Biology:Surgical stress

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Short description: Systemic response to surgical injury

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][4][5] 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 responses triggered by the procedures are compared. Absent any other difference, the technique with the least surgical stress response is considered the best for the patient.[6][7][8][9][10][11][12][13][14][15][16][excessive citations]

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.[17][18][19][20][21][22][23][24][25][26][27][28][29][excessive citations]

It is generally considered or hypothesized that a more invasive surgery, with extensive tissue trauma and noxious stimuli, triggers a more significant stress response.[30][31][32][33][34][35]

However, duration of surgery may affect the stress response which therefore may make comparisons of procedures that differ in time difficult.[36]

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 adrenaline, cortisol, interleukins, noradrenaline and vasopressin.[37][38]

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.[39][40] 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.[41] Today, development of new surgical techniques and anaesthetic protocols aim to minimise the surgical stress reaction.[42][43]

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. ↑ Finnerty, Celeste C.; Mabvuure, Nigel Tapiwa; Ali, Arham; Kozar, Rosemary A.; Herndon, David N. (September 2013). "The Surgically Induced Stress Response". Journal of Parenteral and Enteral Nutrition 37 (5_suppl): 21S–29S. doi:10.1177/0148607113496117. PMID 24009246. 
  5. ↑ Hernández-Avalos, I.; Flores-Gasca, E.; Mota-Rojas, D.; Casas-Alvarado, A.; Miranda-Cortés, A. E.; Domínguez-Oliva, A. (11 February 2021). "Neurobiology of anesthetic-surgical stress and induced behavioral changes in dogs and cats: A review". Veterinary World 14 (2): 393–404. doi:10.14202/vetworld.2021.393-404. ISSN 0972-8988. PMID 33776304. PMC 7994130. http://www.veterinaryworld.org/Vol.14/February-2021/10.pdf. 
  6. ↑ 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. 
  7. ↑ 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. 
  8. ↑ 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. doi:10.1177/145749690709600309. PMID 17966750. 
  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 et al. (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. 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 57 (7): 741–6. PMID 27429462. 
  14. ↑ Krikri, A; Alexopoulos, V; Zoumakis, E; Katsaronis, P; Balafas, E; Kouraklis, G; Karayannacos, PE; Chrousos, GP et al. (2013). "Laparoscopic vs. open abdominal surgery in male pigs: marked differences in cortisol and catecholamine response depending on the size of surgical incision.". Hormones 12 (2): 283–91. doi:10.14310/horm.2002.1412. PMID 23933697. 
  15. ↑ Shivley, Jacob M.; Richardson, Jodi M.; Woodruff, Kimberly A.; Brookshire, Wilson C.; Meyer, Robert E.; Smith, David R. (28 October 2018). "Sharp transection of the suspensory ligament as an alternative to digital strumming during canine ovariohysterectomy". Veterinary Surgery 48 (2): 216–221. doi:10.1111/vsu.13121. PMID 30370635. 
  16. ↑ Del Romero, Ayla; Cuervo, Belén; Peláez, Pau; Miguel, Laura; Torres, Marta; Yeste, Marc; Rivera del Alamo, Maria Montserrat; Rubio, Camila P. et al. (27 November 2020). "Changes in Acute Phase Proteins in Bitches after Laparoscopic, Midline, and Flank Ovariectomy Using the Same Method for Hemostasis". Animals 10 (12): 2223. doi:10.3390/ani10122223. PMID 33260846. 
  17. ↑ 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. doi:10.1007/s001010050098. PMID 7978186. 
  18. ↑ 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 14 (9): CR445–52. PMID 18758414. 
  19. ↑ 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. 
  20. ↑ 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. 
  21. ↑ 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. 
  22. ↑ Väisänen, Misse (2006). Perioperative stress in dogs : different aspects of manifestation and characteristics with medetomidine and acepromazine preanaesthetic medication. Helsinki: University Printing House, Helsinki, Finland. ISBN 978-952-10-2975-2. http://ethesis.helsinki.fi/julkaisut/ela/kliin/vk/vaisanen/perioper.pdf. 
