• Jan Rossaint and Alexander Zarbock.
• Department of Anesthesiology, Intensive Care and Pain Medicine, University Hospital Münster, Münster, Germany.
• Curr Opin Anaesthesiol. 2019 Dec 1; 32 (6): 799-805.

Purpose Of ReviewSurgery, invasive procedures and anesthesia itself may induce an inflammatory response in the patient. This represents an evolutionary inherited and conserved response of the host to environmental stimuli and may lead to both beneficial and potentially harmful effects. This review highlights the mechanisms of anesthesia-induced and perioperative immune modulation.Recent FindingsThe innate and adaptive immune system serve the host in protection against invading pathogens. Yet, an inflammatory immune response may also be induced by different noninfectious stimuli, for example invasive perioperative procedures and the surgical trauma itself. These stimuli may lead to the activation of the immune system with the consequence of perturbation of cell, tissue of even organ functions in cases of an overshooting immune response. Several perioperative factors have been identified that modulate the immune response, for example different anesthetic drugs and surgical tissue injury, but their impact on immune system modulation may also vary with respect to the procedural context and include both pro-inflammatory and anti-inflammatory effects.SummaryThe current review will highlight the current knowledge on the perioperative anesthesia-induced and surgery-induced modulation of the immune response and also address possible intervention strategies for the development of future therapeutic approaches.

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