Peripheral Cytokine Modulation by Anesthetic Agents: A Systematic Review of Neuroprotective and Anti-Inflammatory Effects in Randomised Clinical Trials

Introduction: Perioperative neurocognitive disorders remain a complex and under-diagnosed complication of surgery, linked to increased mortality and reliance on unemployment or disability benefits. Trauma-induced inflammatory responses are a major mechanism behind perioperative neurocognitive disorders. Understanding the impact of pharmacological interventions on modulating inflammatory and neuronal damage markers is crucial for improving perioperative care and patient outcomes.The objective is to evaluate the effects of neuroprotective pharmacological agents: dexmedetomidine, lidocaine, propofol, and magnesium, on peripheral inflammatory and neuronal damage markers in surgical patients. Material and methods: Studies were retrieved from Medline, Embase, and the Cochrane Central Register of Controlled Trials (CENTRAL) databases, covering articles published until January 2024. Results: Nine RCTs involving 870 patients were included. Dexmedetomidine significantly reduced S100β and NSE levels. IL-6 and TNF-α levels were significantly reduced post-surgery in dexmedetomidine-treated patients, highlighting its anti-inflammatory effects. Discussion: Lidocaine effectively reduced S100β and NSE. Propofol and magnesium also demonstrated neuroprotective properties. However, significant heterogeneity in dosing and timing among studies limits the generalizability of these findings. Conclusion: Dexmedetomidine, lidocaine, propofol, and magnesium show promise in reducing biomarkers associated with brain injury and inflammation during surgery, offering potential benefits for perioperative neuroprotection.