Abstracts & commentary: basic scienceSurgical stress: a basic critical concept or is it just voodoo?☆
Section snippets
From Cuthbertson to fast-track surgery: 70 years of progress in reducing stress in surgical patients
Wilmore DW. Ann Surg. 2002;236:643-648.
Objective:
To evaluate the evolution of knowledge concerning the stress response in surgical patients and to determine the therapeutic benefit of stress reduction therapy.
Design:
Review of the literature.
Methods:
Medline search from 1980 to present using the terms “stress response,” “neural-hormonal response,” “fast track surgery,” and “outcome in surgical patients.”
Results:
Significant advancements have been made in the preoperative, intraoperative, and
Systemic stress response after laparoscopic or open cholecystectomy: a randomized trial
Karayiannakis AJ, Makri GG, Mantzioka A, Karousos D, Karatzas G. Br J Surg. 1997;84:467-471.
Objective:
The objective of this study was to show that laparoscopic cholecystectomy significantly reduces the stress response to cholecystectomy.
Design:
Prospective, randomized clinical trial.
Setting:
University of Athens Medical School and Laikon General Hospital, Athens, Greece.
Participants:
Eighty-three consecutive patients randomized to undergo elective laparoscopic or open cholecystectomy from May 1992
Multimodal strategies to improve surgical outcome [review]
Kehlet H, Wilmore DW. Am J Surg. 2002;183:630-641.
Objective:
To evaluate the effect of modifying perioperative care in noncardiac surgical patients on morbidity, mortality, and other outcome measures.
Design:
Review of the literature.
Methods:
Medline review from 1980 to the present using the key terms fast track surgery, accelerated care programs, postoperative complications, and preoperative patient preparation.
Results:
The introduction of newer approaches to perioperative care has reduced both
Questions
1.
After laparoscopic cholecystectomy, which of the following mediators are NOT increased?
a.
Cortisol
b.
Adrenaline
c.
Glucose
d.
IL-6
e.
None of the above
2.
Regional anesthesia:
Increases the neuroendocrine response to blood loss
b.
Inhibits the catabolic response when provided for up to 24 to 48 hours postoperatively
c.
Is associated with an increased incidence of myocardial infarction
d.
Improves postoperative cerebral dysfunction
Beta-blockade:
a.
Increases cardiac complications secondary to increased
References (4)
The wisdom of the body
(1932)- et al.
The intricate interplay among body weight, stress, and the immune response to friend or foe
J Clin Invest
(2003)
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Current Surgery presents a comprehensive review of recent surgical and medical literature for the surgeon who wants to stay well informed in the least amount of time. Our international board of editors selects significant articles to review and provides commentary. The editorial board welcomes suggestions of topics or specific articles from our readers.
The Society of Black Academic Surgeons has decided to bolster the basic science content of the journal by providing abstracts & commentary pieces that will cover topics and issues within basic science. This article is the first installment.