Stress Response to Surgery and Possible Ways of Its Correction

Ivanovs, Igors; Mihelsons, Māris; Boka, Viesturs

doi:10.2478/v10046-012-0014-z

Abstract

The stress response to surgery has two main systemic effects in an organism: neuroendocrine and haemato-immunological. Neuroendocrine effects are induced by changes in the hypothalamic- pituitary-adrenal axis and the sympathetic-adrenal-medullary axis. Haematoimmunological effects are characterised by cytokine production, acute phase reaction and lymphocyte and neutrophil proliferation. All of these responses interact closely. Prolongation of the stress response can increase morbidity and worsen postoperative outcome. Surgical stress can be affected by preoperative, perioperative and postoperative factors. In this paper, we review the main neuroendocrine and haemato-immunological changes related to stress and discuss different possible approaches to minimise the stress response to surgery

References

Ahonen, J., Jokela, R., Uutela, K., Huiku, M. (2007). Surgical stress index reflects surgical stress in gynaecological laparoscopic day-case surgery. Brit. J. Anaesth., 98 (4), 456-461.10.1093/bja/aem03517350969
Search in Google Scholar
Alvarez-Olmos, M., Oberhelman, R. (2001). Probiotic agents and infectious diseases: A modern perspective on a traditional therapy. Clin. Infect. Dis., 32, 1567-1576.10.1086/32051811340528
Search in Google Scholar
Anonymous (1998). Effect of intensive blood-glucose control with sulphonylureas or insulin compared with conventional treatment and risks of complications in patients with type 2 diabetes. UKPDS group. Lancet, 352, 837-853.
Search in Google Scholar
Bagry, H., de la Cuadra Fontaine, J. C., Asenjo, J. F., Bracco, D., Carli, F. (2008). Effect of a continuous peripheral nerve block on the inflammatory response in knee arthroplasty. Reg. Anest. Pain Med., 33 (1), 17-23.10.1097/00115550-200801000-00004
Search in Google Scholar
Barczynski, M., Konturek, A., Herman, R. M. (2006). Superiority of preemptive analgesia with intraperitoneal instillation of bupivacaine before rather than after the creation of pneumoperitoneum for laparoscopic cholecystectomy: A randomized, double-blind, placebo-controlled study. Surg. Endoscopy, 20 (7), 1088-1093.10.1007/s00464-005-0458-116703434
Search in Google Scholar
Bengmark, S. (2006). Bioecological control of inflammation and infection in critical illness. Anest. Clin. North Amer., 24, 325-337.10.1016/j.atc.2006.01.00216927931
Search in Google Scholar
Benschop, R. J., Rodriguez-Feuerhahn, M. (1996). Catecholamine induced leukocytosis: Early observations, current research, and future directions. Brain Behav. Immun., 10, 77-91.10.1006/brbi.1996.00098811932
Search in Google Scholar
Borgdorff P. J., Ionescu, T. I., Houweling, P. L., Knape, J. T. A. (2004). Large-dose intrathecal sufentanil prevents the hormonal stress response during major abdominal surgery: A comparison with intravenous sufentanil in a prospective randomized trial. Anesth. Analg, 99 (4), 1114-1120.10.1213/01.ANE.0000131728.68125.4E15385360
Search in Google Scholar
Bowdle, A., Hines, R. (2002). Guest editor introduction: Pharmacology up-date 2002 seminars in anaesthesia. Perioper. Med. Pain, 11, 247-257.10.1053/sane.2002.34198
Search in Google Scholar
Brand, J.-M., Frohn, C., Luhm, J., Kirhner, H., Schmucker, P. (2003). Early alterations in the number of circulating lymphocyte subpopulation and enchanced proinflammatory immune responce during opioid-based general anaesthesia. Shock, 20 (3), 213-217.10.1097/00024382-200309000-0000312923491
Search in Google Scholar
Brunicardi, F. C. (2010). Schwartz’s Principles of Surgery. 9thed. The McGraw-Hill Companies, Inc. USA. 1866 pp.
Search in Google Scholar
