{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,17]],"date-time":"2026-06-17T03:44:12Z","timestamp":1781667852417,"version":"3.54.5"},"reference-count":45,"publisher":"The Korean Society of Anesthesiologists","issue":"1","license":[{"start":{"date-parts":[[2025,11,5]],"date-time":"2025-11-05T00:00:00Z","timestamp":1762300800000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":["ekja.org"],"crossmark-restriction":true},"short-container-title":["Korean J Anesthesiol"],"published-print":{"date-parts":[[2026,2,1]]},"abstract":"<jats:p>Background: Deep neuromuscular blockade (NMB) optimizes surgical conditions, particularly during laparoscopic procedures. However, its effects on systemic cytokines associated with anesthesia-related complications, including postoperative delirium and cognitive dysfunction, remain unclear. In this review, we quantified the impact of deep NMB on serum cytokine levels.Methods: PubMed, EMBASE, CENTRAL, CINAHL, Scopus, Web of Science, and Google Scholar databases were searched to identify randomized controlled trials (RCTs) evaluating serum cytokine levels in surgical patients under deep or moderate NMB.Results: Eight RCTs, including 661 patients undergoing laparoscopic and orthopedic surgeries, met the inclusion criteria. Immediately postoperatively, meta-analysis suggested a potential reduction in tumor necrosis factor-\u03b1 (TNF-\u03b1, standardized mean difference: \u22120.46, 95% CI [\u22120.87 to \u22120.06], P = 0.03), with no significant differences in interleukin-1\u03b2 (IL-1\u03b2) or interleukin-6 (IL-6) levels. At 24-h and 48-h postoperatively, no significant differences were observed in IL-1\u03b2, IL-6, TNF-\u03b1, or C-reactive protein levels. Meta-regression analysis indicated that inhalational anesthesia was associated with high IL-1\u03b2 (estimate = 1.2135, 95% CI [0.5107\u20131.9162], P &lt; 0.01) and TNF-\u03b1 levels (estimate = 0.6271, 95% CI [0.0544\u20131.1997], P = 0.032) immediately postoperatively; however, younger patients exhibited elevated IL-1\u03b2 levels under moderate NMB at 24-h postoperatively (estimate = 0.0242, 95% CI [0.0065\u20130.0419], P &lt; 0.01).Conclusions: Deep NMB may be associated with reduced TNF-\u03b1 levels immediately postoperatively. Inhalational anesthesia and younger age may contribute more to higher serum cytokine levels compared with total intravenous anesthesia and older age, respectively, suggesting a potential immunomodulatory effect of deep NMB. Further studies should clarify its clinical relevance.<\/jats:p>","DOI":"10.4097\/kja.25279","type":"journal-article","created":{"date-parts":[[2025,11,5]],"date-time":"2025-11-05T06:31:21Z","timestamp":1762324281000},"page":"56-68","update-policy":"https:\/\/doi.org\/10.4097\/crossmark_policy","source":"Crossref","is-referenced-by-count":4,"title":["Impact of neuromuscular blockade depth on postoperative systemic cytokine release: a systematic review and 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