The surgical stress response: should it be prevented?
Postoperative complications such as myocardial infarction, pulmonary infection, thromboembolism and fatigue are probably related to increased demands, hypermetabolism, catabolism and other physiologic changes included in the global "surgical stress response." Strategies have been developed to suppress the detrimental components of the stress response so as to improve postoperative outcome. Of the various techniques to reduce the surgical stress response, afferent neural blockade with regional anesthesia to relieve pain is the most effective, although not optimal. Data from numerous controlled clinical trials have demonstrated a reduction in various aspects of postoperative morbidity by such a nociceptive blockade. Although a causal relationship has still to be demonstrated, these findings strongly argue the concept of "stress-free anesthesia and surgery" as an important instrument in improving surgical outcome.
Kehlet
H
H
Department of Surgical Gastroenterology, Hvidovre University Hospital, Denmark.
D006801:Humans; D009407:Nerve Block; D011183:Postoperative Complications / Q000503:physiopathology / Q000517:prevention & control; D013312:Stress, Physiological / Q000503:physiopathology / Q000517:prevention & control*; D013514:Surgical Procedures, Operative / Q000009:adverse effects