Buunen, M., Gholghesaei, M., Veldkamp, R., Maijer, D. W., Bonjer, H. J., Bouvy, N. D. (2004). Stress response to laparoscopic surgery: A review. Surg. Endosc., 18 (7), 1022-1028.10.1007/s00464-003-9169-715136930
Search in Google Scholar
Chaudhary, S., Sethi, A. K., Motiani, P., Adatia, C. (2008). Pre-operative intravenous fluid therapy with crystalloids or colloids on post-operative nausea & vomiting. Indian J. Med. Res., 127, (6), 577-581.
Search in Google Scholar
Chumbley, G. M., Hall, G. M. (1997). Recovery after major surgery: Does the anaesthetic make any difference? Brit. J. Anaesth., 78, 347-348.10.1093/bja/78.4.347
Search in Google Scholar
Coderre, T. J., Katz, J., Vaccarino, A. L., Melzack, R. (1993). Contribution of central neuroplasticity to pathological pain: Review of clinical and experimental evidence. Pain, 53, 259-285.10.1016/0304-3959(93)90161-H
Search in Google Scholar
Deborah, B., Grainne, N., George, H. (2004). Endocrine and metabolic response to surgery. Contin. Educ. Anaesth. Crit. Care Pain, 4 (5), 144-147.
Search in Google Scholar
Desborough, J. P. (2000). The stress response to trauma and surgery. Brit. J. Anaesth., 85 (1), 109-117.10.1093/bja/85.1.109
Search in Google Scholar
Desborough, J. P. (1999). Physiological responses to surgery and trauma. In: Foundations of Anaesthesia (pp. 713-720). Hemmings, H. C. Jr, Hopkins, P. M. (eds.). London: Mosby.
Search in Google Scholar
Desborough, J. P., Hall, G. M. (1993). Endocrine response to surgery. In: AnaesthesiaReview. Vol. 10 (pp. 131-148). Kaufman, L. (Ed.). Edinburgh: Churchill Livingstone.
Search in Google Scholar
Dimitrov, S., Lange, T., Born, J. (2010). Selective mobilization of cytotoxic leukocytes by epinephrine. J. Immunol., 184, 503-511. Edwards, R. (1997). Thyroid and parathyroid disease. Int. Anesthesiol Clin,35, 63-83.
Search in Google Scholar
Elenkov, I. J., Chrousos, G. P. (2002). Stress hormones, proinflammatory and antiinflammatory cytokines, and autoimmunity. Ann. NY Acad. Sci., 966, 290-303.10.1111/j.1749-6632.2002.tb04229.x
Search in Google Scholar
Elenkov, I. J., Wilder, R. L., Chrousos, G. P., Vizi, E. S. (2000). The sympathetic nerve-an integrative interface between two supersystems: The brain and the immune system. Pharmacol. Rev., 52 (4), 595-638.
Search in Google Scholar
Franke, A., Lante, W., Kurig, E., Zöller, L.G., Weinhold, C., Markewitz, A. (2006). Hyporesponsiveness of T cell subsets after cardiac surgery: A product of altered cell function or merely a result of absolute cell count changes in peripheral blood? Eur. J. Cardiothorac. Surg., 30 (1), 64-71.10.1016/j.ejcts.2006.03.029
Search in Google Scholar
Freitas, M., Tavan, E., Cayuela, C., Diop, L., Sapin, C., Trugnan, G. (2003). Host-pathogens cross-talk. Indigenous bacteria and probiotics also play the game. Biol. Cell, 95, 503-506.10.1016/j.biolcel.2003.08.004
Search in Google Scholar
Golubovska, I., Vanags, I. (2008). Anaesthesia and stress response to surgery. Proc. Latv. Acad. Sci., Section B, 62 (5), 141-147.10.2478/v10046-008-0017-y
Search in Google Scholar
Gorbach, S. L. (2000). Probiotics and gastrointestinal health. Amer. J. Gastroenterol., 95 (suppl), S2- S4.10.1016/S0002-9270(99)00806-0
Search in Google Scholar
Grainne, N. (2005). Hormonal and metabolic responses to trauma. Anaest. Int. Care Med., 6 (9), 313-314.
Search in Google Scholar
Grocott, M. P., Mythen, M. G., Gan, T. J. (2005). Perioperative fluid management and clinical outcomes in adults. Anesth. Analg., 100 (4), 1093-1106.10.1213/01.ANE.0000148691.33690.AC15781528
Search in Google Scholar
Hall, G. M., Salmon, P. (2002). Physiological and psychological influences on postoperative fatigue. Anesth. Analg., 95, 1446-1450.10.1097/00000539-200211000-0006412401642
Search in Google Scholar
