Damage-Associated Molecular Patterns in Perioperative Anesthesia Care: A Clinical Perspective.

Area of Science:

• Immunology
• Anesthesiology
• Critical Care Medicine

Background:

• Damage-associated molecular patterns (DAMPs) are endogenous molecules released during cellular stress or injury.
• Perioperative triggers like surgical trauma and ischemia-reperfusion injury release DAMPs, activating innate immune receptors (TLRs, RAGE).
• DAMPs initiate inflammatory cascades, leading to endothelial dysfunction, coagulation imbalance, and systemic organ dysfunction.

Purpose of the Study:

• To highlight the central role of DAMPs in perioperative sterile inflammation and subsequent organ dysfunction.
• To explore how perioperative management strategies and anesthetic agents influence DAMP-mediated inflammation.
• To suggest future research directions for DAMPs as biomarkers and therapeutic targets.

Main Methods:

• Review of existing literature on DAMPs in perioperative settings.
• Analysis of DAMPs' role in triggering sterile inflammation and organ dysfunction.
• Evaluation of the impact of anesthetic agents on DAMP-mediated inflammatory responses.

Main Results:

• DAMPs contribute significantly to perioperative complications, including acute lung/kidney injury and neurocognitive disorders.
• Anesthetic agents like propofol and dexmedetomidine may possess anti-inflammatory effects, while volatile anesthetics show variable impacts.
• Minimizing DAMP release through protective ventilation and restrictive transfusion is supported by current understanding.

Conclusions:

• Perioperative organ dysfunction can be viewed as a consequence of endogenous danger signaling by DAMPs.
• Anesthetic choice and perioperative management strategies may significantly modulate systemic inflammation and patient recovery.
• Further research validating DAMPs as biomarkers and therapeutic targets could enable precision anesthetic strategies for improved perioperative outcomes.