Document Type : Review Article


1 Professor of Anesthesiology, Department of Anesthesiology, School of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran

2 Instructor of Anesthesiology, Department of Anesthesiology and Operating Room, School of Allied Medical Sciences, Tabriz University of Medical Sciences, Tabriz, Iran

3 Associate Professor of Otorhinolaryngology, Head and Neck Surgery, Tuberculosis and Lung Disease Research Center, Tabriz University of Medical Sciences, Tabriz, Iran


Introduction: Since rhinoplasty surgery is performed under general anesthesia and the prevalence of this type of surgery in the Iranian population is increasing at a very fast rate, and on the other hand, because there is no accurate information about the systemic inflammatory response caused by general anesthesia in candidate patients. Rhinoplasty is not available. We decided to conduct the present study with the aim of reviewing the systemic inflammatory response syndrome in patients with general anesthesia who are candidates for rhinoplasty.
Method: Keywords such as General Anesthesia, rhinoplasty, surgical stress, systemic inflammatory response syndrome, pro-inflammatory cytokines, and anti-inflammatory cytokines in the Iranian and international databases by both authors of the present study with the help of Boolean operators (AND, OR, and NOT) were searched and the obtained studies that met the criteria for entering this study were evaluated.
Results: The most important topics discussed by examining the number of articles include surgical stress and systemic inflammatory response syndrome, the role of immune cells in systemic inflammatory response syndrome, the potential effects of cytokine release during surgery and general anesthesia, and the role of promoting cytokines. Inflammatory in systemic inflammatory response syndrome caused by rhinoplasty.
Conclusion: During surgical stress, neuro-endocrine, metabolic, inflammatory, and immune systems can be activated rapidly and potentially harmful consequences such as cardiac dysfunction, cardiovascular instability, endothelial activation, inflammation, vascular dysfunction, and possibly immunosuppression. Enhancing endothelium function may reduce the incidence of excessive inflammation, immune system, and complement, as well as complications such as systemic inflammatory response syndrome, multiple organ dysfunction syndrome, and multiple organ/organ failure.

Graphical Abstract

A Review of Systemic Inflammatory Response Syndrome in Patients with General Anesthesia Candidates for Rhinoplasty


Main Subjects

  1. A. Kennedy, D. Shipway, K. Barry. Frailty and emergency abdominal surgery: a systematic review and meta-analysis, Surgeon. (2021):S147966X(21)00198-0.
  2. Joseph, B. Zangbar, V. Pandit, M. Fain, M.J. Mohler, N. Kulvatunyou, et al. Emergency general surgery in the elderly: too old or too frail? J Am Coll Surg., 222 (2016) 805–13.
  3. S. Lin, J.N. Watts, N.M. Peel, R.E. Hubbard. Frailty and post-operative outcomes in older surgical patients: a systematic review. BMC Geriatr., 16 (2016) 157.
  4. Costa, P. Fransvea, M. Podda, A. Pisanu, F.M. Carrano, A. Iossa, et al. The use of emergency laparoscopy for acute abdomen in the elderly: the Frailesel Italian Multicenter Prospective Cohort Study. Updates Surg., 72 (2020) 513–25.
  5. Fransvea, V. Fico, V. Cozza, G. Costa, L. Lepre, P. Mercantini, et al. Clinical-pathological features and treatment of acute appendicitis in the very elderly: an interim analysis of the FRAILESEL Italian multicentre prospective study. Eur J Trauma Emerg Surg., 48 (2022) 1177–88.
  6. Shahidi, A. Lotfi. Epidemiology and Clinical Findings of Oral Squamous Cell Carcinoma Majallah-i Pizishki-i Danishgah-i ulum-i Pizishki-i Tabriz. 44 (2022) 67–71.
  7. Hirode, R.J. Wong. Trends in the prevalence of metabolic syndrome in the United States, 2011–2016. JAMA., 323 (2020) 2526–8.
  8. Strazzullo, A. Barbato, A. Siani, F.P. Cappuccio, M. Versiero, P. Schiattarella, et al. Diagnostic criteria for metabolic syndrome: a comparative analysis in an unselected sample of adult male population. Metabolism., 57 (2008) 355–61.
