British Journal of Anaesthesia, Vol 78, Issue 5 606-617, Copyright © 1997 by The Board of Management and Trustees of the British Journal of Anaesthesia
H. Kehlet
Major surgery is still associated with undesirable sequelae such as pain,
cardiopulmonary, infective and thromboembolic complications, cerebral
dysfunction, nausea and gastrointestinal paralysis, fatigue and prolonged
convalescence. The key pathogenic factor in postoperative morbidity,
excluding failures of surgical and anaesthetic technique, is the surgical
stress response with subsequent increased demands on organ function. These
changes in organ function are thought to be mediated by trauma-induced
endocrine metabolic changes and activation of several biological cascade
systems (cytokines, complement, arachidonic acid metabolites, nitric oxide,
free oxygen radicals, etc). To understand postoperative morbidity it is
therefore necessary to understand the pathophysiological role of the
various components of the surgical stress response and to determine if
modification of such responses may improve surgical outcome. While no
single technique or drug regimen has been shown to eliminate postoperative
morbidity and mortality, multimodal interventions may lead to a major
reduction in the undesirable sequelae of surgical injury with improved
recovery and reduction in postoperative morbidity and overall costs.
COMMENTARIES
Multimodal approach to control postoperative pathophysiology and rehabilitation
Department of Surgical Gastroenterology, Hvidovre University Hospital, DK-2650 Hvidovre, Denmark
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