The Evaluation of the Influence Increased Immunomodulatory Effects of Anesthetic Drugs in Elderly Patients in the Perioperative Phase: A Review

Milia Khalil Alahmar *

Health Plus Fertility Center, UAE.

Muna Ali Amam

Health Plus Fertility Center, UAE.

*Author to whom correspondence should be addressed.


Every drug, taken for whatever purpose, has its set of implications on the patient. These drugs, apart from causing the desired effects in an individual's body, also work to cause several interactions with different parts of the body. In doing so, they may alter several mechanisms and also cause side effects if taken suddenly or without any checks and balances. These side effects are problematic and also the reason that causes a patient’s body to malfunction in the long run. In a very similar way, the impact of increased immunomodulatory effects of anesthetic drugs in elderly patients during the perioperative phase is an important topic in the field of anesthesiology and perioperative medicine. It is a well-known fact that anesthetic drugs, particularly intravenous anesthetics like propofol and inhalational anesthetics like isoflurane, can have immunomodulatory effects. These drugs can influence the immune response of the body, including cytokine production, leukocyte function, and the inflammatory response. However, the target audience here, that is, the elderly population is often already experiencing age-related changes in their immune system, a condition referred to as immunosenescence. This can lead to a less robust immune response, making them more susceptible to infections and complications. However, the pre-operative phase is a critical period when the patient’s body is exposed to various stressors, including surgery itself, tissue damage, and potential infections. This phase is when the immune system plays a significant role in maintaining the patient’s health. During such a delicate phase, anesthetic drugs may make elderly patients more vulnerable to postoperative infections. This can lead to longer hospital stays, increased healthcare costs, and a higher risk of complications. Immune suppression can also result in delayed wound healing and a slower recovery process. This can affect the overall quality of life for elderly patients. To address these problems, this review has been designed with the intention of highlighting all such problems that arise with the usage of anesthetic drugs in elderly patients.

Keywords: Anesthetic drugs, propofol, immunomodulatory effects, elderly patients, side effects of anesthesia

How to Cite

Alahmar, Milia Khalil, and Muna Ali Amam. 2023. “The Evaluation of the Influence Increased Immunomodulatory Effects of Anesthetic Drugs in Elderly Patients in the Perioperative Phase: A Review”. Asian Journal of Medical Principles and Clinical Practice 6 (2):305-11.


Download data is not yet available.


Forman SA, Chin VA. General anesthetics and molecular mechanisms of unconsciousness. Int Anesthesiol Clin. 2008;46(3):43–53.

Smith G, D’Cruz JR, Rondeau B, Goldman J. General anesthesia for surgeons. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023. Available:

[Acccess on 2023 Oct 23]

Vlassakov KV, Kissin I. Scientometrics of anesthetic drugs and their techniques of administration, 1984–2013. Drug Des Devel Ther. 2014;8:2463–73.

Garmon EH, Huecker MR. Topical, local, and regional anesthesia and anesthetics. In: Stat Pearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023. Available:

[Accessed on cited 2023 Oct 23]

Billard V. Pharmacokinetic-pharmacodynamic relationship of anesthetic drugs: from modeling to clinical use. F1000Research. 2015 ;4:F1000 Faculty Rev-1289.

Ferry N, Hancock LE, Dhanjal S. Opioid anesthesia. In: Stat Pearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023. Available:

[Accessed on 2023 Oct 23]

Taylor A, McLeod G. Basic pharmacology of local anaesthetics. BJA Educ. 2020;20(2):34–41.

Folino TB, Muco E, Safadi AO, Parks LJ. Propofol. In: Stat Pearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023. Available:

[Accessed on 2023 Oct 23]

Boavista Barros Heil L, Leme Silva P, Ferreira Cruz F, Pelosi P, Rieken Macedo Rocco P. Immunomodulatory effects of anesthetic agents in perioperative medicine. Minerva Anestesiol. 2020;86(2):181–95.

Landoni G, Biondi-Zoccai GGL, Zangrillo A, Bignami E, D’Avolio S, Marchetti C, et al. Desflurane and sevoflurane in cardiac surgery: A meta-analysis of randomized clinical trials. J Cardiothorac Vasc Anesth. 2007;21(4):502–11.

Beck-Schimmer B, Breitenstein S, Bonvini JM, Lesurtel M, Ganter M, Weber A, et al. Protection of pharmacological postconditioning in liver surgery: Results of a prospective randomized controlled trial. Ann Surg. 2012;256(5):837–44; discission 844-845.

