Review of the Effects of Anesthetic Techniques and Medications on the Immune Response During the Perioperative Period

Anesthetic techniques have a measurable influence on immune function during the perioperative period, with potential consequences for infection risk, tissue repair, and oncological outcomes. The key pathways implicated include mTOR (mechanistic target of rapamycin), NF-kappaB (nuclear factor kappa-light-chain-enhancer of activated B cells), and JAK/STAT (Janus kinase-signal transducer and activator of transcription), which together shape cytokine release, T-cell responsiveness, macrophage function, and natural killer cell-mediated cytotoxicity. Available studies indicate that several anesthetic agents can attenuate innate and adaptive immunity, potentially compromising host defense, while in selected contexts a controlled reduction in perioperative inflammation may confer benefit. Particular emphasis is placed on cancer surgery, in which anesthetic choices may influence perioperative control of micrometastases and, consequently, long-term oncological outcomes. Despite growing interest, the evidence base is limited by methodological heterogeneity, short follow-up intervals, and the predominance of preclinical data. To address these gaps, we propose practical considerations for tailoring anesthesia to patients at immunological or oncological risk and outline priorities for future research. These include standardized perioperative immune biomarkers, harmonized protocols, and multicenter randomized trials integrating mechanistic and clinical endpoints. Understanding how anesthetic techniques shape perioperative immunity offers an opportunity to refine anesthetic decision-making and develop evidence-based strategies aimed at improving short- and long-term patient outcomes. This article aims to review the effect of anesthetic techniques and medications on the immune response during the perioperative period.