How Can Anesthetists Modify Stress Response during Perioperative Period?

  • V. Novak-Jankovič
  • V. Paver-Eržen
Conference paper


During his daily routine, the anesthetist as a specialist of perioperative medicine deals with injured and surgical patients who are under huge stress. The essential task of an anesthetist is not only providing anesthesia and analgesia, but maintaining vital functions, such as circulation and respiration. The anesthetist has to be familiar with the pathophysiology of the neuroendocrine stress response to trauma and surgery and also with the drugs and anesthetic techniques that can diminish any negative consequences. Stress is defined as a state of disharmony or threatened homeostasis provoked by psychological, environmental, or physiological stress [1]. Stress response or general adaptive response refers to the biochemical and physiological adaptation made by an organism, presumably to allow for improved survival after injury [2]. Stress response is adaptive for injury “in the wild”. Stress response developed allowing injured animals to survive by metabolizing their own stored body fuels [3]. However stress response after surgical injury is potentially harmful to the patient and can result in a poor postoperative outcome [4, 5].


Epidural Analgesia Regional Anesthesia Epidural Anesthesia Thoracic Epidural Anesthesia Thoracic Epidural Analgesia 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


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  1. 1.
    Black PH (1994) Central nervous system-immune system interactions: psychoneuroendocrinology of stress and its immune consequences. Antimicrob Agents Chemother 38: 1–6PubMedCrossRefGoogle Scholar
  2. 2.
    Speight KL (1993) Perioperative stress response suppression in cardiothoracic surgery. In: Grevlee, Rauck (eds) Pain management in cardiothoracic surgery. Lippincott, Philadelphia, pp 169–199Google Scholar
  3. 3.
    Desborough JP (2000) The stress response to trauma and surgery. Br J Anaesth 85: 109–17.PubMedCrossRefGoogle Scholar
  4. 4.
    Weissman C (1990) The metabolic response to stress: an overview and update. Anesthesiology 73: 308–328PubMedCrossRefGoogle Scholar
  5. 5.
    Anand KJS, Hansen DD, Hickey PR (1990) Hormonal-metabolic stress responses in neonates undergoing cardiac surgery. Anesthesiology 73: 661–670PubMedCrossRefGoogle Scholar
  6. 6.
    Baumann H, Gauldie J (1994) The acute phase response. Immunol Today 15: 74–80PubMedCrossRefGoogle Scholar
  7. 7.
    Black PH (1994) Immune system-central nervous system interactions: effects and immunomodulatory consequences of immune system mediators on the brain. Antimicrob Agents Chemother 38: 7–12PubMedCrossRefGoogle Scholar
  8. 8.
    Calogero AE, Norton JA, Sheppard BC, et al (1992) Pulsatile activation of the hypothalamicpituitary-adrenal axis during major surgery. Metabolism 41: 839–845PubMedCrossRefGoogle Scholar
  9. 9.
    Bessey PQ, Watters JM, Aoki TT, et al (1984) Combined hormonal infusion simulates the metabolic response to injury. Ann Surg 200: 264–281PubMedCrossRefGoogle Scholar
  10. 10.
    Blalock JE (1989) A molecular basis for bidirectional communication between the immune and neuroendocrine systems. Physiol Rev 69: 1–30PubMedGoogle Scholar
  11. 11.
    Reves JG, Karp RB, Buttner EE, et al (1982) Neuronal and adrenomedullary catecholamine release in response to cardiopulmonary bypass in man. Circulation 66: 49–55PubMedCrossRefGoogle Scholar
  12. 12.
    Acosta F, Diaz J, Moreno J, et al (1995) Relationship between ß-endorphin release and surgical stress in orthotopic liver transplantation. Transplant Proc 27: 2303PubMedGoogle Scholar
  13. 13.
    Roizen MF, Lampe GH, Benefiel DJ, et al (1987) Is increased operative stress associated with worse outcome? Anesthesiology 67: 3ACrossRefGoogle Scholar
  14. 14.
    Bovill JG, Sebel PS, Stanley TH (1984) Opioid analgesics in anesthesia: with special reference to their use in cardiovascular anesthesia. Anesthesiology 61: 731–755PubMedCrossRefGoogle Scholar
  15. 15.
    Brandt MR, Korshin J, Prange Hansen A, et al (1978) Influence of morphine anesthesia on the endocrine-metabolic response to open-heart surgery. Acta Anaesth Scand 22: 400–412PubMedCrossRefGoogle Scholar
  16. 16.
    Anand KJS, Sippell WG, Aynsley-Green A (1987) Randomised trial of fentanyl anesthesia in preterm babies undergoing surgery: effects on the stress response. Lancet 31: 243–247CrossRefGoogle Scholar
  17. 17.
