Journal of Anesthesia

, Volume 22, Issue 3, pp 263–277 | Cite as

Anesthetics, immune cells, and immune responses

  • Shin Kurosawa
  • Masato Kato
Invited Review Article


General anesthesia accompanied by surgical stress is considered to suppress immunity, presumably by directly affecting the immune system or activating the hypothalamic-pituitary-adrenal axis and the sympathetic nervous system. Along with stress such as surgery, blood transfusion, hypothermia, hyperglycemia, and postoperative pain, anesthetics per se are associated with suppressed immunity during perioperative periods because every anesthetic has direct suppressive effects on cellular and neurohumoral immunity through influencing the functions of immunocompetent cells and inflammatory mediator gene expression and secretion. Particularly in cancer patients, immunosuppression attributable to anesthetics, such as the dysfunction of natural killer cells and lymphocytes, may accelerate the growth and metastases of residual malignant cells, thereby worsening prognoses. Alternatively, the anti-inflammatory effects of anesthetics may be beneficial in distinct situations involving ischemia and reperfusion injury or the systemic inflammatory response syndrome (SIRS). Clinical anesthesiologists should select anesthetics and choose anesthetic methods with careful consideration of the clinical situation and the immune status of critically ill patients, in regard to long-term mortality, morbidity, and the optimal prognosis.

Key words

Anesthetics Immunosuppression Immune cells Prognosis Hypothalamic-pituitary-adrenal axis 


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Copyright information

© Japanese Society of Anesthesiologists 2008

Authors and Affiliations

  • Shin Kurosawa
    • 1
  • Masato Kato
    • 2
  1. 1.Department of Anesthesiology and Intensive Care MedicineTohoku University HospitalSendaiJapan
  2. 2.Department of Anesthesiology and Perioperative MedicineTohoku University Graduate School of MedicineSendaiJapan

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