Table 2.

Effects of anesthetics on cancer recurrence

Effects of anesthetics on cancer recurrence
Type of anesthetics	Effects
Volatile anesthetics	-Pro-inflammatory and immunosuppressive action -Reduces Th1/Th2 ratio -Impairs NK cell activity -Induces T cell and B cell apoptosis -Upregulation of hypoxia-inducible factors (HIF-1α, HIF-2α,) -Increase transcription of pro-metastatic factors (VEGF, angiopoietin-1, proteases MMP-2, and MMP-9) -Enhanced tumor cell proliferation -Increase angiogenesis, and cell migration
Intravenous anesthetics	-Anti-inflammatory and immunosuppression properties -Suppression of prostaglandin and inflammatory cytokine production -Inhibition of cyclooxygenase (COX) activity -Stimulate the proliferation of NK cells -Increase expression of granzyme B and IFNγ -Increase cytotoxic T lymphocyte activity -Does not affect the Th1/Th2 ratio -Modulate genetic signaling pathways -Inhibits histone acetylation
Ketamine, Thiopental	-Suppress the activity of NK cells -Induce apoptosis in lymphocytes -Inhibits the functional maturation of dendritic cells -Reduce the synthesis of pro-inflammatory cytokines
Opioids	-Modulate wound healing -Immunosuppression effects -Inhibits natural killer cell activity -Inhibits responses of T and B cells to mitogens -Inhibits antibody production -Promotes lymphocyte apoptosis, -Reduces the differentiation of T cells -Inhibits phagocytic activity -Inhibits of the release of cytokine/ chemokine production
Local anesthetics	-Activates apoptotic pathway -Inhibits tumor cell growth and migration -Increases the activity of NK -Increases the number of T-helper (Th) cells -Preserves Th1/Th2 cells ratio -Preserves IFN-gamma concentrations -Modulates gene expression -Increases IL-4 levels -Decreases IL-10, IL-8, TNF-alfa production
NSAIDs and COX-2 inhibitors	-Inhibits the cyclooxygenase 1 and the cyclooxygenase 2 -Reduces prostaglandin synthesis
Paracetamol	-Inhibits prostaglandin endoperoxide H2 synthase and cyclooxygenase activity