    Anand KJS, Phil D, Hickey PR (1992) Halothane-morphine compared with high-dose sufentanil for anesthesia and postoperative analgesia in neonatal cardiac surgery. N Engl J Med 326: 1–9PubMedCrossRefGoogle Scholar
  18. 18.
    Walsh ES, Paterson JL, O’Riordan JBA, et al (1981) Effect of high-dose fentanyl anesthesia on the metabolic and endocrine response to cardiac surgery. Br J Anaesth 53: 1155–1165PubMedCrossRefGoogle Scholar
  19. 19.
    Vanacker B, Wiebalck A, VanAken H, et al (1993) Quality of induction and adrenocortical function. A clinical comparison of etomidate-lipuro and hypnomidate. anesthesist 42: 81–89Google Scholar
  20. 20.
    Adams HA, Hempelmann G (1991) The endocrine stress reaction in anesthesia and surgery-origin and significance. Anasthesiol Intensivmed Notfallmed Schmerzther 26: 294–305PubMedCrossRefGoogle Scholar
  21. 21.
    Kiefer RT, Weindler J, Ruprecht KW (1998) The endocrine stress response after oral premedication with low-dose midazolam for intraocular surgery in retrobulbar anesthesia. Eur J Ophthalmol 8: 239–245PubMedGoogle Scholar
  22. 22.
    Child CSB (1993) anesthesia and the endocrine response to surgery. Curr Anesth Crit Care 4: 13–18CrossRefGoogle Scholar
  23. 23.
    Ng A, Tan SSW, Lee HS, et al (1995) Effect of propofol infusion on the endocrine response to cardiac surgery. Anaesth Intensive Care 23: 543–547PubMedGoogle Scholar
  24. 24.
    Adams HA (1997) Endocrine reactions following S-(+)-ketamine. anesthesist 46[Suppl 1]: S30-S37Google Scholar
  25. 25.
    Adams HA, Russ W, Leisin M, et al (1987) Inhalation anesthetic agents and endocrine stress response during surgery. A comparison of halothane, enflurane and isoflurane. anesthesist 36: 159–165Google Scholar
  26. 26.
    Holdcroft A (2000) Hormones and the gut. Br J Anaesth 85: 58–68PubMedCrossRefGoogle Scholar
  27. 27.
    Helbo-Hansen S, Fletcher R, Lundberg D (1986) Clonidine and the sympatico-adrenal response to coronary artery by-pass surgery. Acta anesthesiol Scand 30: 235–242CrossRefGoogle Scholar
  28. 28.
    Eisenach JC, DeCock M, Klimscha W (1996) Alpha 2-adrenergic agonists for regional anesthesia. Anesthesiology 85: 655–674PubMedCrossRefGoogle Scholar
  29. 29.
    Quintin L, Roudot F, Roux C, et al (1991) Effect of clonidine on the circulation and vasoactive hormones after aortic surgery. Br J Anaesth 66: 108–115PubMedCrossRefGoogle Scholar
  30. 30.
    Kallio A, Koulu M, Scheinin H, et al (1988) Acute effects of medetomidine, a selective alpha 2-adrenoceptor agonist, on anterior pituitary hormone and cortisol secretion in man. Acta Endocrinol (Copenh) 119: 11–15Google Scholar
  31. 31.
    Masala A, Satta G, Alagna S, et al (1985) Effect of clonidine on stress-induced cortisol release in man during surgery. Pharmacol Res Commun 17: 293–298PubMedCrossRefGoogle Scholar
  32. 32.
    Dorman T, Clarkson K, Rosenfeld BA, et al (1997) Effects of clonidine on prolonged postoperative sympathetic response. Crit Care Med 25: 1147–1152PubMedCrossRefGoogle Scholar
  33. 33.
    Ellis JE, Drijvers G, Pedlow S, et al (1994) Premedication with oral and transdermal clonidine provides safe and efficacious postoperative sympatholysis. Anesth Analg 79: 1133–1140PubMedCrossRefGoogle Scholar
  34. 34.
    Eisenach J, Detweiler D, Hood D (1993) Hemodynamic and analgesic actions of epidurally administered clonidine. Anesthesiology 78: 277–287.PubMedCrossRefGoogle Scholar
  35. 35.
    De Kock M (1996) Alpha-2 adrenoceptor agonists: clonidine, dexmedetomidine, mivazerol. Curr Opin Anesthesiol 9: 295–299CrossRefGoogle Scholar
  36. 36.
    Novak-Jankovic V, Paver-Erzen V, Bovill JG, et al (2000) Effect of epidural and intravenous clonidine on the neuro-endocrine and immune stress response in patients undergoing lung surgery. Eur J anesthesiol (EJA) 17: 50–56Google Scholar
  37. 37.
