Stress response to surgery and possible ways of its correction

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.