Table 2 Effect of anesthetic agent on immune function
From: Effects of surgery and anesthetic choice on immunosuppression and cancer recurrence
| Agent | Experimental data NK cell numbers (activity) | T-lymphocyte | Others | Clinical data |
|---|---|---|---|---|
| Intravenous | ||||
| Ketamine | Decrease [34, 35, 66] | Apoptosis [36] |
Attenuation of proinflammatory cytokine (IL-6, TNF-α) production [35] Inhibition of functional maturation of DC [37] Suppression of neutrophil functions [35] Inhibition of NF-κB activation [39] Impairment of monocyte and neutrophil function [42] Decrease in secretion of proinflammatory cytokines [42] Inhibition of COX-2 and PGE2 43 |
Inhibition of the lipopolysaccharide-induced production of IL-1β, TNF-α, and IL-6 by monocytes [40] No change in Th1/Th2 ratio [44] |
| Thiopental | Decrease [66] | Protection of apoptosis [38] | ||
| Midazolam | No effect on CTL [41] | |||
| Propofol | No suppression [66] | Increased activity on CTL [41] | ||
| Volatile anesthetics | ||||
| Halothane | Decrease [45, 66] |
Upregulation of HIF-1α [46] Upregulation of HIF-1α [46] B-lymphocyte apoptosis [50] |
Increased levels of pro-tumorigenic cytokines and matrix metalloproteinases (MMPs) in breast cancer surgery [48] Decrease in Th1/Th2 ratio [44] | |
| Sevoflurane | Decrease [49] | Apoptosis [47] /Decrease [49] | ||
| Isoflurane | Attenuation [45] | Apoptosis [47] | ||
| Nitrous oxide |
Depression of neutrophil chemotaxis [18] Inhibition of formation of hematopoietic cells for tumor surveillance [52] Impairment of DNA, purine, and thymidylate synthesis [74] | No difference in cancer recurrence compared with oxygen [75] | ||
| Opioids | ||||
| Morphine | Suppression [52] |
Suppressive effect on Th-cell differentiation [53] Increase in Tregs [56] Increase in Tregs [56] Decease in proliferation [58] |
Inhibition of NF-κB binding [52] Decrease of TLR4 on MΦ [54] Promotion of apoptosis in lymphocytes and macrophages [77] Inhibitory effect on leucocyte migration [57] |
Decrease in T-lymphocyte proliferation [51] Increase in IL-6; decrease in T cell subsets [59] Increase in IL-6; decrease in T cell subsets (less than sufentanil) [59] |
| Fentanyl | Decrease [34, 55] | |||
| Sufentanil | Decrease [55] | |||
| Alfentanil | Decrease [52] | |||
| Remifentanil | Decrease [58] | |||
| Others | ||||
| COX-2 inhibitor | Attenuation of NK cytotoxicity reduction using combined β-adrenergic antagonism [31] |
Promotes CTL immune response [61] Reduced number of and suppressive function of MDSC [62] |
Reduced postoperative LTR [31] Combination with β-adrenergic antagonist eliminates LTR [31] and decreases metastasis in animal models [60] | NSAIDs increase tumor infiltration by activated immune cells [63] |
| β-adrenergic antagonist | ||||
| Local anesthetics | ||||
| Lidocaine | Increase [64] | |||