  23. ↑ 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. 
  24. ↑ Kaka, Ubedullah; Rahman, Nor-Alimah; Abubakar, Adamu Abdul; Goh, Yong Meng; Fakurazi, Sharida; Omar, Mohamed Ariff; Chen, Hui Cheng (April 2018). "Pre-emptive multimodal analgesia with tramadol and ketamine–lidocaine infusion for suppression of central sensitization in a dog model of ovariohysterectomy" (in English). Journal of Pain Research 11: 743–752. doi:10.2147/JPR.S152475. ISSN 1178-7090. PMID 29695926. 
  25. ↑ Fizzano, Kristen M.; Claude, Andrew K.; Kuo, Lan-Hsin; Eells, Jeffrey B.; Hinz, Simone B.; Thames, Brittany E.; Ross, Matthew K.; Linford, Robert L. et al. (September 2017). "Evaluation of a modified infraorbital approach for a maxillary nerve block for rhinoscopy with nasal biopsy of dogs". American Journal of Veterinary Research 78 (9): 1025–1035. doi:10.2460/ajvr.78.9.1025. PMID 28836847. http://sun.library.msstate.edu/ETD-db/theses/available/etd-06222017-095553/. 
  26. ↑ Sández, I; Soto, M; Torralbo, D; Rioja, E (April 2018). "Effect of different analgesic techniques on hemodynamic variables recorded with an esophageal Doppler monitor during ovariohysterectomy in dogs.". The Canadian Veterinary Journal 59 (4): 419–424. PMID 29606730. 
  27. ↑ Kropf, Josephine; Hughes, J.M. Lynne (17 December 2018). "Effects of midazolam on cardiovascular responses and isoflurane requirement during elective ovariohysterectomy in dogs". Irish Veterinary Journal 71 (1): 26. doi:10.1186/s13620-018-0136-y. PMID 30568789. 
  28. ↑ Cicirelli, V; Lacalandra, GM; Aiudi, GG (14 October 2021). "The effect of splash block on the need for analgesia in dogs subjected to video-assisted ovariectomy.". Veterinary Medicine and Science 8 (1): 104–109. doi:10.1002/vms3.637. PMID 34647415. PMC 8788979. https://doi.org/10.1002/vms3.637. 
  29. ↑ Ledowski, Thomas; Bein, Berthold; Hanss, Robert; Paris, Andrea; Fudickar, Wolfgang; Scholz, Jens; Tonner, Peter H. (December 2005). "Neuroendocrine Stress Response and Heart Rate Variability: A Comparison of Total Intravenous Versus Balanced Anesthesia". Anesthesia & Analgesia 101 (6): 1700–1705. doi:10.1213/01.ane.0000184041.32175.14. PMID 16301244. 
  30. ↑ 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 42 (3): 342–5. doi:10.1111/vcp.12063. PMID 23899087. 
  31. ↑ 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 (1): 34. doi:10.1186/s13028-015-0121-3. PMID 26104069. 
  32. ↑ 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. 
  33. ↑ 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. 
  34. ↑ Chernow, B; Alexander, HR; Smallridge, RC; Thompson, WR; Cook, D; Beardsley, D; Fink, MP; Lake, CR et al. (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. 
  35. ↑ JACOBSEN, STINE; NIELSEN, JON VEDDING; KJELGAARD-HANSEN, MADS; TOELBOELL, TRINE; FJELDBORG, JULIE; HALLING-THOMSEN, MAJ; MARTINUSSEN, TORBEN; THOEFNER, MARTIN BANG (August 2009). "Acute Phase Response to Surgery of Varying Intensity in Horses: A Preliminary Study". Veterinary Surgery 38 (6): 762–769. doi:10.1111/j.1532-950X.2009.00564.x. PMID 19674420. 
  36. ↑ 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. 
  37. ↑ 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 43 (7): 852–9. doi:10.1111/j.1532-950X.2014.12264.x. PMID 25130060. 
  38. ↑ 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. 
  39. ↑ 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. PMID 16744448. 
  40. ↑ 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:10.1097/00000658-200211000-00015. PMID 12409671. 
  41. ↑ Kamei, K; Nimura, Y; Nagino, M; Aono, K; Nakashima, I (January 2002). "Surgical stress reduces mortality from endotoxin shock". Langenbeck's Archives of Surgery 386 (7): 512–7. doi:10.1007/s00423-001-0261-y. PMID 11819109. 
  42. ↑ Kehlet, H (December 1991). "The surgical stress response: should it be prevented?". Canadian Journal of Surgery. Journal Canadien de Chirurgie 34 (6): 565–7. PMID 1747833. 
  43. ↑ Kehlet, H (May 1997). "Multimodal approach to control postoperative pathophysiology and rehabilitation". British Journal of Anaesthesia 78 (5): 606–617. doi:10.1093/bja/78.5.606. PMID 9175983. 



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