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Perioperative Inflammation and Its Modulation by Anesthetics

Rossaint, Jan, MD; Zarbock, Alexander, MD

doi: 10.1213/ANE.0000000000002484
Basic Science: Narrative Review Article

Surgery and other invasive procedures, which are routinely performed during general anesthesia, may induce an inflammatory response in the patient. This inflammatory response is an inherent answer of the body to the intervention and can be both beneficial and potentially harmful. The immune system represents a unique evolutionary achievement equipping higher organisms with an effective defense mechanism against exogenous pathogens. However, not only bacteria might evoke an immune response but also other noninfectious stimuli like the surgical trauma or mechanical ventilation may induce an inflammatory response of varying degree. In these cases, the immune system activation is not always beneficial for the patients and might carry the risk of concomitant, harmful effects on host cells, tissues, or even whole organ systems. Research over the past decades has contributed substantial information in which ways surgical patients may be affected by inflammatory reactions. Modulations of the patient’s immune system may be evoked by the use of anesthetic agents, the nature of surgical trauma and the use of any supportive therapy during the perioperative period. The effects on the patient may be manifold, including various proinflammatory effects. This review focuses on the causes and effects of inflammation in the perioperative period. In addition, we also highlight possible approaches by which inflammation in the perioperative may be modulated in the future.

From the Department of Anesthesiology, Intensive Care and Pain Medicine, University Hospital Münster, Münster, Germany.

Published ahead of print September 14, 2017.

Accepted for publication August 17, 2017.

Funding: This study was supported by the Deutsche Forschungsgemeinschaft (ZA428/6-1 and ZA428/8-1 to A.Z., RO 4537/2-1 to J.R.) and Cells-in-Motion Cluster of Excellence EXC 1003-CiM (University of Münster, Germany, to A.Z.).

The authors declare no conflicts of interest.

Reprints will not be available from the authors.

Address correspondence to Alexander Zarbock, MD, Department of Anesthesiology, Intensive Care and Pain Medicine, University of Münster, Albert-Schweitzer-Campus 1, Bldg A1, 48149 Münster, Germany. Address e-mail to

© 2018 International Anesthesia Research Society
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