ANESTHESIA-INDUCED IMMUNE MODULATION IN SEPSIS PATIENTS: A TRANSLATIONAL STUDY ON INFLAMMATORY PATHWAYS AND CLINICAL OUTCOMES

Abstract

Sepsis is a leading cause of mortality in critical care, often exacerbated by immune dysregulation. While anesthetic agents are indispensable during surgical interventions, their influence on immune function in septic patients remains underexplored. This translational study aimed to investigate the immunomodulatory effects of different anesthetic techniques volatile anesthesia versus total intravenous anesthesia (TIVA) on inflammatory markers, immune cell profiles, and clinical outcomes in patients with sepsis.There were 120 surgical sepsis patients and they were divided into two groups to be given TIVA (propofol) or volatile anaesthetics (isoflurane/sevoflurane).  Blood was taken at the beginning, during the surgery and after surgery to look at immune cells, check how active the NF-κB pathway was and determine the levels of IL-6, IL-10 and TNF-α cytokines.  Some clinical metrics were the occurrence of surgical infections, mortality within 28 days, how long patients stayed in the intensive care unit and the use of dialysis.  Researchers did in vitro studies where PBMCs were challenged with endotoxin after exposure to anaesthetics.  Patients treated with TIVA had lower postoperative IL-6 and TNF-α cytokines which implied their immune system was working more efficiently.  When NF-κB was less active in the TIVA group, immune balance was also better.  Compared with AIVA, TIVA was shown to result in a shorter ICU period, less infection and a lower death rate (19.4% vs. 29.3%)  analyzing immune profiles from TIVA patients, revealed more advantageous numbers of neutrophils and better-preserved CD4+ T cells.  Propofol decreased the release of pro-inflammatory cytokines in the in vitro study compared to volatile anesthetics.  By controlling inflammation, TIVA is more useful than volatile anaesthetics in cases of sepsis and it increases the positive effects on important clinical outcomes.  Since individualised immunomodulation plays a role, anaesthetic strategy should be seen as something that can be changed in sepsis therapy.  This demonstrates the need for greater study of sepsis management in patients receiving anaesthesia.