Surgical stress

Surgical stress is 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] Measurement of surgical stress is used in anaesthesia, physiology and surgery.

Analysis 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][13]

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.[14][15][16][17][18][19][20]

It is generally considered or hypothesized that a more invasive surgery, with extensive tissue trauma and noxious stimuli, triggers a more significant stress response.[21][22][23][24][25]

However, duration of surgery may affect the stress response which therefore may make comparisons of procedures that differ in time difficult.[26]

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. Intraoperative neurophysiological monitoring can also be used. Examples of commonly used biomarkers are adrenalin, cortisol, interleukins, noradrenalin and vasopressin.[27][28]

History

Loss of nitrogen (urea) was observed already in the 1930s in fracture patients by the Scottish physician David 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.[29][30] 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. However, surgical stress reduced mortality from endotoxin shock.[31] Today, development of new surgical techniques and anaesthetic protocols aim to minimise the surgical stress reaction.

References

  1. ↑ Desborough, JP (Jul 2000). "The stress response to trauma and surgery.". British journal of anaesthesia. 85 (1): 109–17. doi:10.1093/bja/85.1.109. PMID 10927999.
  2. ↑ Giannoudis, PV; Dinopoulos, H; Chalidis, B; Hall, GM (Dec 2006). "Surgical stress response.". Injury. 37 Suppl 5: S3–9. doi:10.1016/S0020-1383(07)70005-0. PMID 17338909.
  3. ↑ Weissman, C (Aug 1990). "The metabolic response to stress: an overview and update.". Anesthesiology. 73 (2): 308–27. doi:10.1097/00000542-199008000-00020. PMID 2200312.
  4. ↑ Freeman, LJ; Rahmani, EY; Al-Haddad, M; Sherman, S; Chiorean, MV; Selzer, DJ; Snyder, PW; Constable, PD (Aug 2010). "Comparison of pain and postoperative stress in dogs undergoing natural orifice transluminal endoscopic surgery, laparoscopic, and open oophorectomy.". Gastrointestinal endoscopy. 72 (2): 373–80. doi:10.1016/j.gie.2010.01.066. PMID 20537637.
  5. ↑ 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.
  6. ↑ Höglund, OV; Olsson, K; Hagman, R; Öhlund, M; Olsson, U; Lagerstedt, AS (Aug 2011). "Comparison of haemodynamic changes during two surgical methods for neutering female dogs.". Research in veterinary science. 91 (1): 159–63. doi:10.1016/j.rvsc.2010.08.013. PMID 20888021.
  7. ↑ Kataja, J; Chrapek, W; Kaukinen, S; Pimenoff, G; Salenius, JP (2007). "Hormonal stress response and hemodynamic stability in patients undergoing endovascular vs. conventional abdominal aortic aneurysm repair.". Scandinavian Journal of Surgery. 96 (3): 236–42. PMID 17966750.
  8. ↑ Ledowski, T; Bein, B; Hanss, R; Paris, A; Fudickar, W; Scholz, J; Tonner, PH (Dec 2005). "Neuroendocrine stress response and heart rate variability: a comparison of total intravenous versus balanced anesthesia.". Anesthesia and Analgesia. 101 (6): 1700–5. doi:10.1213/01.ane.0000184041.32175.14. PMID 16301244.
  9. ↑ Naitoh, T; Garcia-Ruiz, A; Vladisavljevic, A; Matsuno, S; Gagner, M (Nov 2002). "Gastrointestinal transit and stress response after laparoscopic vs conventional distal pancreatectomy in the canine model.". Surgical endoscopy. 16 (11): 1627–30. doi:10.1007/s00464-002-0007-0. PMID 12073003.