  9. J. Magliano, J.E. Shaw, P.Z. Zimmet. How to best define the metabolic. Ann Med., 38 (2006) 34–41.
  10. M. Reaven. The metabolic syndrome: requiescat in pace. Clin Chem., 51 (2005) 931–8.
  11. M. Grundy, J.I. Cleeman, S.R. Daniels, K.A. Donato, R.H. Eckel, B.A. Franklin, et al. Diagnosis and management of the metabolic syndrome: an American Heart Association/National Heart, Lung, and Blood Institute Scientific Statement, Circulation. 112 (2005) 2735–52.
  12. L. Huang. A comprehensive definition for metabolic syndrome. Dis Model Mech., 2 (2009) 231–7.
  13. G. Alberti, P. Zimmet, J. Shaw, Metabolic syndrome – a new world-wide definition. A consensus statement from the international diabetes federation. Diabet Med., 23 (2006) 469–80.
  14. Bonyadi, M. Esmaeili, M. Abhari, A. Lotfi, Mutation analysis of familial GJB2-related deafness in Iranian Azeri Turkish patients. Genetic testing and molecular biomarkers. 13 (2009) 689–92.
  15. A. Banks, M.L. Freeman, Practice Parameters Committee of the American College of Gastroenterology . Practice guidelines in acute pancreatitis. Am J Gastroenterol. 101 (2006) 2379–2400.
  16. Boukerrouche. The Stepup Approach in Treating Infected Pancreatic Necrosis. Med Clin Rev., 6 (2020)95.
  17. M. Haghdoost, M.K. Gol. The necessity of paying more attention to the neurological and psychological problems caused by the COVID-19 pandemic during pregnancy. International Journal of Women’s Health and Reproduction Sciences., 3 (2020) 243-44.
  18. G. Lankisch, M. Apte, P.A. Banks, Acute pancreatitis. Lancet., 386 (2015) 85–96.
  19. Mounzer, C.J. Langmead, B.U. Wu, et al., Comparison of existing clinical scoring systems to predict persistent organ failure in patients with acute pancreatitis. Gastroenterology., 142 (2012) 1476–1482.
  20. J. Schepers, O.J. Bakker, M.G. Besselink, et al., Impact of characteristics of organ failure and infected necrosis on mortality in necrotising pancreatitis. Gut., 68 (2019) 1044–1051.
  21. J. Mole, K.L. McClymont, S. Lau, et al. Discrepancy between the extent of pancreatic necrosis and multiple organ failure score in severe acute pancreatitis. World J Surg. 33 (2019) 2427–2432.
  22. L. Bradley. A clinically based classification system for acute pancreatitis. Summary of the International Symposium on Acute Pancreatitis, Atlanta, Ga, September 11 through 13, 1992. Arch Surg., 128 (1993) 586–590.
  23. Larvin, M.J. McMahon, APACHE-II score for assessment and monitoring of acute pancreatitis. Lancet., 2 (1989) 201–205.
  24. U. Wu, R.S. Johannes, X. Sun, et al., The early prediction of mortality in acute pancreatitis: a large population-based study. Gut., 57 (2008) 1698–1703.
  25. Miller, Y. Wu, R. Safa, et al., Derivation and validation of the ED-SAS score for very early prediction of mortality and morbidity with acute pancreatitis: a retrospective observational study. BMC Emerg Med., 21 (2021) 16.
  26. W. Browne, C.S. Pitchumoni, Pathophysiology of pulmonary complications of acute pancreatitis. World J Gastroenterol., 12 (2006) 7087–7096.
  27. M. Ronagh, A. PANAHALI, A. LOTFI, P.F. Ahmadpour. Comparison of body image and life satisfaction among patients undergoing cosmetic surgery and candidates for the surgery in maxillofacial department at Imam Reza Hospital in Tabriz. Razi Journal Of Medical Sciences. 2018.
  28. O. Nyström, The systemic inflammatory response syndrome: definitions and aetiology, J Antimicrob Chemother., 41 (1998) 1–7.