Hart, A. L., Lammers, K., Brigidi, P., Vitali, B., Rizzello, F., Gionchetti, P., Campieri, M., Kamm. M. A., Knight, S. C., Stagg, A. J. (2004). Modulation of human dendritic cell phenotype and function by probiotic bacteria. Gut, 53, 1602-1609.10.1136/gut.2003.037325
Search in Google Scholar
Hollmann, M. W., Durieux, M. E.,(2000). Local anaesthetics and the inflammatory response: A new therapeutic indication? Anasthesiology, 93, 858-875.10.1097/00000542-200009000-00038
Search in Google Scholar
Insler, S. R., Sessler, D. I. (2006). Perioperative thermoregulation and temperature monitoring. Anesthesiol. Clin., 24 (4), 823-837.10.1016/j.atc.2006.09.001
Search in Google Scholar
Ichikawa, H., Kuroiwa, T., Inagaki, A., Shineha, R, Nishihira, T, Satomi, S, Sakata, T. (1999). Probiotics bacteria stimulate gut epithelial cell proliferation in rat. Dig. Dis. Sci., 44 (10), 2119-2123.10.1023/A:1026647024077
Search in Google Scholar
Ivanovs, I., Pavars, A., Vetra, J., Saba, M. (2006). Probiotics use in early postoperative period after large bowel resection. Colorect. Dis. 8 (4) (suppl.), 29.
Search in Google Scholar
Jokela, R., Ahonen, J., Valijus, M., Seppälä, T., Korttila, K. (2007). Premedication with controlled-release oxycodone does not improve management of postoperative pain after day-case gynaecological laparoscopic surgery. Brit. J. Anaesth., 98 (2), 255-260.10.1093/bja/ael342
Search in Google Scholar
Karabiyik, L., Sardas, S. (2001). Comparison of genotoxicity of sevoflurane and isoflurane in human lymphocytes studied in vivo using comet assay. Mutat. Res., 492, 99-107.10.1016/S1383-5718(01)00159-0
Search in Google Scholar
Kawasaki, T., Ogata, M., Kawasaki, C., Okamoto, K., T. Sata. (2007). Effects of epidural anaesthesia on surgical stress-induced immunosuppression during upper abdominal surgery. Brit. J. Anaesth., 98 (2), 196-203.10.1093/bja/ael334
Search in Google Scholar
Kehlet, H. (1997). Multimodal approach to control postoperative pathophysiology and rehabilitation. Brit. J. Anaesth., 78, 606-617.10.1093/bja/78.5.606
Search in Google Scholar
Kehlet, H. (1999). Acute pain control and accelerated postoperative surgical recovery. Surg. Clin. N. Amer., 79, 431-443.10.1016/S0039-6109(05)70390-X
Search in Google Scholar
Kitching, A. J., O’Neill, S. S. (2009). Fast-track surgery and anaesthesia. Contin. Educ. Anaesth. Crit. Care Pain, 9 (2), 39-43.10.1093/bjaceaccp/mkp006
Search in Google Scholar
Kraehenbuhl, J. P., Corbett, M. (2004). Immunology. Keeping the gut microflora at bay. Science, 303, 1624-1625.10.1126/science.109622215016988
Search in Google Scholar
Krüger, K., Mooren, F. C. (2007). T cell homing and exercise. Exerc. Imm. Rev, 13, 37-54.
Search in Google Scholar
Latterman, R., Carli, F., Wykes, L., Schricker, T. (2003) Perioperative glucose infusion and catabolic response to surgery: The effect of epidural block. Anesth. Analg., 96, 555-562.
Search in Google Scholar
Ledowski, T., Bein, B., Hanss, R., Paris, A., Fudickar, W., Scholz, J., Tonner, P. H. (2005). Neuroendocrine stress response and heart rate variability: A comparison of total intravenous versus balanced anesthesia. Anesth. Analg., 101, 1700-1705.10.1213/01.ane.0000184041.32175.1416301244
Search in Google Scholar
Lin, E., Lowry, F. S., Calvano, E. S. (1999). The systemic response to injury. In: Principles of Surgery. 7th edn. (pp. 3-53). New York: McGraw Hill.
Search in Google Scholar
Lyons, F. M., Meeran, K. (1997). The physiology of the endocrine system. Int. Anesthesiol. Clin., 35, 1-21.10.1097/00004311-199703540-000029444528
Search in Google Scholar
Macpherson, A. J., Uhr, T. (2004). Induction of protective IgA by intestinal dendritic cells carrying commensal bacteria. Science, 303, 1662-1665.10.1126/science.109133415016999
Search in Google Scholar
