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]
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]
^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.
PMID20537637.
^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.
PMID20888021.
^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.
PMID17966750.
S2CID43913306.
^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.
PMID12073003.
S2CID26440980.
^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.
PMID15780400.
^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.
PMID30370635.
S2CID53098012.
^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.
PMID7978186.
S2CID38923309.
^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.
PMID18758414.
^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.
PMID12732764.
^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.
PMID3606284.
^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.
PMID19674420.
^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.
PMID15780400.
^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.
PMID25130060.
^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.
PMID11819109.
S2CID1739773.
^Kehlet, H (December 1991). "The surgical stress response: should it be prevented?". Canadian Journal of Surgery. Journal Canadien de Chirurgie. 34 (6): 565–7.
PMID1747833.
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]
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]
^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.
PMID20537637.
^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.
PMID20888021.
^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.
PMID17966750.
S2CID43913306.
^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.
PMID12073003.
S2CID26440980.
^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.
PMID15780400.
^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.
PMID30370635.
S2CID53098012.
^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.
PMID7978186.
S2CID38923309.
^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.
PMID18758414.
^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.
PMID12732764.
^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.
PMID3606284.
^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.
PMID19674420.
^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.
PMID15780400.
^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.
PMID25130060.
^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.
PMID11819109.
S2CID1739773.
^Kehlet, H (December 1991). "The surgical stress response: should it be prevented?". Canadian Journal of Surgery. Journal Canadien de Chirurgie. 34 (6): 565–7.
PMID1747833.