  29. M. Robertson, C.M. Coopersmith, The systemic inflammatory response syndrome. Microbes Infect., 8 (2006) 1382–9.
  30. A. Balk, Systemic inflammatory response syndrome (SIRS): where did it come from and is it still relevant today? Virulence., 5 (2014) 20–6.
  31. M. Haghdoost, S. Mousavi, M.K. Gol, M. Montazer. T Frequency of Chlamydia trachomatis Infection in Spontaneous Abortion of Infertile Women During First Pregnancy Referred to Tabriz University of Medical Sciences by Nested PCR Method in 2015. International Journal of Women’s Health and Reproduction Sciences., 7 (2019) 526-30.
  32. L. Chang, A.R. Cortez, A. Bondoc, D.P. Schauer, A. Fitch, S.A. Shah, et al. Metabolic syndrome in liver transplantation: a preoperative and postoperative concern. Surgery., 160 (2016) 1111–7.
  33. Shiota, A. Takeuchi, M. Sugimoto, E. Kashiwagi, T. Dejima, K. Kiyoshima, et al. The differential impact of body mass index and the feature of metabolic syndrome on oncological outcomes following different surgical procedures in Japanese men with prostate cancer. Ann Surg Oncol., 24 (2017) 1443–50.
  34. Dent, P. Kowal, E.O. Hoogendijk, Frailty measurement in research and clinical practice: a review. Eur J Intern Med., 31 (2016) 3–10.
  35. N. Robinson, J.D. Walston, N.E. Brummel, S. Deiner, C.H. Brown, M. Kennedy, et al. Frailty for surgeons: review of a national institute on aging conference on frailty for specialists. J Am Coll Surg., 221 (2015) 1083–92.
  36. K. Gol, F. Jabarzade, V. Zamanzadeh, Cultural competence among senior nursing students of medical universities in North-West Iran . J Urmia Nurs Midwifery Fac.;18 (2017) 612-19.
  37. Costa, P. Ruscelli, G. Balducci, F. Buccoliero, L. Lorenzon, B. Frezza, et al. Clinical strategies for the management of intestinal obstruction and pseudo-obstruction. A Delphi Consensus study of SICUT (Società Italiana di Chirurgia d’Urgenza e del Trauma)., Ann Ital Chir., 87 (2016) 105–17.
  38. von Elm, D.G. Altman, M. Egger, S.J. Pocock, P.C. Gøtzsche, J.P. Vandenbroucke, et al., The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) Statement: guidelines for reporting observational studies. Int J Surg., 12 (2014) 1495–9.
  39. Maezawa, T. Aoyama, K. Kano, H. Tamagawa, M. Numata, K. Hara, et al. Impact of the Age-adjusted Charlson comorbidity index on the short- and long-term outcomes of patients undergoing curative gastrectomy for gastric cancer. J Cancer., 10 (2019) 5527–35.
  40. L. Kirkland, D.T. Kashiwagi, M.C. Burton, S. Cha, P. Varkey. The Charlson Comorbidity Index Score as a predictor of 30-day mortality after hip fracture surgery. Am J Med Qual. 26 (2011) 461–7.
  41. National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III). Third Report of the National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III) final report. Circulation., 106 (2002) 3143–421.
  42. C. Bone, R.A. Balk, F.B. Cerra, American College of Chest Physicians/Society of Critical Care Medicine Consensus Conference: definitions for sepsis and organ failure and guidelines for the use of innovative therapies in sepsis. Crit Care Med., 20 (1992) 864–74.
  43. M. Tracy, J.M. Wilson, R.N. Smith, M.L. Schenker, R.B. Gelbard. The 5-item modified frailty index predicts adverse outcomes in trauma. J Surg Res., 253 (2020) 167–72.
  44. Costa, L. Bersigotti, G. Massa, L. Lepre, P. Fransvea, A. Lucarini, et al. The Emergency Surgery Frailty Index (EmSFI): development and internal validation of a novel simple bedside risk score for elderly patients undergoing emergency surgery. Aging Clin Exp Res., 33 (2021) 2191–201.
