Review
Copyright ©The Author(s) 2017. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Crit Care Med. Aug 4, 2017; 6(3): 140-152
Published online Aug 4, 2017. doi: 10.5492/wjccm.v6.i3.140
Immunomodulatory effects of anesthetics in obese patients
Luciana Boavista Barros Heil, Pedro Leme Silva, Paolo Pelosi, Patricia Rieken Macedo Rocco
Luciana Boavista Barros Heil, Pedro Leme Silva, Patricia Rieken Macedo Rocco, Laboratory of Pulmonary Investigation, Carlos Chagas Filho Institute of Biophysics, Federal University of Rio de Janeiro, Centro de Ciências da Saúde, Avenida Carlos Chagas Filho, Rio de Janeiro 21941-902, Brazil
Paolo Pelosi, Department of Surgical Sciences and Integrated Diagnostics, IRCCS AOU San Martino-IST, University of Genoa, 16132 Genoa, Italy
Author contributions: Heil LBB and Silva PL designed and conducted the literature review, wrote the manuscript, and prepared the tables; Silva PL prepared the figures, and supervised all the process; Pelosi P and Rocco PRM wrote the manuscript and supervised all the process.
Supported by Brazilian Council for Scientific and Technological Development (CNPq); Carlos Chagas Filho Rio de Janeiro State Foundation (FAPERJ); Department of Science and Technology (DECIT); Brazilian Ministry of Health; and Coordination for the Improvement of Higher Level Personnel (CAPES).
Conflict-of-interest statement: The authors have no conflict of interest.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Patricia Rieken Macedo Rocco, MD, PhD, Professor, Laboratory of Pulmonary Investigation, Carlos Chagas Filho Institute of Biophysics, Federal University of Rio de Janeiro, Centro de Ciências da Saúde, Avenida Carlos Chagas Filho, 373, Bloco G-014, Ilha do Fundão, Rio de Janeiro 21941-902, Brazil. prmrocco@biof.ufrj.br
Telephone: +55-21-39386530 Fax: +55-21-22808193
Received: January 26, 2017
Peer-review started: February 8, 2017
First decision: April 17, 2017
Revised: June 27, 2017
Accepted: July 7, 2017
Article in press: July 10, 2017
Published online: August 4, 2017
Abstract

Anesthesia and surgery have an impact on inflammatory responses, which influences perioperative homeostasis. Inhalational and intravenous anesthesia can alter immune-system homeostasis through multiple processes that include activation of immune cells (such as monocytes, neutrophils, and specific tissue macrophages) with release of pro- or anti-inflammatory interleukins, upregulation of cell adhesion molecules, and overproduction of oxidative radicals. The response depends on the timing of anesthesia, anesthetic agents used, and mechanisms involved in the development of inflammation or immunosuppression. Obese patients are at increased risk for chronic diseases and may have the metabolic syndrome, which features insulin resistance and chronic low-grade inflammation. Evidence has shown that obesity has adverse impacts on surgical outcome, and that immune cells play an important role in this process. Understanding the effects of anesthetics on immune-system cells in obese patients is important to support proper selection of anesthetic agents, which may affect postoperative outcomes. This review article aims to integrate current knowledge regarding the effects of commonly used anesthetic agents on the lungs and immune response with the underlying immunology of obesity. Additionally, it identifies knowledge gaps for future research to guide optimal selection of anesthetic agents for obese patients from an immunomodulatory standpoint.

Keywords: Anesthesia, Immune system, Perioperative care, Obesity, Inflammation

Core tip: Anesthetic agents have been studied not only for their effects on anesthesia and analgesia, but also their action on the lungs and immune system. Obesity is associated with a chronic state of low-grade systemic inflammation, and may predispose to development of comorbidities. Although efforts have been made to develop guidelines for anesthesia in obesity, to date, no ideal drug combination has been found. Optimization of the immunomodulatory properties of anesthetic agents may enable perioperative modulation of inflammatory response in obese patients and improve postoperative outcomes.