Intravenous anesthetics in sepsis

Overactive inflammatory responses that destroy rather than protect are the crucial issues in the development of a spectrum of septic disease states, such as adult respiratory distress syndrome, systemic inflammatory response syndrome, septic shock, and multiple organ failure. This review focuses on an area in which alternative actions of intravenous anesthetics show much promise for sepsis: their effects on the inflammatory response and on inflammatory cells in vitro and in vivo. The endotoxin-induced pro-inflammatory cytokine activity and its consequent nitric oxide generation, free radicals production and neutrophil activity are generally depressed by intravenous anesthetics. Different intravenous anesthetics, such as propofol, ketamine, benzodiazepine and barbiturates, which produce different levels of inhibition of inflammatory effects, are discussed in this article. In addition, such modulations of inflammatory responses may be of great relevance to the practice of intensive care, and intravenous anesthetics may play significant roles in this regard.