Immune Modulation by Volatile Anesthetics

Abstract

Volatile general anesthetics continue to be an important part of clinical anesthesia worldwide. The impact of volatile anesthetics on the immune system has been investigated at both mechanistic and clinical levels, but previous studies have returned conflicting findings due to varied protocols, experimental environments, and subject species. While many of these studies have focused on the immunosuppressive effects of volatile anesthetics, compelling evidence also exists for immunoactivation. Depending on the clinical conditions, immunosuppression and activation due to volatile anesthetics can be either detrimental or beneficial. This review provides a balanced perspective on the anesthetic modulation of innate and adaptive immune responses as well as indirect effectors of immunity. Potential mechanisms of immunomodulation by volatile anesthetics are also discussed. A clearer understanding of these issues will pave the way for clinical guidelines that better account for the impact of volatile anesthetics on the immune system, with the ultimate goal of improving perioperative management.

Proper selection of sedative drugs improves outcomes: volatile anesthetics are surgeons’ best friends

“…The immunomodulatory qualities of IAs are well reported in the literature. IAs decrease inflammation and attenuate lung injury by suppressing inflammatory responses (2,3). Mechanisms include modulation of alveolar macrophage r e s p o n s e s a n d G A B A A -r e c e p t o r m e d i a t e d a n t iinflammatory effects at the level of lung epithelial cells.…”

Deep anesthesia: too much of a good thing?

“…É tant donné que de fortes doses d'anesthésiques provoquent une dépression cardiovasculaire ainsi qu'une dégradation des réponses inflammatoires et immunitaires, 5,6 il n'est pas surprenant qu'une anesthésie profonde puisse entraîner une hypoperfusion tissulaire et, par la suite, un dysfonctionnement des organes. À cet égard, le débat fait rage quant à savoir si une anesthésie profonde peut causer une incidence accrue de delirium postopératoire et de trouble cognitif, 3,4,7,8 voire une augmentation de la récurrence de cancer ou de métastase.…”

“…Given that large doses of anesthetics produce cardiovascular depression and impairment of inflammatory and immune responses, 5,6 it is not surprising that deep anesthesia could result in tissue hypoperfusion and subsequent organ dysfunction. In this regard, there is ongoing debate whether deep anesthesia can lead to an increased incidence of postoperative delirium and cognitive impairment, 3,4,7,8 and even increased cancer recurrence or metastasis.…”

Effects of Anesthesia & Anesthetic techniques on Cellular Immunity

“…The identification and characterization of the immunosuppressive effects of inhalational agents has been challenging for researchers because of the many variables in the conditions of inhalational anesthesia administration and the different drugs to which patients are exposed. Figure 1 shows some of the direct immune modulations by volatile anesthetics [11]. In a large retrospective analysis, Schlagenhauff et al found a relationship between anesthesia and cancer survival rate: compared with the use of local anesthesia, general anesthesia was associated with a decreased survival rate for patients with primary melanoma excisions [3].…”