**4.2 Drugs**

Anesthetic drugs can induce changes in cell pathophysiology, such as cell proliferation, angiogenesis, and apoptosis, which can be determinants of the progression of cancer in patients [4]. Anesthesia alters the functions of immune cells, including neutrophils, macrophages, dendritic cells, T lymphocytes, and NK cells [33]. Some of the drugs frequently used in general anesthesia have an inhibitory effect on naturalkiller cell-mediated immunity, particularly morphine, ketamine, thiopental, and inhalational anesthetics [24], on the other hand, it would seem that propofol, nonsteroidal anti-inflammatory drugs (NSAIDs) and local anesthetics have shown promising results (**Table 1**) [3-5].



*NK- natural killer. HIF- Hipoxia inducible factor. HPA- Hypothalamus pituitary adrenal. NSAIDs- Non-Steroidal Anti-Inflammatory Drugs. COX-2- Cyclooxygenase 2.*

### **Table 1.**

*Pharmacological implications in immunosurveillance.*

### *4.2.1 Inhaled anesthetics*
