title: Effects of anaesthesia on the inflammatory response to injury.
abstract: OBJECTIVE
  The systemic inflammatory response to injury is essential for wound healing and recovery in concert with other endocrinological, metabolic and immunological changes. However, recent studies suggest that a hyperinflammatory state is associated with adverse perioperative outcomes. Therefore interventions that modulate the inflammatory response, surgical, anaesthetic and pharmacological, may enhance recovery with fewer complications.
  
  
  RESULTS
  Basic research on wound biology has shown the importance of genetic variability in determining the initial inflammatory response. Clinically, studies of cardiac surgery predominate in which genetic polymorphisms have been shown to result in a hyperinflammatory state.
  
  
  CONCLUSIONS
  The use of an interleukin-1 receptor antagonist to control wound pain and limit local inflammation is under consideration. The role of glucocorticoids in obtunding the inflammatory response to injury with improved outcome requires confirmation with better-quality trials. Systemic lidocaine is anti-inflammatory but is effective only in abdominal surgery. NSAIDs are neglected, despite their widespread clinical use and merit detailed investigation.
authors.affiliation: St George's, University of London, Cranmer Terrace, London, UK.
authors.forename: Grainne
authors.initials: G
authors.lastname: Nicholson
authors.forename: George M
authors.initials: GM
authors.lastname: Hall
mesh_terms: D000758:Anesthesia; D000818:Animals; D006348:Cardiac Surgical Procedures; D006801:Humans; D007249:Inflammation / Q000517:prevention & control*; D053583:Interleukin-1beta / Q000502:physiology; D008012:Lidocaine / Q000494:pharmacology; D013514:Surgical Procedures, Operative; D014945:Wound Healing / Q000276:immunology*
chemical_list: D053583:Interleukin-1beta; D008012:Lidocaine