic measurement of IgE (total and specific) and skin tests. The aim of testing is to diagnose an anaphylactic or anaphylactoid reaction, to identify the causative agent and to test for cross reactivity with other related agents. Muscle relaxants are the most common cause of anaphylaxis during anesthesia in pediatrics, followed by latex which have high incidence in children more than adults, anaphylaxis to opiates and hypnotics are rare, there is no reports indicating anaphylaxis to inhaled anesthesia. Prevention of anaphylaxis is done by careful history, identification of risk factors and avoidance of drugs that induce anaphylaxis, if patients are given, from birth, a latex-free environment during invasive techniques, babies with this condition, and other patients requiring multiple surgery, do not become sensitized. The effect of anesthetic agents on PMN function best comes from in vitro studies. The immunosuppressive effects were more marked in neonates than in older children. Thiopental exerted a dose dependent inhibitory effect on neutrophil chemotaxis and phagocytosis and on (ROS) production. Inhibitory effect of thiopental was greater than ketamine and midazolam. Therapeutic concentration impaired phagocytosis, chemotaxis and ROS generation. Higher concentration also impaired ROS production, these effects caused by Suppression of the increase in Ca+2 ions. Therapeutic concentration of thiopental also had affect phagocytic activity and ROS production of macrophages due to direct effect on macrophage function or increased corticosteroid hormone production. Aim of work: The aim of this study is getting a focus on the effect of different anesthetic methods on pediatric immunity and immunocompromised patients. The reason behind the concern is that the risk of postoperative infection rise as a result of longer durations of anesthesia. Conclusions: Intraoperative anaphylaxis is the most severe complication of pediatric anesthesia and it is prevented by careful identification of risk groups, identification of causative agent, serologic and skin tests. Postoperative immunosuppressive effects are transient for aproximatly 48 hours irrespective to the mechanism of drugs actions. Immunocompromised patients should be carefully observed for fear of postoperative infections and neurological complications, which occur as a result of regional anesthesia technique. Anesthesia should be postponed for one week for killed vaccines and for three weeks for live vaccines for fear of increased complications of vaccines or decrease the effectiveness of vaccines.