Anesthesia drugs, immunity, and long-term outcome.
OBJECTIVE
We provide an overview of the immunological effects of commonly used anesthetic drugs and highlight their potential impact on long-term outcome after surgery.


RESULTS
Clinical trials provide preliminary evidence that the perioperative process can influence long-term patient outcome. Immunology may begin to elucidate the biology of this safety concern and open new therapeutic opportunities. In this context, awareness of the immunological properties of drugs administered in the perioperative period may assist in their deliberate use to modulate this risk. Statins, beta-blockers, and clonidine can potentially improve long-term cardiac risk. Volatile anesthetics appear to suppress effector functions of both the innate and adaptive immunity, assist tumor growth in animal models, and facilitate aggregation of certain neurodegenerative disease proteins. Local anesthetics block neurons, but are also potent antiinflammatory drugs. Morphine has recognized immunosuppressive functions, which the newer, synthetic opioids don't seem to share. The cholinergic nervous system has antiinflammatory control functions that are largely unexploited.


CONCLUSIONS
Long-term outcome after surgery is a new safety concern in perioperative care. We are faced with enormous challenges in healthcare and research. As providers, tailoring an anesthetic plan to patients' needs will become increasingly critical, and immunology should help in this pursuit.
Homburger
Jay A
JA
Department of Anesthesiology and Perioperative Medicine, Medical College of Georgia, Augusta, Georgia, USA.
Meiler
Steffen E
SE
D000316:Adrenergic alpha-Agonists / Q000009:adverse effects / Q000494:pharmacology; D000319:Adrenergic beta-Antagonists / Q000009:adverse effects / Q000494:pharmacology; D000701:Analgesics, Opioid / Q000009:adverse effects / Q000494:pharmacology; D000777:Anesthetics / Q000009:adverse effects / Q000494:pharmacology*; D018685:Anesthetics, Inhalation / Q000009:adverse effects / Q000494:pharmacology; D000779:Anesthetics, Local / Q000009:adverse effects / Q000494:pharmacology; D000818:Animals; D003000:Clonidine / Q000009:adverse effects / Q000494:pharmacology; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000009:adverse effects / Q000494:pharmacology; D007107:Immune System / Q000187:drug effects*; D007249:Inflammation / Q000503:physiopathology; D010275:Parasympathetic Nervous System / Q000503:physiopathology
D000316:Adrenergic alpha-Agonists; D000319:Adrenergic beta-Antagonists; D000701:Analgesics, Opioid; D000777:Anesthetics; D018685:Anesthetics, Inhalation; D000779:Anesthetics, Local; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; D003000:Clonidine