A critical appraisal of the effects of anesthetics on immune system modulation in critically ill patients with COVID-19

Chalkias, Athanasios; Barreto, Erin F.; Laou, Eleni; Kolonia, Konstantina; Scheetz, Marc H.; Gourgoulianis, Konstantinos; Pantazopoulos, Ioannis; Xanthos, Theodoros

Purpose The aim of the present article is to briefly summarize current knowledge about the immunomodulatory effects of general anesthetics and the possible clinical effects of this immunomodulation in patients with COVID-19. Methods The PubMed, Scopus, and Google Scholar databases were comprehensively searched for relevant studies. Findings The novel coronavirus causes a wide spectrum of clinical manifestations, with large absolute number of patients experiencing severe pneumonia and rapid progression to acute respiratory distress syndrome and multiple organ failure. In these patients, the equilibrium of the inflammatory response is a major determinant of survival. The impact of anesthetics on immune system modulation may vary and include both pro-inflammatory and anti-inflammatory effects. Implications Inhibition of the development of severe inflammation and/or the enhancement of inflammation resolution by anesthetics may limit organ damage and improve outcomes in COVID-19 patients.