Maharaj, C. H., Kallam, S. R., Malik, A., Hassett, P., Grady, D., Laffey, J. G. (2005). Preoperative intravenous fluid therapy decreases postoperative nausea and pain in high risk patients. Anesth. Analg., 100 (3), 675-682.10.1213/01.ANE.0000148684.64286.3615728051
Search in Google Scholar
Manorama, S. (2003). Stress response and anaesthesia altering the peri and post-operative management. Inidan J. Anaesth., 47 (6), 427-434.
Search in Google Scholar
Marc, G. H., Timmerman, H. M., et al. (2005). Prevention of infectious complications in surgical patients: Potential role of probiotics. Digest. Surg., 22, 234-244.10.1159/00008805316174980
Search in Google Scholar
Matsuoka, H., Kurosawa, S., Horinouchi, T. (2001). Inhalation anaesthetics induce apoptosis in normal peripheral lymphocytes in vitro. Anaesthesiology, 95, 1467-1472.10.1097/00000542-200112000-0002811748407
Search in Google Scholar
Menigaux, C., Fletcher, D., Dupont, X., Guingard, B., Guirimand, F., Chauvin, M. (2000). The benefits of intraoperative small-dose ketmine on postoperative pain after anterior cruciate ligamentrepair. Anaesth. Analg.,90, 129-135.10.1097/00000539-200001000-0002910624993
Search in Google Scholar
Miller, G. E., Chen, E., Zhou, E. S. (2007). If it goes up, must it come down? Chronic stress and the hypothalamic-pituitary-adrenocortical axis in humans. Psychol. Bull., 133, 25-45.10.1037/0033-2909.133.1.2517201569
Search in Google Scholar
Nathan, C. (2006). Neutrophils and immunity: Challenges and opportunities. Nat. Rev. Immunol., 6, 173-182.10.1038/nri178516498448
Search in Google Scholar
Niers, L. E. M., Rijkers, G. T., Timmerman, H. M., Van Bleek, G. M., Van Uden, N. O. P., Kimpen, J. L. L.(2004). A central immunoregulatory role for IL-10 in the suppression of type 2 T-helper cell cytokines by probiotic bacteria. In: Proceedings of the XXIII European Academy of Allergologyand Clinical Immunology Congress, Amsterdam. Amsteram.
Search in Google Scholar
Ogawa, K., Hirai, M., Katsube, T., Murayama, M., Hamaguchi, K., Shimakawa,T., Nritake, Y., Hosokawa, T., Kajiwara, T. (2000). Suppression of cellular immunity by surgical stress. Surgery, 127(3), 329-336.10.1067/msy.2000.103498
Search in Google Scholar
Pepys, M. B., Hirschfield, G. M. (2003). C-reactive protein: A critical update. J. Clin. Invest., 111 (12),1805-1812.10.1172/JCI200318921
Search in Google Scholar
Pöpping, D., Elia, N., Marret, E., Remy, C., Tramèr, M. (2008). Protective effects of epidural analgesia on pulmonary complications after abdominal and thoracic surgery: A meta-analysis. Arch. Surg., 143 (10), 990-999.10.1001/archsurg.143.10.990
Search in Google Scholar
Puura, A., Puolakka, P., Rorarius, M., Salmelin, R., Lindgren, L. (2006). Etoricoxib pre-medication for post-operative pain after laparoscopic cholecystectomy. Acta Anaesthesiol Scand, 50 (6), 688-693.10.1111/j.1399-6576.2006.01049.x
Search in Google Scholar
Rigg, J. R., Jamrozik, K., Myles, P. S., Silbert, B. S., Peyton, P. J., Parsons, R. W., Collins, K. S. (2002). Epidural anaesthesia and analgesia and outcome of major surgery: A randomised trial. MASTER Anaesthesia Trial Study Group. Lancet, 359, 1276-1282.10.1016/S0140-6736(02)08266-1
Search in Google Scholar
Salmon, P., Hall, G. M. (1997). A theory of postoperative fatigue. J. R. Soc. Med., 90, 661-664.10.1177/01410768970900120712967349496290
Search in Google Scholar
Sanders, V. M., Kavelaars, A. (2007). Adrenergic regulation of immunity. In: Psychoneuroimmunology (4th edn.) (pp. 65-66). Ader, R. (Ed.). Vol. 1. Chapter 2. New York: Elsevier Academic Press.
Search in Google Scholar
Scarlett, M., Crawford-Sykes, A., Nelson, M. (2002). Preoperative starvation and pulmonary aspiration. New perspectives and guidelines. West IndianMed. J., 51 (4), 241-245.
Search in Google Scholar
