Immunomodulatory effects of anesthetics in obese patients

Table 2 Animal studies of effects of inhalational anesthesia in obese or MetS animals

Ref.	Population	Interventions	Comparison	Outcome in obese animals	Outcome in lean animals
Song et al[123]	Animals fed high-fat vs low-fat diet	Myocardial ischemia and reperfusion	Ctrl x Sevoflurane preconditioning	No sevoflurane cardioprotection	Sevoflurane: ↓ infarct size; ↑endothelial nitric oxide synthase, myocardial nitrite and nitrate
van den Brom et al[124]	Animals fed western vs control diet	Sevoflurane 2% vs baseline on echocardiographic myocardial perfusion and function	Myocardial perfusion and systolic function	Sevoflurane: No additional effect on myocardial perfusion but impaired systolic function	Sevoflurane: ↑ microvascular filling velocity, no change in myocardial perfusion
Bussey et al[125]	Zucker type 2 diabetic Zucker obese vs lean counterpart animals	Conscious vs 2% isoflurane anesthesia	Hemodynamic effects (mean arterial pressure, heart rate) of α or β adrenoreceptor (AR) stimulation	Isoflurane exacerbated and prolonged α-AR sensitivity and normalized chronotropic β-AR responses	Maintenance of ↑ α-AR sensitivity, ↑ chronotropic β-AR heart rate and mean arterial pressure responses
Zhang et al[126]	Animals with hypercholesterolemia vs normocholesterolemic animals	60 min sevoflurane pre-treatment, 12 h before myocardial IR surgery	Expression of myocardial iNOS and eNOS	No cardioprotectant effects of sevoflurane, downregulation of eNOS. Interference with iNOS signaling pathway	Delayed sevoflurane cardioprotection: decreased infarct size and improved ventricular function
Yang et al[127]	Animals fed high-fat vs low-fat diet	60 min focal cerebral ischemia followed by 24 h of reperfusion 15 min sevoflurane postconditioning	Cerebral infarct volume, neurological score, motor coordination 24 h after reperfusion	Sevoflurane post-conditioning failed to confer neuroprotection; no neuroprotective effect of mitoKATP channel opener	Sevoflurane ↓ infarct size, improved neurological deficit scores; neuroprotective effect of mitoKATP channel opener
Yu et al[128]	Animals fed high-fat vs low-fat diet	Middle cerebral artery occlusion; Isoflurane post-treatment after 20 min in vitro ischemia or transient middle cerebral artery occlusion	Cell injury in hippocampal slices, brain infarct volume, neurological deficit	Attenuated isoflurane-induced neuroprotection; ↓ Akt signaling pathway	Isoflurane post-treatment ↓ injury

Summary of the results of experimental studies comparing inhalational anesthetics according to population, intervention, comparison, and outcomes. AR: Adrenergic receptor; eNOS: Endothelial nitric oxide; IR: Ischemia-reperfusion.