Perioperative Period: Immunological Modifications

Abstract

Surgical stress induces complex modifications in the hemodynamic, metabolic, neuro-hormonal and immune response ofthe individual. The magnitude ofthese alterations depends on preoperative events leading to surgery, the severity of surgical trauma, and also on post-operative/post-traumatic complications ("multiple hit hypothesis"). As in other conditions of tissue damage, surgery trauma is followed by an immune-inflammatory response, initiated at the site of injury by the innate immune system, followed by a compensatory anti-inflammatory (or immunosuppressive) response (CARS), involving mainly cells of the adaptive immune system, which predispose the host to septic complications. The up-regulated inflammatory response, together with a profound impairment of macrophage and cell-mediated immunity, appear to be the cause for patients' increased susceptibility in developing subsequent sepsis after major surgery.

Comparison of postoperative immune function in patients with thoracic esophageal cancer after video-assisted thoracoscopic surgery or conventional open esophagectomy

“…They perform nonspecific and specific immune tasks essential for surveillance against tumors [15]. Major surgery is associated with a sustained postoperative reduction in the numbers and activity of NK cells and T lymphocyte subsets, including lymphokine-activated killer T cells [4,16,17]. This can significantly delay postoperative immune function; one study showed that T lymphocyte activation in response to mitogens may be delayed up to 1 week after surgery in patients underwent liver transplantation [18].…”

Is Minimally Invasive Spine Surgery Also Minimally Pro-Inflammatory? Muscular Markers, Inflammatory Parameters and Cytokines to Quantify the Operative Invasiveness Assessment in Spine Fusion

“…The host's immune response to tissue injury and surgery is complex and still poorly understood. It involves hemodynamic, metabolic, neuro-hormonal and immune responses of the individual (52). It is essential to determine the balance between pro-and anti-inflammatory factors and to quantify their changes over time (53).…”

Remote ischemic preconditioning and outcome

“…Although intraoperative events, such as hypotension, can cause organ injury and dysfunction, other pathophysiologic mechanisms are encountered more commonly [8,9]. Major surgery provokes a stress response, initiated by direct tissue injury, inflammation, pain, anxiety, and change in body core temperature [8].…”

“…Major surgery provokes a stress response, initiated by direct tissue injury, inflammation, pain, anxiety, and change in body core temperature [8]. As a result, changes in parasympathetic and sympathetic tone and in catecholamine release occur, giving rise to tachycardia, hypertension, and fluid shift.…”