Surgical stress: Difference between revisions
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Measurements of the surgical stress response can be used for evaluation of surgical techniques and comparisons of different anaesthetic protocols. Moreover they can be performed both in the intraoperative or postoperative period. |
Measurements of the surgical stress response can be used for evaluation of surgical techniques and comparisons of different anaesthetic protocols. Moreover they can be performed both in the intraoperative or postoperative period. |
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If there is a choice between different techniques for a surgical procedure, one method to evaluate and compare the surgical techniques is to subject one group of patients to one technique, and the other group of patients to another technique, after which the surgical stress response triggered by the procedure is compared. The technique with the least surgical stress response is considered the best for the patient |
If there is a choice between different techniques for a surgical procedure, one method to evaluate and compare the surgical techniques is to subject one group of patients to one technique, and the other group of patients to another technique, after which the surgical stress response triggered by the procedure is compared. The technique with the least surgical stress response is considered the best for the patient. |
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<ref>{{cite journal|last=Freeman|first=LJ|coauthors=Rahmani, EY; Al-Haddad, M; Sherman, S; Chiorean, MV; Selzer, DJ; Snyder, PW; Constable, PD|title=Comparison of pain and postoperative stress in dogs undergoing natural orifice transluminal endoscopic surgery, laparoscopic, and open oophorectomy.|journal=Gastrointestinal endoscopy|date=2010 Aug|volume=72|issue=2|pages=373-80|pmid=20537637}}</ref> <ref>{{cite book|last=Höglund|first=Odd Viking|title=A resorbable device for ligation of blood vessels : development, assessment of surgical procedures and clinical evaluation|date=2012|isbn=978-91-576-7686-3|url=http://pub.epsilon.slu.se/8589/1/odd_v_hoglund_120210..pdf}}</ref> <ref>{{cite journal|last=Höglund|first=OV|coauthors=Olsson, K; Hagman, R; Öhlund, M; Olsson, U; Lagerstedt, AS|title=Comparison of haemodynamic changes during two surgical methods for neutering female dogs.|journal=Research in veterinary science|date=2011 Aug|volume=91|issue=1|pages=159-63|pmid=20888021}}</ref> <ref>{{cite journal|last=Kataja|first=J|coauthors=Chrapek, W; Kaukinen, S; Pimenoff, G; Salenius, JP|title=Hormonal stress response and hemodynamic stability in patients undergoing endovascular vs. conventional abdominal aortic aneurysm repair.|journal=Scandinavian journal of surgery : SJS : official organ for the Finnish Surgical Society and the Scandinavian Surgical Society|date=2007|volume=96|issue=3|pages=236-42|pmid=17966750}}</ref> <ref>{{cite journal|last=Ledowski|first=T|coauthors=Bein, B; Hanss, R; Paris, A; Fudickar, W; Scholz, J; Tonner, PH|title=Neuroendocrine stress response and heart rate variability: a comparison of total intravenous versus balanced anesthesia.|journal=Anesthesia and analgesia|date=2005 Dec|volume=101|issue=6|pages=1700-5|pmid=16301244}}</ref> <ref>{{cite journal|last=Naitoh|first=T|coauthors=Garcia-Ruiz, A; Vladisavljevic, A; Matsuno, S; Gagner, M|title=Gastrointestinal transit and stress response after laparoscopic vs conventional distal pancreatectomy in the canine model.|journal=Surgical endoscopy|date=2002 Nov|volume=16|issue=11|pages=1627-30|pmid=12073003}}</ref> <ref>{{cite journal|last=Veenhof|first=AA|coauthors=Sietses, C; von Blomberg, BM; van Hoogstraten, IM; vd Pas, MH; Meijerink, WJ; vd Peet, DL; vd Tol, MP; Bonjer, HJ; Cuesta, MA|title=The surgical stress response and postoperative immune function after laparoscopic or conventional total mesorectal excision in rectal cancer: a randomized trial.|journal=International journal of colorectal disease|date=2011 Jan|volume=26|issue=1|pages=53-9|pmid=20922542}}</ref> <ref>{{cite journal|last=Yoder|first=B|coauthors=Wolf JS, Jr|title=Canine model of surgical stress response comparing standard laparoscopic, microlaparoscopic, and hand-assisted laparoscopic nephrectomy.|journal=Urology|date=2005 Mar|volume=65|issue=3|pages=600-3|pmid=15780400}}</ref> <ref>{{cite journal|last=Yoo|first=KY|coauthors=Lee, MK; Jeong, CW; Kim, SJ; Jeong, ST; Shin, MH; Lee, JK; Lee, J|title=Anaesthetic requirement and stress hormone responses in patients undergoing lumbar spine surgery: anterior vs. posterior approach.|journal=Acta anaesthesiologica Scandinavica|date=2009 Sep|volume=53|issue=8|pages=1012-7|pmid=19426236}}</ref> |
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Similarly, a group of patients can be subjected to a surgical procedure where one anaesthetic protocol is used, and another group of patients are subjected to the same surgical procedure but with a different anaesthetic protocol. The anaesthetic protocol that yields the least stress response is considered the most suitable for that surgical procedure (Crozier et al., 1994; Goldmann et al., 2008; Ledowski et al., 2005; Väisänen et al., 2002). |
Similarly, a group of patients can be subjected to a surgical procedure where one anaesthetic protocol is used, and another group of patients are subjected to the same surgical procedure but with a different anaesthetic protocol. The anaesthetic protocol that yields the least stress response is considered the most suitable for that surgical procedure (Crozier et al., 1994; Goldmann et al., 2008; Ledowski et al., 2005; Väisänen et al., 2002). |
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Surgical stress
Surgery causes a stress response referred to as surgical stress. It is described as the systemic response to surgical injury and is characterized by activation of the sympathetic nervous system, endocrine responses as well as immunological and haematological changes. [1] [2] [3]
Measurements of the surgical stress response can be used for evaluation of surgical techniques and comparisons of different anaesthetic protocols. Moreover they can be performed both in the intraoperative or postoperative period. If there is a choice between different techniques for a surgical procedure, one method to evaluate and compare the surgical techniques is to subject one group of patients to one technique, and the other group of patients to another technique, after which the surgical stress response triggered by the procedure is compared. The technique with the least surgical stress response is considered the best for the patient. [4] [5] [6] [7] [8] [9] [10] [11] [12]
Similarly, a group of patients can be subjected to a surgical procedure where one anaesthetic protocol is used, and another group of patients are subjected to the same surgical procedure but with a different anaesthetic protocol. The anaesthetic protocol that yields the least stress response is considered the most suitable for that surgical procedure (Crozier et al., 1994; Goldmann et al., 2008; Ledowski et al., 2005; Väisänen et al., 2002).
