The Impact of Different Anesthetics on the Distribution and Cytotoxic Function of NK Cell Subpopulations: An In Vitro Study

Only some subpopulations of natural killer (NK) cells have cytotoxic functionality, and the effects of anesthetics on these subpopulations are unknown. This study aimed to evaluate the in vitro effects of various anesthetics, both alone and in combination, on the distribution and cytotoxic function of NK cells and their subpopulations. Peripheral blood mononuclear cells (PBMCs) from eight healthy volunteers were treated for 4 h in vitro with dexmedetomidine, remifentanil, lidocaine, propofol, sevoflurane, and combinations in clinically relevant concentrations or left untreated. Flow cytometry was used to quantify the percentage of sampled NK cells and evaluate their distribution (CD56^brightCD16^neg, CD56^brightCD16^dim, CD56^dimCD16^neg, CD56^dimCD16^bright, and CD56^negCD16^bright) and cytotoxicity (Granzyme B (GrzB) and perforin) of NK cell subpopulations. Although the percentage of total NK cells did not change following exposure to anesthesia, the most important cytotoxic subpopulation (CD56^dimCD16^bright NK cells) decreased after exposure to both propofol (-3.58%, <i>p</i> = 0.045) and sevoflurane (-16.10%, <i>p</i> = 0.008) alone, and most combinations, especially in combination with lidocaine (propofol with lidocaine (-9.66%, <i>p</i> = 0.002) and sevoflurane with lidocaine (-21.90%, <i>p</i> < 0.001)). Dexmedetomidine and remifentanil had no effect on CD56^dimCD16^bright NK cells. Furthermore, no anesthetic regimen or combination altered the expression of GrzB and perforin in NK cells or NK cell subpopulations. In short, propofol and sevoflurane suppressed the highly cytotoxic phenotype (CD56^dimCD16^bright) of NK cells, with those exposed to sevoflurane combinations showing greater reductions. Immunosuppression was intensified with the inclusion of lidocaine in the anesthetic regimen.