The inflammatory response to surgery and trauma

Abstract

An understanding of the stress response will aid the clinician in preparing for expected responses, recognizing and perhaps correcting deviations from the norm and accounting for potential complications that arise in the face of preexisting disease. Deviations from the normal time course may represent the effects of preexisting medical illness, treatment or postoperative/injury complications.

Effects of sedation during upper gastrointestinal endoscopy on endocrine response and cardiorespiratory function

“…Secretion of the mediators, and the intracellular and intercellular metabolic alterations that initiate the neuroendocrine response developing after trauma depend on the duration and type of trauma (10,11). Regardless of its duration, gastroscopic examination is also a trauma which elicits a metabolic endocrine response in the body.…”

The Acute Stress Reaction to Major Thoracic Surgery

“…trauma) injury [4]. It includes an adaptive set of events, a predictable well orchestrated reaction, that has evolved to maximize an organism's healing potential and it is not unique to humans but is found in all vertebrate animals [1].…”

“…The activation of these conservative mechanisms occur in anesthetized or unanesthetized injury. In the former (elective major surgery) the beginning may be represented by the dilatation of the venous capacitance system produced by the commonly used anesthetic induction agents which decreases the blood return to the heart diminishing the cardiac output [1] or by the cytochines produced by activated leucocytes, fibroblasts and endothelia cells at the site of the surgical insult. [5] In case of unanesthetized injury the neuro-endocrine-hormonal response is activated by afferent neuronal impulses from the site of injury that travel along sensory nerve roots through the dorsal root of the spinal cord to the medulla to activate the hypothalamus [4].…”

“…[1] The first description of the clinical manifestations of such responses was presented in 1942 by Cuthbertson [2] who described a biphasic immune, inflammatory and metabolic response to injury. However during the last 20 years, as knowledge has continuously accumulated, it has become clear that the physiologic response to injury is not as simple as initially described and represents a rather complex physiological phenomenon, yet even today it is not completely understood.…”

The Stress Response in Laparoscopic Urological Surgery

“…However, it can be deleterious, especially in patients with concurrent medical conditions and altered physiology. Increased oxygen requirements result in greater cardiorespiratory effort, endogenous substrate stores are depleted and persistence of inflammatory mediators can result in a systemic inflammatory response syndrome and possible multiple-organ failure [5]. In addition, activation of cytokine and other humoral cascade systems by surgical trauma reduces both cellular and cell-mediated immunity, resulting in immunosuppression [6].…”