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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
 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
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]
 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]
 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]    
  1. NK natural killer; IL-6 interleukin 6;TNF-α tumor necrosis factor-α; DC dendritic cell; CTL cytotoxic T-lymphocyte; COX-2 cyclooxygenase 2; PGE 2 prostaglandin E2; HIF- hypoxia inducible factor-1α; MMPs matrix metalloproteinases; TLR4 toll-like receptor 4; macrophage; NF-κB nuclear factor kappa B; LTR lung tumor retention; Tregs CD4(+) CD25(+) Foxp3(+) regulatory T cells; MDSC myeloid-derived suppressor cells