Effects of Midazolam on Organ Dysfunction in Rats with Endotoxemia Induced by Lipopolysaccharide

Immunomodulators in anesthesia

PURPOSE OF REVIEW

Anesthetics are known to have immunomodulatory effects. These can be detrimental, inducing immunosuppression and facilitating the development of opportunistic infections, especially when used at high doses, for prolonged periods, or in patients with preexisting immune deficiency; or beneficial, modulating the inflammatory response, particularly in critical illness and systemic hyperinflammatory states.

RECENT FINDINGS

Anesthetics can have microbicidal properties, and both anti- and pro-inflammatory effects. They can act directly on immune cells as well as modulate immunity through indirect pathways, acting on the neuroimmune stress response, and have recently been described to interact with the gut microbiota.

SUMMARY

Anesthesiologists should take into consideration the immunomodulatory properties of anesthetic agents in addition to their hemodynamic, neuroprotective, and other impacts. In future, patient stratification according to the perioperative assessment of serum biomarkers associated with postoperative complications may be used to guide anesthetic agent selection based on their immunomodulatory properties.

Immunosedation: a consideration for sepsis

In a recent issue of Critical Care, Qiao and colleagues showed in a rat model of sepsis that dexmedetomidine and midazolam suppress the generation of pro-inflammatory mediators but the effects vary between agents. While dexmedetomidine limited apoptosis to a greater extent than midazolam, both agents significantly reduced short-term mortality compared with saline. This study, in addition to those by others, suggests there are disparate immunomodulating effects between sedatives. Clinical studies are warranted to investigate whether these effects impact outcomes of septic patients. Perhaps one day the choice of sedative in septic patients will not be based solely on sedative properties but rather immunosedative profiles.