Perioperative period: immunological modifications.
Surgical stress induces complex modifications in the hemodynamic, metabolic, neuro-hormonal and immune response of the individual. The magnitude of these 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&#x0027; increased susceptibility in developing subsequent sepsis after major surgery.
Department of Allergy and Pulmonology, Pediatric Hospital Giovanni XXIII, University of Bari, Bari, Italy. fabiocardinale@libero.it
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F
Cardinale
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I
Chinellato
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S
Caimmi
D G
DG
Peroni
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F
Franceschini
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Miraglia Del Giudice
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R
Bernardini
D000210:Acute-Phase Reaction / Q000276:immunology; D000818:Animals; D018925:Chemokines / Q000502:physiology; D004730:Endothelium, Vascular / Q000502:physiology; D024243:HMGB1 Protein / Q000502:physiology; D006801:Humans; D007107:Immune System / Q000187:drug effects / Q000502:physiology*; D007249:Inflammation / Q000209:etiology / Q000276:immunology; D018655:Lymphocyte Count; D008264:Macrophages / Q000276:immunology; D009000:Monocytes / Q000276:immunology; D009504:Neutrophils / Q000502:physiology; D059035:Perioperative Period
D018925:Chemokines; D024243:HMGB1 Protein