Methods
Examples of used parameters are blood pressure, heart rate, heart rate variability, photoplethysmography and skin conductance. Essentially, physiologic parameters are measured in order to assess sympathetic tone as a surrogate measure of stress. Examples of commonly used biomarkers are adrenalin, cortisol, interleukins, noradrenalin and vasopressin.
History
Loss of nitrogen (urea) was observed in fracture patients by Cuthbertson. The reason for the patients’ catabolic response was not understood at the time, but later attention was turned to the stress reaction caused by the surgery (Cuthbertson, 1930; Wilmore, 2002). The evolutionary background is believed to be that a wounded animal increases its chance of survival by using stored energy reserves. The stress reaction thus initiates a catabolic state by an increased release of catabolic hormones. Additionally immunosuppressive hormones are also released. In a surgery patient, the stress reaction is considered detrimental for wound healing. Today, development of new surgical techniques and anaesthetic protocols aim to minimise the surgical stress reaction.
References
- ^ Desborough, JP (2000 Jul). "The stress response to trauma and surgery". British journal of anaesthesia. 85 (1): 109–17. PMID 10927999.
{{cite journal}}: Check date values in:|date=(help) - ^ Giannoudis, PV (2006 Dec). "Surgical stress response". Injury. 37 Suppl 5: S3-9. PMID 17338909.
{{cite journal}}: Check date values in:|date=(help); Unknown parameter|coauthors=ignored (|author=suggested) (help) - ^ Weissman, C (1990 Aug). "The metabolic response to stress: an overview and update". Anesthesiology. 73 (2): 308–27. PMID 2200312.
{{cite journal}}: Check date values in:|date=(help) - ^ Freeman, LJ (2010 Aug). "Comparison of pain and postoperative stress in dogs undergoing natural orifice transluminal endoscopic surgery, laparoscopic, and open oophorectomy". Gastrointestinal endoscopy. 72 (2): 373–80. PMID 20537637.
{{cite journal}}: Check date values in:|date=(help); Unknown parameter|coauthors=ignored (|author=suggested) (help) - ^ Höglund, Odd Viking (2012). A resorbable device for ligation of blood vessels : development, assessment of surgical procedures and clinical evaluation (PDF). ISBN 978-91-576-7686-3.
- ^ Höglund, OV (2011 Aug). "Comparison of haemodynamic changes during two surgical methods for neutering female dogs". Research in veterinary science. 91 (1): 159–63. PMID 20888021.
{{cite journal}}: Check date values in:|date=(help); Unknown parameter|coauthors=ignored (|author=suggested) (help) - ^ Kataja, J (2007). "Hormonal stress response and hemodynamic stability in patients undergoing endovascular vs. conventional abdominal aortic aneurysm repair". Scandinavian journal of surgery : SJS : official organ for the Finnish Surgical Society and the Scandinavian Surgical Society. 96 (3): 236–42. PMID 17966750.
{{cite journal}}: Unknown parameter|coauthors=ignored (|author=suggested) (help) - ^ Ledowski, T (2005 Dec). "Neuroendocrine stress response and heart rate variability: a comparison of total intravenous versus balanced anesthesia". Anesthesia and analgesia. 101 (6): 1700–5. PMID 16301244.
{{cite journal}}: Check date values in:|date=(help); Unknown parameter|coauthors=ignored (|author=suggested) (help) - ^ Naitoh, T (2002 Nov). "Gastrointestinal transit and stress response after laparoscopic vs conventional distal pancreatectomy in the canine model". Surgical endoscopy. 16 (11): 1627–30. PMID 12073003.
{{cite journal}}: Check date values in:|date=(help); Unknown parameter|coauthors=ignored (|author=suggested) (help) - ^ Veenhof, AA (2011 Jan). "The surgical stress response and postoperative immune function after laparoscopic or conventional total mesorectal excision in rectal cancer: a randomized trial". International journal of colorectal disease. 26 (1): 53–9. PMID 20922542.
{{cite journal}}: Check date values in:|date=(help); Unknown parameter|coauthors=ignored (|author=suggested) (help) - ^ Yoder, B (2005 Mar). "Canine model of surgical stress response comparing standard laparoscopic, microlaparoscopic, and hand-assisted laparoscopic nephrectomy". Urology. 65 (3): 600–3. PMID 15780400.
{{cite journal}}: Check date values in:|date=(help); Unknown parameter|coauthors=ignored (|author=suggested) (help) - ^ Yoo, KY (2009 Sep). "Anaesthetic requirement and stress hormone responses in patients undergoing lumbar spine surgery: anterior vs. posterior approach". Acta anaesthesiologica Scandinavica. 53 (8): 1012–7. PMID 19426236.
{{cite journal}}: Check date values in:|date=(help); Unknown parameter|coauthors=ignored (|author=suggested) (help)