Long et al.1 provided a well-written and accessible review of new ideas in the field of surgical site infection prevention. Within their discussion of the patient’s microbiome, the authors touch on the potential for interactions between the patient microbiome and anesthetic agents administered perioperatively. Although they accurately identify the immunosuppressive potential of volatile anesthetics and intravenous opioids, we think that it is important to note that there exist other agents capable of producing and maintaining general anesthesia. Medications like ketamine and propofol are immunomodulatory in different ways, and thus their use may also impact the development of surgical site infections.
Long et al.1 cite two mouse model articles where exposure to volatile anesthetics was associated with a decrease in intestinal microbiome diversity.2,3 In contrast, Guo et al.,4 using a rat model, looked at the effect of a continuous infusion of propofol during...
