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Continuing Education in Anaesthesia, Critical Care & Pain 2004 4(5):144-147; doi:10.1093/bjaceaccp/mkh040
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Continuing Education in Anaesthesia, Critical Care & Pain | Volume 4 Number 5 2004 © The Board of Management and Trustees of the British Journal of Anaesthesia 2004

Endocrine and metabolic response to surgery

Deborah Burton, FRCA, Lecturer in Anaesthesia
Department of Anaesthesia, St George's Hospital Medical School, London, SW17 0RE

Grainne Nicholson, MB BCh BAO FFARCSI, Senior Lecturer in Anaesthesia
Department of Anaesthesia, St George's Hospital Medical School, London, SW17 0RE

George Hall, MBBS PhD DSc FRCA, Professor of Anaesthesia
Department of Anaesthesia, St George's Hospital Medical School, London, SW17 0RE
Tel: 020 8725 2615, Fax: 020 8725 0256, E-mail: gnichols{at}sghms.ac.uk (for correspondence)

The neuroendocrine, metabolic and inflammatory aspects of injury are part of the overall ‘stress response’ (Table 1). This has been studied most commonly in relation to surgery, because the catabolic changes that occur can be observed from a well-defined starting point, but similar features occur in trauma, burns, severe infection and strenuous exercise. These result in substrate mobilization, muscle protein loss and sodium and water retention, with suppression of anabolic hormone secretion. There is activation of the sympathetic nervous system and immunological and haematological changes. Generally, the magnitude of the metabolic response is proportional to the severity of the surgical trauma. These changes have probably evolved to aid survival in a more primitive environment, by mobilizing substrates, limiting tissue damage, destroying infectious organisms and activating repair processes. Psychological and behavioural changes accompany the physiological events. The benefits of the stress response are not obvious in modern medicine, when physiological changes can be more easily corrected and it may even have a detrimental effect. In recent years, research has focused on methods to modify the response associated with surgery in an attempt to improve patient outcome.


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  		Table 1 Changes occurring during the stress response

 

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