Review of the Effects of Anesthetic Techniques and Medications on the Immune Response During the Perioperative Period

24 March 2026 : Review article

Paweł Radkowski

^{ABCDEFG 1,2,3}, Marta Joanna Pisula

^{ABCDEF 4}, Dawid Kamil Malicki

^{ABCDEF 5}, Maciej Szewczyk

^{ABCDEF 6*}, Karolina Marczuk

^{ABCDEF 7}, Mateusz Mamala

^{ABCDEF 8}, Łukasz Grabarczyk

^{ABCDEFG 9}

DOI: 10.12659/MSM.951077

Med Sci Monit 2026; 32:e951077

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Introduction The Immune System’s Structure and Functions Activation of Innate and Adaptive Immunity in Response to Surgical Injury General Anesthesia as a Modulator of the Inflammatory and Immune Response in Surgical Patients Immunomodulatory Mechanisms of Action of General Anesthesia Methodological Considerations and Limitations Effects of Inhalation Anesthetics on the Immune System Controversial Findings and Interpretative Variability Conclusions Future Directions References

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Table 3 Effects of intravenous anesthetics on the immune system [10,23,25–27].

Effects of intravenous anesthetics on the immune system
Propofol	Modulates mast cell function
	Alters secretion of IL-4, IL-5, and TNF-α
	May impact the character of the postoperative inflammatory response
Etomidate	Modulates GABA-A receptors
	Reduces perioperative immune and hormonal stress
	Increases CD4+ T-cell counts and CD4/CD8 ratio
	Decreases IL-6, TNF-α, and IL-8 levels
	Increases IL-10 (anti-inflammatory)
Dexmedetomidine	Attenuates proinflammatory signaling
	Reduces cytokine release
	Alters leukocyte activity
	Regulates neurotransmitters, oxidative stress and apoptotic pathways
Midazolam	Inhibits LPS-stimulated immune responses in human macrophages
	Activates TSPO signaling
	Suppression of macrophage activity may underlie harmful immunosuppressive adverse effects in critically ill patients
S-ketamine	Noncompetitive NMDA-receptor antagonist
	Modulates immune responses
	When combined with sevoflurane, shows no significant change in postoperative cellular immune function
Remimazolam	Preserves perioperative immune function more effectively than propofol
Remimazolam	Results in significantly higher NK, CD3+ and CD4+ lymphocyte levels immediately after surgery and at 24 h postoperatively
Source: own. IL-4 – interleukin 4; IL-5 – interleukin 5; TNF-α – tumor necrosis factor alpha; GABA-A – gamma-aminobutyric acid type A; IL-8 – interleukin 8; IL-10 – interleukin 10; NMDA – N-methyl-D-aspartate; LPS – lipopolysaccharide; TSPO – translocator protein.

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