Scherer, R. (1997). Intraoperative Wärmekonservierung. Viel Lärm um heiße Luft? [Intraoperative heat conservation. A lot of hot air?]. Anaesthesist, 46 (2), 81-90 (in German).10.1007/s0010100503759133182
Search in Google Scholar
Segerstrom, S. C., Miller, G. E., (2004). Psychological stress and the human immune system: A meta-analytic study of 30 years of inquiry. Psychol. Bull., 130, 601-630.10.1037/0033-2909.130.4.601136128715250815
Search in Google Scholar
Sheeran, P., Hall, G. M., (1997). Cytokines in anaesthesia. Brit. J. Anaesth.,78, 201-219.10.1093/bja/78.2.2019068342
Search in Google Scholar
Smith, E. M. (2008). Neuropeptides as signal molecules in common with leukocytes and the hypothalamic-pituitary-adrenal axis. Brain Behav. Immun., 22(1), 3-14.10.1016/j.bbi.2007.08.005219429017900859
Search in Google Scholar
Sonohata, M., Tsunoda, K., Kugisaki, H., Someya, S., Honke, H.,Mitsunori, Kitajima, M., Mawatari, M., Hotokebuchi, T. (2009). Surgical stress differences between total hiparthroplasty and total knee arthroplasty. Int. J. Med. Sci., 1 (11), 505-509.
Search in Google Scholar
Steinbrook, R. A. (1998). Epidural anesthesia and gastrointestinal motility. Anesth. Analg., 86, 837-844.
Search in Google Scholar
Stuart, P. C. (2006). The evidence base behind modern fasting guidelines. Best Pract. Res. Clin. Anaesthesiol., 20 (3), 457-469.10.1016/j.bpa.2006.03.00117080696
Search in Google Scholar
Tewes, U. (1999) Concepts in psychology. In: Psychoneuroimmunology. AnInterdisciplinary Introduction. Chapter 4 (pp 96-98). New York, NY: Kluwer Academic/Plenum Publishers.
Search in Google Scholar
Tilbrook, A.J., Turner, A.I., Clarke, I.J. (2000). Stress and reproduction: Central mechanisms and sex differences in non-rodent species. Stress, 5 (2), 83-100.
Search in Google Scholar
Timmerman, H. M., Koning, C. J. M., Mudler, L., Rombouts, F.M., Beynen, A.C. (2004). Monostrain, multistrain and multispecies probiotics. A comparison of functionality and efficacy. Int. J. Food Microbiol., 96, 219-233.10.1016/j.ijfoodmicro.2004.05.01215454313
Search in Google Scholar
Veenhof, A. A., Vlug, M. S., van der Pas, M. H., Sietses, C., van der Peet, D. L., de Lange-de Klerk, E. S., Bonjer, H. J., Bemelman, W. A., Cuesta, M. A. (2012). Surgical stress response and postoperative immune function after laparoscopy or open surgery with fast track or standard perioperative care: A randomized trial. Ann. Surg., 255 (2), 216-221.10.1097/SLA.0b013e31824336e222241289
Search in Google Scholar
Velickovic, I., Yan, J., Gross A. J. (2002). Modifying the neuroendocrine stress response. Semin. Anaesth. Periop. Med. Pain, 21 (1), 16-25.10.1053/sane.2002.30675
Search in Google Scholar
Souba, W. W., Fink, M. P., Jurkovich, G. J., Kaiser, L. P., Pearce, W. H., Pemberton, J. H., Soper, N. J. (2007). ACS Surgery: Principles and Practice.6th edn. American College of Surgeons. Philadelphia, PA: BC Decker, Inc. 1956 pp.
Search in Google Scholar
Witko-Sarsat, V., Rieu, P., Descamps-Latscha, B., Lesavre, P., Halbwachs- Mecarelli, L. (2000). Neutrophils: Molecules, functions and pathophysiological aspects. Labor. Investig., 80, 617-653.10.1038/labinvest.378006710830774
Search in Google Scholar
Wu, C. L., Naqibuddin, M., Rowlingson, A. J., Lietman, S. A., Jermyn, R. M., Fleisher, L. A. (2003). The effect of pain on health-related quality of life in the immediate postoperative period. Anesth. Analg., 97, 1078 -1108.10.1213/01.ANE.0000081722.09164.D514500161
Search in Google Scholar
Zura, M., Sakic, K., Malenica, B., Vrbanovic, V. (2009). Immune response to surgical stress in spinal anaesthesia. Periodicum Biologorum, 111 (2), 193-196.
Search in Google Scholar

Stress Response to Surgery and Possible Ways of Its Correction

Abstract

Paradigm

My account