Anesthetics, immune cells, and immune responses

Abstract

General anesthesia accompanied by surgical stress is considered to suppress immunity, presumably by directly affecting the immune system or activating the hypothalamic-pituitary-adrenal axis and the sympathetic nervous system. Along with stress such as surgery, blood transfusion, hypothermia, hyperglycemia, and postoperative pain, anesthetics per se are associated with suppressed immunity during perioperative periods because every anesthetic has direct suppressive effects on cellular and neurohumoral immunity through influencing the functions of immunocompetent cells and inflammatory mediator gene expression and secretion. Particularly in cancer patients, immunosuppression attributable to anesthetics, such as the dysfunction of natural killer cells and lymphocytes, may accelerate the growth and metastases of residual malignant cells, thereby worsening prognoses. Alternatively, the anti-inflammatory effects of anesthetics may be beneficial in distinct situations involving ischemia and reperfusion injury or the systemic inflammatory response syndrome (SIRS). Clinical anesthesiologists should select anesthetics and choose anesthetic methods with careful consideration of the clinical situation and the immune status of critically ill patients, in regard to long-term mortality, morbidity, and the optimal prognosis.

Anti-Inflammatory Properties of Anesthetic Agents

“…1; [4]). Anesthetic agents and anesthesia management are suspected of impairing several aspects of the inflammatory response process, either indirectly by modulating the stress response or directly by disturbing the functions of immune cells [1,2,4,7].…”

“…Diverse in vitro experiments with human immune cells ex vivo [2], in vivo tests [10] and animal models have demonstrated a wide range of effects of anesthetic drugs on the immune system, including changes in immune cell counts and their functionality and effects on the secretion patterns of diverse immune mediators, affecting the inflammatory response in the postoperative period [1][2][3].…”

“…Morphine promotes apoptosis by direct activation of the enzymes involved in cell apoptosis, inhibits leukocyte function by increasing intracellular concentrations of NO and cyclic AMP, and by inhibiting nuclear NF-κB via NO-dependent mechanisms [4]. Recent studies of the effects of synthetic opioids used in general anesthesia showed no more than transient immunomodulatory changes [1,2,4].…”

“…Dexmedetomidine, an agonist of α 2 -adrenergic receptors in certain regions of the brain, has been shown to reduce proinflammatory cytokine levels in experimental sepsis [35] as well as in critically ill [1,4] and postoperative patients [36]. A significant decrease in leukocyte counts, CRP, IL-6, IL-8 and TNF-α levels in dexmedetomidinetreated patients is indicative of its anti-inflammatory potential when used as a perioperative adjunct [1,2,4].…”

Cytokine response after radical operations for tumors of the colon

“…Также имеются сообщения, что эпидуральная аналгезия может привести к уменьшению воспали-тельного ответа [9]. Alhers сообщил о 54 больных, перенесших операцию на брюшной полости с груд-ной эпидуральной аналгезией и пришел к выводу, что этот метод снижает реакцию на стресс и пре-дотвращает стресс-индуцированные послеопера-ционные нарушения провоспалительных функций лимфоцитов [5].…”