ABSTRACT
Major surgery leads to an activation of inflammatory and endocrine responses resulting in catabolism, immunosuppression, and adverse physiological effects in various organ systems. In addition, hypothermia, opioid administration, immobilization, and semistarvation may amplify the negative effects of the stress responses on perioperative organ physiology. Currently available options to modify the stress response activation per se are epidural local anesthetics, minimally invasive surgery, and a single high-dose glucocorticoid. Recent studies indicate that the stress-induced perioperative impairment in various organ functions may be profoundly reduced by multimodal rehabilitation programs aiming to control perioperative pathophysiology and thereby improve recovery.
KEYWORDS
Surgical stress - postoperative complications - postoperative analgesia - minimally invasive surgery