Li L, Peng L, Zuo Z. Isoflurane preconditioning increases B-cell lymphoma-2 expression and reduces cytochrome c release from the mitochondria in the ischemic penumbra of rat brain. Eur J Pharmacol. 2008;586(1–3):106–13.

Wakeno-Takahashi M, Otani H, Nakao S, Imamura H, Shingu K. Isoflurane induces second window of preconditioning through upregulation of inducible nitric oxide synthase in rat heart. Am J Physiol Heart Circ Physiol. 2005;289(6):H2585-2591.

Pan ZG, Zhang XZ, Zhang ZM, Dong YJ. Optimal pathways involved in the treatment of sevoflurane or propofol for patients undergoing coronary artery bypass graft surgery. Exp Ther Med. 2019;17(5):3637–43.

Swyers T, Redford D, Larson DF. Volatile anesthetic-induced preconditioning. Perfusion. 2014;29(1):10–5.

Holewijn RA, Verbaan D, De Bie RMA, Schuurman PR. General anesthesia versus local anesthesia in stereota XY (GALAXY) for Parkinson’s disease: study protocol for a randomized controlled trial. Trials. 2017;18(1):417.

Baum M, Demicheli R, Hrushesky W, Retsky M. Does surgery unfavourably perturb the “natural history” of early breast cancer by accelerating the appearance of distant metastases? Eur J Cancer Oxf Engl 1990. 2005;41(4):508–15.

Yang EV, Kim S jae, Donovan EL, Chen M, Gross AC, Webster Marketon JI, et al. Norepinephrine upregulates VEGF, IL-8, and IL-6 expression in human melanoma tumor cell lines: implications for stress-related enhancement of tumor progression. Brain Behav Immun. 2009;23(2):267–75.

Liang H, Yang CX, Zhang B, Wang HB, Liu HZ, Lai XH, et al. Sevoflurane suppresses hypoxia-induced growth and metastasis of lung cancer cells via inhibiting hypoxia-inducible factor-1α. J Anesth. 2015;29(6):821–30.

de Sousa GC, Cruz FF, Heil LB, Sobrinho CJS, Saddy F, Knibel FP, et al. Intraoperative immunomodulatory effects of sevoflurane versus total intravenous anesthesia with propofol in bariatric surgery (the OBESITA trial): Study protocol for a randomized controlled pilot trial. Trials. 2019;20(1):300.

Rodríguez-González R, Baluja A, Veiras Del Río S, Rodríguez A, Rodríguez J, Taboada M, et al. Effects of sevoflurane postconditioning on cell death, inflammation and TLR expression in human endothelial cells exposed to LPS. J Transl Med. 2013;11:87.

Arruda NM, Braz LG, Nogueira FR, Souza KM, Aun AG, Figueiredo DBS, et al. Inflammation and DNA damage induction in surgical patients maintained with desflurane anesthesia. Mutat Res Genet Toxicol Environ Mutagen. 2019;846:403073.

Geze S, Cekic B, Imamoğlu M, Yörük MF, Yuluğ E, Alver A, et al. Use of dexmedetomidine to prevent pulmonary injury after pneumoperitoneum in ventilated rats. Surg Laparosc Endosc Percutan Tech. 2012;22(5):447–53.

Chen CY, Tsai YF, Huang WJ, Chang SH, Hwang TL. Propofol inhibits endogenous formyl peptide-induced neutrophil activation and alleviates lung injury. Free Radic Biol Med. 2018;129:372–82.

Gao M, Jin W, Qian Y, Ji L, Feng G, Sun J. Effect of N-methyl-D-aspartate receptor antagonist on T helper cell differentiation induced by phorbol-myristate-acetate and ionomycin. Cytokine. 2011;56(2):458– 65.

Dabbagh A, Rajaei S. The role of anesthetic drugs in Liver Apoptosis. Hepat Mon. 2013;13(8):e13162.

Li J, Tan H, Zhou X, Zhang C, Jin H, Tian Y, et al. The protection of midazolam against immune mediated liver injury induced by lipopolysaccharide and galactosamine in mice. Front Pharmacol. 2018;9:1528.

Roy S, Ninkovic J, Banerjee S, Charboneau RG, Das S, Dutta R, et al. Opioid drug abuse and modulation of immune function: consequences in the susceptibility to opportunistic infections. J Neuroimmune Pharmacol Off J Soc NeuroImmune Pharmacol. 2011;6(4):442–65.

Rodgers A, Walker N, Schug S, McKee A, Kehlet H, van Zundert A, et al. Reduction of postoperative mortality and morbidity with epidural or spinal anaesthesia: Results from overview of randomised trials. BMJ. 2000;321(7275):1493.