  45. Dindo, N. Demartines, P.A. Clavien. Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg., 240 (2004) 205–13.
  46. Fransvea, V. Fico, V. Cozza, G. Costa, L. Lepre, P. Mercantini, et al. Clinical-pathological features and treatment of acute appendicitis in the very elderly: an interim analysis of the FRAILESEL Italian multicentre prospective study. Eur J Trauma Emerg Surg., 48 (2022) 1177–88.
  47. S. Ford, C. Li, G. Zhao, Prevalence and correlates of metabolic syndrome based on a harmonious definition among adults in the US. J Diabetes., 2 (2010) 180–93.
  48. I. Edelstein, L.I. Suleiman, A.P. Alvarez, R.M. Sacotte, C.D. Qin, M.D. Beal, et al. The interaction of obesity and metabolic syndrome in determining risk of complication following total joint arthroplasty. J Arthroplasty., 31 (2016) 192–6.
  49. H. Cichos, J.L. Churchill, S.G. Phillips, S.L. Watson, G. McGwin, E.S. Ghanem, et al. Metabolic syndrome and hip fracture: epidemiology and perioperative outcomes. Injury., 49 (2018) 2036–41.
  50. M. Tracy, J.M. Wilson, C. Staley, B. Frias, M.L. Schenker, R.B. Gelbard. Metabolic syndrome: major risk factor for morbidity and mortality in severely injured trauma patients. J Am Coll Surg., 230 (2020) 145–50.
  51. Mikolasevic, S. Milic, L. Orlic, G. Poropat, I. Jakopcic, N. Franjic, et al. Metabolic syndrome and acute pancreatitis. Eur J Intern Med., 32 (2016) 79–83.
  52. G. Glance, R. Wissler, D.B. Mukamel, Y. Li, C.A. Diachun, R. Salloum, et al. Perioperative outcomes among patients with the modified metabolic syndrome who are undergoing noncardiac surgery. Anesthesiology., 113 (2010) 859–72.
  53. H. Bhayani, O. Hyder, W. Frederick, R.D. Schulick, C.L. Wolgang, K. Hirose, et al., Effect of metabolic syndrome on perioperative outcomes after liver surgery: a National Surgical Quality Improvement Program (NSQIP) analysis. Surgery., 152 (2012) 218–26.
  54. A. Cornier, D. Dabelea, T.L. Hernandez, R.C. Lindstrom, A.J. Steig, N.R. Stob, et al. The metabolic syndrome. Endocr Rev., 29 (2008) 777–822.
  55. Zhang, L.O. Lerman. The metabolic syndrome and chronic kidney disease. Transl Res., 183 (2017) 14–25.
  56. Cebron Lipovec, R.J. Beijers, B. van den Borst, W. Doehner, M. Lainscak, A.M. Schols, The prevalence of metabolic syndrome in chronic obstructive pulmonary disease: a systematic review. COPD., 13 (2016) 399–406.
  57. J. Arnaoutakis, S. Selvarajah, N. Mathioudakis, J.H. Black, J.A. Freischlag, C.J. Abularrage, Metabolic syndrome reduces the survival benefit of the obesity paradox after infrainguinal bypass. Ann Vasc Surg., 28 (2014) 596–605.
  58. He, Q. Fei, T. Sun, Metabolic syndrome increases risk for perioperative outcomes following posterior lumbar interbody fusion. Medicine (Baltimore)., 99 (2020) e21786.
  59. Zavlin, K.T. Jubbal, J.L. Van Eps, B.L. Bass, W.A. Ellsworth, A. Echo, et al., Safety of open ventral hernia repair in high-risk patients with metabolic syndrome: a multi-institutional analysis of 39, 118 cases. Surg Obes Relat Dis.,14 (2018) 206–13.
  60. K. Williams, E.L. Rosato, E.P. Kennedy, K.A. Chojnacki, J. Andrel, T. Hyslop, et al., Impact of obesity on perioperative morbidity and mortality after pancreaticoduodenectomy. J Am Coll Surg., 208 (2009) 210–7.