  10. ↑ Veenhof, AA; Sietses, C; von Blomberg, BM; van Hoogstraten, IM; vd Pas, MH; Meijerink, WJ; vd Peet, DL; vd Tol, MP; Bonjer, HJ; Cuesta, MA (Jan 2011). "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. doi:10.1007/s00384-010-1056-9. PMC 3015173Freely accessible. PMID 20922542.
  11. ↑ Yoder, B; Wolf JS, Jr (Mar 2005). "Canine model of surgical stress response comparing standard laparoscopic, microlaparoscopic, and hand-assisted laparoscopic nephrectomy.". Urology. 65 (3): 600–3. doi:10.1016/j.urology.2004.10.021. PMID 15780400.
  12. ↑ Yoo, KY; Lee, MK; Jeong, CW; Kim, SJ; Jeong, ST; Shin, MH; Lee, JK; Lee, J (Sep 2009). "Anaesthetic requirement and stress hormone responses in patients undergoing lumbar spine surgery: anterior vs. posterior approach.". Acta anaesthesiologica Scandinavica. 53 (8): 1012–7. doi:10.1111/j.1399-6576.2009.01993.x. PMID 19426236.
  13. ↑ Tallant, A; Ambros, B; Freire, C; Sakals, S (July 2016). "Comparison of intraoperative and postoperative pain during canine ovariohysterectomy and ovariectomy". The Canadian veterinary journal (La revue veterinaire canadienne). 57 (7): 741–6. PMID 27429462.
  14. ↑ Crozier, TA; Müller, JE; Quittkat, D; Sydow, M; Wuttke, W; Kettler, D (Sep 1994). "[Total intravenous anesthesia with methohexital-alfentanil or propofol-alfentanil in hypogastric laparotomy. Clinical aspects and the effects of stress reaction].". Der Anaesthesist. 43 (9): 594–604. PMID 7978186.
  15. ↑ Goldmann, A; Hoehne, C; Fritz, GA; Unger, J; Ahlers, O; Nachtigall, I; Boemke, W (Sep 2008). "Combined vs. Isoflurane/Fentanyl anesthesia for major abdominal surgery: Effects on hormones and hemodynamics.". Medical science monitor : international medical journal of experimental and clinical research. 14 (9): CR445–52. PMID 18758414.
  16. ↑ Ledowski, T; Bein, B; Hanss, R; Paris, A; Fudickar, W; Scholz, J; Tonner, PH (Dec 2005). "Neuroendocrine stress response and heart rate variability: a comparison of total intravenous versus balanced anesthesia.". Anesthesia and Analgesia. 101 (6): 1700–5. doi:10.1213/01.ane.0000184041.32175.14. PMID 16301244.
  17. ↑ Väisänen, M; Raekallio, M; Kuusela, E; Huttunen, P; Leppäluoto, J; Kirves, P; Vainio, O (Jul 2002). "Evaluation of the perioperative stress response in dogs administered medetomidine or acepromazine as part of the preanesthetic medication.". American journal of veterinary research. 63 (7): 969–75. doi:10.2460/ajvr.2002.63.969. PMID 12118677.
  18. ↑ Moldal, ER; Eriksen, T; Kirpensteijn, J; Nødtvedt, A; Kristensen, AT; Sparta, FM; Haga, HA (Jan 2013). "Intratesticular and subcutaneous lidocaine alters the intraoperative haemodynamic responses and heart rate variability in male cats undergoing castration.". Veterinary anaesthesia and analgesia. 40 (1): 63–73. doi:10.1111/j.1467-2995.2012.00773.x. PMID 23033908.
  19. ↑ Väisänen, Misse (2006). Perioperative stress in dogs : different aspects of manifestation and characteristics with medetomidine and acepromazine preanaesthetic medication (PDF). Helsinki: University Printing House, Helsinki, Finland. ISBN 952-10-2975-7.
  20. ↑ Joris, JL; Chiche, JD; Canivet, JL; Jacquet, NJ; Legros, JJ; Lamy, ML (Nov 1998). "Hemodynamic changes induced by laparoscopy and their endocrine correlates: effects of clonidine.". Journal of the American College of Cardiology. 32 (5): 1389–96. doi:10.1016/s0735-1097(98)00406-9. PMID 9809953.
