We thank Drs. Mundangepfupfu and Nadler for their letter1  regarding our review, “Emerging Paradigms in the Prevention of Surgical Site Infection,”2  in which they comment that other common anesthetic medications, beyond those highlighted in the article (volatile agents and opioids), may influence the microbiome or host immunologic response—specifically propofol and ketamine. We agree and thank them for raising this point. In addition, local anesthetics,3  dexmedetomidine4  and cisatracurium,5  have also been shown to have immunomodulatory properties.

The authors further caution that evidence to date (primarily from animal models) is conflicted regarding the potential detrimental or protective effects of these agents on infection and that it is premature to advocate for the use of total intravenous anesthesia on such grounds. We agree with this statement and would like to emphasize that our review similarly does not advocate for use of total intravenous or any other anesthetic technique...

You do not currently have access to this content.