Review Article  |   August 2016
Immune Modulation by Volatile Anesthetics
Author Notes
  • Departments of Anesthesiology (L.M.S., P.T., Y.X.), Immunology (B.L.), Pharmacology and Chemical Biology (P.T., Y.X.), Computational and Systems Biology (P.T.), and Structural Biology (Y.X.), University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania; Department of Anesthesiology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China (L.-J.J.); and Department of Biomedical Sciences, Texas Tech University Health Sciences Center, El Paso, Texas (H.D.)
  • This article is featured in “This Month in Anesthesiology,” page 1A.
    This article is featured in “This Month in Anesthesiology,” page 1A.×
  • Figures 1 and 2 were enhanced by Annemarie B. Johnson, C.M.I., Medical Illustrator, Vivo Visuals, Winston-Salem, North Carolina. L.M.S. and L.-J.J. equally contributed as co-first authors.
    Figures 1 and 2 were enhanced by Annemarie B. Johnson, C.M.I., Medical Illustrator, Vivo Visuals, Winston-Salem, North Carolina. L.M.S. and L.-J.J. equally contributed as co-first authors.×
  • Submitted for publication September 28, 2015. Accepted for publication March 10, 2016.
    Submitted for publication September 28, 2015. Accepted for publication March 10, 2016.×
  • Address correspondence to Dr. Xu: Department of Anesthesiology, University of Pittsburgh, 2048 Biomedical Science Tower 3, 3501 Fifth Avenue, Pittsburgh, Pennsylvania 15260. xuy@anes.upmc.edu. Information on purchasing reprints may be found at www.anesthesiology.org or on the masthead page at the beginning of this issue. Anesthesiology’s articles are made freely accessible to all readers, for personal use only, 6 months from the cover date of the issue.
Article Information
Education / Review Article / Pharmacology
Review Article   |   August 2016
Immune Modulation by Volatile Anesthetics
Anesthesiology 8 2016, Vol.125, 399-411. doi:10.1097/ALN.0000000000001195
Anesthesiology 8 2016, Vol.125, 399-411. doi:10.1097/ALN.0000000000001195
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.