O impacto da anestesia na resposta inflamatória e imunológica

Abstract

This article reviews the scientific literature on the impact of different anesthetic techniques on the modulation of the inflammatory and immunological response in patients undergoing surgical procedures, with emphasis on the clinical implications related to postoperative recovery, infectious risk, and short- and long-term prognosis. The research was conducted in the PubMed, Scopus, and Web of Science databases, using the descriptors "Anesthesia," "Inflammatory Response," "Immune Response," "General Anesthesia," "Regional Anesthesia," and "Immunomodulation." The analysis of the studies demonstrates that surgical trauma triggers a systemic inflammatory response characterized by the release of pro-inflammatory cytokines, neuroendocrine activation, and transient suppression of cellular immunity, this process being significantly influenced by the type of anesthesia employed. Evidence indicates that general anesthesia, especially when associated with the prolonged use of volatile agents and opioids, can intensify the inflammatory response and promote greater depression of T lymphocyte and natural killer (NK) cell function. In contrast, regional anesthesia techniques, such as epidural anesthesia and peripheral nerve blocks, have been shown to attenuate the surgical stress response by reducing sympathetic activation and the hypothalamic-pituitary-adrenal axis, resulting in less release of catecholamines and inflammatory cytokines. Furthermore, regional analgesia contributes to the preservation of immune function, with potential benefits in reducing postoperative infections and tumor recurrence in oncological surgeries. Recent studies also highlight the immunomodulatory role of specific anesthetic agents, such as propofol, associated with anti-inflammatory and antioxidant effects, compared to inhaled anesthetics, which may be related to greater inflammatory activation. Understanding the interaction between anesthesia, inflammation, and immunity is fundamental for the development of safer and more individualized anesthetic strategies capable of minimizing perioperative immune dysfunction and optimizing patient clinical outcomes.