The effect of anesthesia on the postoperative systemic inflammatory response in patients undergoing surgery: A systematic review and meta-analysis

Abstract

Background Surgical injury stimulates the systemic inflammatory response. The magnitude of the postoperative systemic inflammatory response has been shown to be significantly associated with short and long-term outcomes following surgery of varying severity. Different anesthetic techniques for surgery may have an impact on the postoperative systemic inflammatory response and on the rate of the postoperative infective complications. The aim of the present systematic review was to examine the relationship between perioperative anesthesia, the postoperative systemic inflammatory response and postoperative infective complications in patients undergoing surgery. Methods This was carried out using PubMed and other established databases from 1987 up to March 2018. In particular, randomized controlled studies and systemic inflammation markers, interleukin 6 and C-reactive protein were examined. Results Overall, 60 controlled, randomized clinical trials were included in the review. The mean or median values of both interleukin 6 and C-reactive protein were taken for each study and the mean value was calculated for each anesthetic group at sampling points of 12–24 and 24–72 hours for interleukin 6 and C-reactive protein respectively. When taking the magnitude of surgery into account, TIVA using propofol was significantly associated with a reduction in particular C-reactive protein ( P = .04). However, there were no other specific anesthetic methods including general, regional and combined anesthetics that were associated with a reduction in either interleukin 6 or C-reactive protein. Conclusion There is some evidence that anesthetic regimens may reduce the magnitude of the postoperative systemic inflammatory response. However, the studies were heterogeneous and generally of low quality. Future, well conducted, adequately powered studies are required to clarify the effect of anesthesia on the postoperative systemic inflammatory response and infective complications.

Molecular mechanisms of lidocaine

“…This immune response initiates immediately after a surgical injury. Polymorphonuclear leukocytes (PMNs), endothelial cells, macrophages, and lymphocytes are activated by the secretion of pro-inflammatory mediators including cytokines, chemokines, and other molecules including but not limited to reactive oxygen species, nitric oxide, and platelet-activating factor [ 3 ]. While essential, when unchecked, excessive inflammation can disrupt the body's immune system, potentially leading to certain inflammation-related conditions and even organ failure [ 4 , 5 ].…”

The effect of anesthesia on the magnitude of the postoperative systemic inflammatory response in patients undergoing elective surgery for colorectal cancer in the context of an enhanced recovery pathway

“…Specifically, Alhayyan et al [ 5 ] in systematic review and meta-analysis reported that it was not clear in the literature whether anesthetic technique has an effect on the magnitude of the postoperative SIR. This was due to the heterogeneity and poor quality of identified studies.…”

“…This was due to the heterogeneity and poor quality of identified studies. [ 5 ] Furthermore, these authors, in a retrospective audit of the effect of anesthetic technique on the magnitude of the postoperative CRP in patients undergoing elective open or laparoscopic surgery for colon cancer, reported that the magnitude of the postoperative SIR in particular, POD 2 CRP, was modulated by the induction of RA in patients who underwent open surgery, but not laparoscopic surgery for colorectal cancer. [ 6 ]…”

The Effects of Propofol on Hypoxia- and TNF-α-Mediated Brain-Derived Neurotrophic Factor/Tyrosine Kinase Receptor B Pathway Dysregulation in Primary Rat Hippocampal Neurons and Astrocytes

“…Propofol is (2, 6-diisopropyl phenol) is an intravenous general anesthetic, which is extensively used in the induction and maintenance of anesthetization and procedural sedation. Apart from its multiple anesthetic advantages, it has been reported to possess anti-oxidative and anti-in ammatory effects [14,15] as well as neuro-protective properties [16]. A number of in vitro studies revealed that propofol may protect mouse hippocampal neurons from in ammation-induced autophagy [17] and from in ammationand hypoxia-as well as oxidative stress-induced apoptosis [18][19][20].…”