  21. ↑ Kjelgaard-Hansen, M; Strom, H; Mikkelsen, LF; Eriksen, T; Jensen, AL; Luntang-Jensen, M (September 2013). "Canine serum C-reactive protein as a quantitative marker of the inflammatory stimulus of aseptic elective soft tissue surgery.". Veterinary clinical pathology / American Society for Veterinary Clinical Pathology. 42 (3): 342–5. doi:10.1111/vcp.12063. PMID 23899087.
  22. ↑ Horta, RS; Figueiredo, MS; Lavalle, GE; Costa, MP; Cunha, RM; Araújo, RB (24 June 2015). "Surgical stress and postoperative complications related to regional and radical mastectomy in dogs.". Acta veterinaria Scandinavica. 57: 34. doi:10.1186/s13028-015-0121-3. PMID 26104069.
  23. ↑ Marana, E; Scambia, G; Maussier, ML; Parpaglioni, R; Ferrandina, G; Meo, F; Sciarra, M; Marana, R (May 2003). "Neuroendocrine stress response in patients undergoing benign ovarian cyst surgery by laparoscopy, minilaparotomy, and laparotomy.". The Journal of the American Association of Gynecologic Laparoscopists. 10 (2): 159–65. doi:10.1016/s1074-3804(05)60291-5. PMID 12732764.
  24. ↑ Holzer-Petsche, U; Brodacz, B (March 1999). "Traction on the mesentery as a model of visceral nociception.". Pain. 80 (1-2): 319–28. doi:10.1016/s0304-3959(98)00233-4. PMID 10204745.
  25. ↑ Chernow, B; Alexander, HR; Smallridge, RC; Thompson, WR; Cook, D; Beardsley, D; Fink, MP; Lake, CR; Fletcher, JR (July 1987). "Hormonal responses to graded surgical stress.". Archives of Internal Medicine. 147 (7): 1273–8. doi:10.1001/archinte.147.7.1273. PMID 3606284.
  26. ↑ Yoder, B; Wolf JS, Jr (March 2005). "Canine model of surgical stress response comparing standard laparoscopic, microlaparoscopic, and hand-assisted laparoscopic nephrectomy.". Urology. 65 (3): 600–3. doi:10.1016/j.urology.2004.10.021. PMID 15780400.
  27. ↑ Höglund, OV; Hagman, R; Olsson, K; Olsson, U; Lagerstedt, AS (Aug 8, 2014). "Intraoperative Changes in Blood Pressure, Heart Rate, Plasma Vasopressin, and Urinary Noradrenalin During Elective Ovariohysterectomy in Dogs: Repeatability at Removal of the 1st and 2nd Ovary.". Veterinary surgery : VS. 43: 852–9. doi:10.1111/j.1532-950X.2014.12264.x. PMID 25130060.
  28. ↑ Joris, JL; Chiche, JD; Canivet, JL; Jacquet, NJ; Legros, JJ; Lamy, ML (November 1998). "Hemodynamic changes induced by laparoscopy and their endocrine correlates: effects of clonidine.". Journal of the American College of Cardiology. 32 (5): 1389–96. doi:10.1016/s0735-1097(98)00406-9. PMID 9809953.
  29. ↑ Cuthbertson, DP (1930). "The disturbance of metabolism produced by bony and non-bony injury, with notes on certain abnormal conditions of bone.". The Biochemical Journal. 24 (4): 1244–63. doi:10.1042/bj0241244. PMC 1254622Freely accessible. PMID 16744448.
  30. ↑ Wilmore, DW (Nov 2002). "From Cuthbertson to fast-track surgery: 70 years of progress in reducing stress in surgical patients.". Annals of Surgery. 236 (5): 643–8. doi:10.1097/01.SLA.0000032942.79841.ED. PMC 1422623Freely accessible. PMID 12409671.
  31. ↑ Kamei, K; Nimura, Y; Nagino, M; Aono, K; Nakashima, I (January 2002). "Surgical stress reduces mortality from endotoxin shock.". Langenbeck's archives of surgery / Deutsche Gesellschaft fur Chirurgie. 386 (7): 512–7. doi:10.1007/s00423-001-0261-y. PMID 11819109.
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