Immunomodulatory effects of anesthetics in obese patients

Figure 2 Modulatory effects of anesthetic agents on lung immune cells. A: Inhaled anesthetics: Decreased neutrophil influx, synthesis, and expression of macrophage inflammatory protein (MIP)-2, IL-1β, and stress proteins heme oxygenase (HO-1) and heat shock protein (HSP-70). Reduction of pro-inflammatory cytokine release, inhibition of iNOS expression and activity by blockade of NF-κB activation in lung tissue, inhibition of proapoptotic procaspase protein expression, and maintenance of alveolar epithelial adherence by attenuating reduction of zona occludens 1 (ZO-1) levels; B: Intravenous anesthetic (propofol): Impairs neutrophil activity by inhibition of phosphorylation of the mitogen-activated protein kinases p44/42 MAPK signaling pathway and disrupts the downstream signaling pathway involving calcium, Akt, and ERK1/2, which decreases superoxide generation, elastase release, and chemotaxis.