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Erschienen in:

01.05.2019 | Other Pain (A Kaye and N Vadivelu, Section Editors)

Metabolic and the Surgical Stress Response Considerations to Improve Postoperative Recovery

verfasst von: Erik M. Helander, Michael P. Webb, Bethany Menard, Amit Prabhakar, John Helmstetter, Elyse M. Cornett, Richard D. Urman, Viet H. Nguyen, Alan David Kaye

Erschienen in: Current Pain and Headache Reports | Ausgabe 5/2019

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Abstract

Purpose of Review

Enhanced recovery pathways are a multimodal, multidisciplinary approach to patient care that aims to reduce the surgical stress response and maintain organ function resulting in faster recovery and improved outcomes.

Recent Findings

A PubMed literature search was performed for articles that included the terms of metabolic surgical stress response considerations to improve postoperative recovery. The surgical stress response occurs due to direct and indirect injuries during surgery. Direct surgical injury can result from the dissection, retraction, resection, and/or manipulation of tissues, while indirect injury is secondary to events including hypotension, blood loss, and microvascular changes. Greater degrees of tissue injury will lead to higher levels of inflammatory mediator and cytokine release, which ultimately drives immunologic, metabolic, and hormonal processes in the body resulting in the stress response. These processes lead to altered glucose metabolism, protein catabolism, and hormonal dysregulation among other things, all which can impede recovery and increase morbidity. Fluid therapy has a direct effect on intravascular volume and cardiac output with a resultant effect on oxygen and nutrient delivery, so a balance must be maintained without excessively loading the patient with water and salt. All in all, attenuation of the surgical stress response and maintaining organ and thus whole-body homeostasis through enhanced recovery protocols can speed recovery and reduce complications.

Summary

The present investigation summarizes the clinical application of enhanced recovery pathways, and we will highlight the key elements that characterize the metabolic surgical stress response and improved postoperative recovery.

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Titel: Metabolic and the Surgical Stress Response Considerations to Improve Postoperative Recovery
verfasst von: Erik M. Helander
Michael P. Webb
Bethany Menard
Amit Prabhakar
John Helmstetter
Elyse M. Cornett
Richard D. Urman
Viet H. Nguyen
Alan David Kaye
Publikationsdatum: 01.05.2019
Verlag: Springer US
Erschienen in: Current Pain and Headache Reports / Ausgabe 5/2019
Print ISSN: 1531-3433
Elektronische ISSN: 1534-3081
DOI: https://doi.org/10.1007/s11916-019-0770-4

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Metabolic and the Surgical Stress Response Considerations to Improve Postoperative Recovery