The Effect of Anaesthesia on the Postoperative Systemic Inflammatory Response in Patients Undergoing Surgery: A Systematic Review and Meta-Analysis

Abstract

Background: Surgical injury stimulates the systemic inflammatory response (SIR). The magnitude of the postoperative SIR has been shown to be significantly associated with short and long-term outcomes following surgery of varying severity. Different anaesthetic techniques for surgery may have an impact on the post-operative SIR and on the rate of the postoperative infective complications.The aim of the present systematic review was to examine the relationship between perioperative anaesthesia, the post-operative SIR and post-operative infective complications in patients undergoing surgery. Methods: This was carried out using PubMed and other established databases from 1987 up to March 2018. In particular, randomised controlled studies and systemic inflammation markers, IL-6 and CRP were examined. Results: Overall, 60 controlled, randomised clinical trials were included in the review. The mean or median values of both IL-6 and CRP were taken for each study and the mean value was calculated for each anaesthetic group at sampling points of 12-24 and 24-72 hours for IL-6 and CRP respectively. When taking the magnitude of surgery into account, TIVA using propofol was significantly associated with a reduction in particular CRP (p=0.04). However, there were no other specific anaesthetic methods including general, regional and combined anaesthetics that were associated with a reduction in eitherIL-6 or CRP. Conclusion: There is some evidence that anaesthetic regimens may reduce the magnitude of the post-operative SIR. However, the studies were heterogeneous and generally of low quality.Future, well conducted, adequately powered studies are required to clarify the effect of anaesthesia on the postoperative SIR and infective complications.