| Impact of neuromuscular blockade depth on postoperative systemic cytokine release: a systematic review and meta-analysis |
|
Soowon Lee1,2,3, Jung-Hee Ryu1,2, Chang-Hoon Koo1,2, Yu Kyung Bae1, Ah-Young Oh1,2 |
1Department of Anesthesiology and Pain Medicine, Seoul National University Bundang Hospital, Seongnam, South Korea
2Department of Anesthesiology and Pain Medicine, Seoul National University College of Medicine, Seoul, South Korea
3Center for Synaptic Brain Dysfunctions, Institute for Basic Science (IBS), Daejeon, South Korea |
Corresponding author:
Ah-Young Oh, Tel: +82-31-787-7509,
Email: ohahyoung@hanmail.net
|
Received: 11 April 2025 • Revised: 12 October 2025 • Accepted: 14 October 2025
*Soowon Lee and Jung-Hee Ryu contributed equally to this study as co-first authors. |
|
|
| Abstract |
Background
Deep neuromuscular blockade (NMB) optimizes surgical conditions, particularly during laparoscopic procedures. However, its effects on systemic cytokines associated with anesthesia-related complications, including postoperative delirium and cognitive dysfunction, remain unclear. In this review, we quantified the impact of deep NMB on serum cytokine levels.
Methods
PubMed, EMBASE, CENTRAL, CINAHL, Scopus, Web of Science, and Google Scholar databases were searched to identify randomized controlled trials (RCTs) evaluating serum cytokine levels in surgical patients under deep or moderate NMB.
Results
Eight RCTs, including 661 patients undergoing laparoscopic and orthopedic surgeries, met the inclusion criteria. Immediately postoperatively, meta-analysis suggested a potential reduction in tumor necrosis factor-α (TNF-α, standardized mean difference −0.48; 95% confidence interval [95% CI] −0.90 to −0.06; P = 0.03), with no significant differences in interleukin-1β (IL-1β) or interleukin-6 (IL-6) levels. At 24-h and 48-h postoperatively, no significant differences were observed in IL-1β, IL-6, TNF-α, or C-reactive protein levels. Meta-regression analysis indicated that inhalational anesthesia was associated with high IL-1β (estimate = 1.2135; 95% CI, 0.5107–1.9162; P < 0.01) and TNF-α levels (estimate = 0.6271; 95% CI, 0.0544–1.1997; P = 0.032) immediately postoperatively; however, younger patients exhibited elevated IL-1β levels under moderate NMB at 24-h postoperatively (estimate = 0.0242; 95% CI, 0.0065–0.0419; P < 0.01).
Conclusions
Deep NMB may be associated with reduced TNF-α levels immediately postoperatively. Inhalational anesthesia and younger age may contribute more to higher serum cytokine levels compared with total intravenous anesthesia and older age, respectively, suggesting a potential immunomodulatory effect of deep NMB. Further studies should clarify its clinical relevance.
|
| Key Words:
Anesthesia; Cytokines; General anesthesia; Interleukin-6; Interleukins; Neuromuscular blockade; Tumor necrosis factor-alpha |
|
PDF Links
Full text via DOI
Download Citation