  61. T. Kassahun, M. Mehdorn, J. Babel, The impact of obesity on surgical outcomes in patients undergoing emergency laparotomy for high-risk abdominal emergencies. BMC Surg., 22 (2022) 15.
  62. T. Mullen, D.W. Moorman, D.L. Davenport, The obesity paradox: body mass index and outcomes in patients undergoing nonbariatric general surgery. Ann Surg., 250 (2009) 166–72.
  63. Musaei, The Effect of Pregnancy on the Skin, Eurasian Journal of Chemical, Medicinal and Petroleum Research, 2(2023) 17-23.
  64. Atashzadeh-Shoorideh, S. Parvizy, M. Hosseini, Y. Raziani, F. Mohammadipour, Developing and validating the nursing presence scale for hospitalized patients, BMC nursing, 21 (2022) 1-6
  65. Raziani, L. Hasheminasab, R. Ghanei Gheshlagh, P. Dalvand, V. Baghi, M. Aslani, The prevalence of intimate partner violence among Iranian pregnant women: a systematic review and meta-analysis, Scandinavian Journal of Public Health, 2022.
  66. Raziani, S.H. Qadir, A.H. Hermis, A. Nazari, B. Salah Othman, S. Raziani, Pistacia atlantica as an effective remedy for diabetes: a randomised, double-blind, placebo-controlled trial, Australian Journal of Herbal and Naturopathic Medicine, 34 (2022) 118-124
  67. Amin, M.R. Gavanrudi, K. Karami, Y. Raziani, P. Baharvand, The role of aromatherapy with lavender in reducing the anxiety of patients with cardiovascular diseases: A systematic review of clinical trials, Journal of Herbmed Pharmacology, 11 (2022) 182-187
  68. Raziani, S. Hossein Qadir, B. Salah Othman, A. Mohammed Ahmed, THE STUDENT VOICE TO IMPROVE OSCE, Mosul Journal of Nursing, 10 (2022) 89-97
  69. Raziani, B. Salah Othman, S. Raziani, A common but unknown disease; A case series study, Annals of Medicine and Surgery, 69 (‎2021) 102739.
  70. Alnomasy, G. Raheem Lateef Al-Awsi, Y. Raziani, A.E. Albalawi, A.D. Alanazi, M. Niazi, H. Mahmoudvand, Systematic review on medicinal plants used for the treatment of Giardia infection, Saudi Journal of Biological Sciences, 28 (2021) 5391-5402
  71. Ghorbanizadeh, Y. Raziani, M. Amraei, M. Heydarian, Care and precautions in performing CT Scans in children, Journal of Pharmaceutical Negative Results, 12 (2021) 54
  72. Raziani, S. Raziani, Evaluation of Mental Health of Chemotherapy-Treated Cancer Nurses, Journal of Medicinal and Chemical Sciences, 4 (2021) 351-363
  73. Raziani, B. Salah Othman, Ointment therapy and prevention of cannulation-induced superficial phlebitis, Veins and Lymphatics, 10 (2021).
  74. Raziani, S. Raziani, The effect of air pollution on myocardial infarction, Journal of Chemical Reviews, 3 (2021) 83-96
  75. Shahkarami, M. Nazari, M. Milanifard, R. Tavakolimoghadam, A. Bahmani, Eurasian Chem. Commun., 4 (2022) 463-472. [Crossref], [Google Scholar], [Publisher]‏‏‏
  76. Z. Nazardani, S.H. Nourizadeh Dehkordi A. Ghorbani, A comprehensive evaluation of the Sports Physiotherapy curriculum, Eurasian Journal of Chemical, Medicinal and Petroleum Research, 2 (2023) 10-16. [Google Scholar], [Publisher]‏‏‏
  77. Ghaibi, M.R. Soltani Manesh, H. Jafari Dezfouli, F. Zarif, Z. Jafari, Z. Gilani, Comparison of Marital Satisfaction, Emotional Divorce and Religious Commitment among Nurses and Staff of Ahvaz Government Hospitals, Eurasian Journal of Chemical, Medicinal and Petroleum Research, 1 (2022) 33-39. [Google Scholar], [Publisher]‏‏‏