    Stenseth R, Bjella L, Berg EM, et al (1994) Thoracic epidural analgesia in aortocoronary bypass surgery II. Effects on the endocrine metabolic response. Acta anesthesiol Scand 38: 834–839CrossRefGoogle Scholar
  38. 38.
    Loick HM, Schmidt C, VanAKen H, et al (1999) High thoracic epidural anesthesia, but not clonidine, attenuates the perioperative stress response via sympatholysis and reduces the release of troponin T in patients undergoing coronary artery bypass grafting. Anesth Analg 88: 701–709PubMedGoogle Scholar
  39. 39.
    Chae BK, Lee HW, Sun K, et al (1998) The effect of combined epidural and light general anesthesia on stress hormones in open heart surgery patients. Surg Today 28: 727–731PubMedCrossRefGoogle Scholar
  40. 40.
    Aono H, Takeda A, Tarver SD, et al (1998) Stress responses in three different anesthetic techniques for carbon dioxide laparoscopic cholecystectomy. J Clin Anesth 10: 546–550PubMedCrossRefGoogle Scholar
  41. 41.
    Kehlet H, Brandt MR, Hansen AP, et al (1979) Effect of epidural analgesia on metabolic profiles during and after surgery. Br J Surg 66: 543–546PubMedCrossRefGoogle Scholar
  42. 42.
    Naito Y, Tamai S, Shingu K, et al (1992) Responses of plasma adrenocorticotropic hormone, cortisol, and cytokines during and after upper abdominal surgery. Anesthesiology 77: 426–431PubMedCrossRefGoogle Scholar
  43. 43.
    Bromage PR, Shibata HR, Willoughby HW (1971) Influence of prolonged epidural blockade on blood sugar and cortisol responses to operations upon the upper part of the abdomen and the thorax. Surg Gynecol Obstet 132: 1051–1059PubMedGoogle Scholar
  44. 44.
    Rem J, Brandt MR, Kehlet H (1980) Prevention of postoperative lymphopenia and granulocytosis by epidural analgesia. Lancet 9: 283–284CrossRefGoogle Scholar
  45. 45.
    Yeager MP, Glass DD, Neff RK, et al (1987) Epidural anesthesia and analgesia in high risk surgical patients. Anesthesiology 66: 729–736PubMedCrossRefGoogle Scholar
  46. 46.
    Tuman KJ, McCarthy RJ, March RJ, et al (1991) Effects of epidural anesthesia and analgesia on coagulation and outcome after major vascular surgery. Anesth Analg 73: 696–704.PubMedCrossRefGoogle Scholar
  47. 47.
    Raggi R, Dardik H, Mauro AL (1987) Continuous epidural anesthesia and postoperative epidural narcotics in vascular surgery. Am J Surg 154: 192–197PubMedCrossRefGoogle Scholar
  48. 48.
    Turfrey DJ, Ray DAA, Sutcliffe NP, et al (1997) Thoracic epidural anesthesia for coronary artery bypass graft surgery. Effects on postoperative complications, anesthesia 52: 1090–1113Google Scholar
  49. 49.
    Handley GH, Silbert BS, Mooney PH, et al (1997) Combined general and epidural anesthesia versus general anesthesia for major abdominal surgery: postanesthesia recovery characteristics. Reg Anesth 22: 435–441PubMedCrossRefGoogle Scholar
  50. 50.
    McKenzie PJ, Wishart HY, Smith G (1984) Long-term outcome after repair of fractured neck of femur. Comparison of subarachnoid and general anesthesia. Br J Anaesth 56: 581–585PubMedCrossRefGoogle Scholar
  51. 51.
    Bode RH, Lewis KP, Zarich SW, et al (1996) Cardiac outcome after peripheral vascular surgery. Comparison of general and regional anesthesia. Anesthesiology 84: 3–13PubMedCrossRefGoogle Scholar
  52. 52.
    Liu S, Carpenter RL, Neal JM (1995) Epidural anesthesia and analgesia. Their role in postoperative outcome. Anesthesiology 82: 1474–1506PubMedCrossRefGoogle Scholar
  53. 53.
    Ballantyne JC, Carr DB, deFerranti S, et al (1998) The comparative effects of postoperative analgesic therapies on pulmonary outcome: cumulative meta-analyses of randomized, controlled trials. Anesth Analg 86: 598–612PubMedGoogle Scholar
  54. 54.
    Ballantyne J 2001 Does regional anesthesia improve outcome after surgery. Refresher course lectures. 9th ESA Annual Meeting Gothenburg pp 41–50Google Scholar
  55. 55.
    Kompan L, Kremzar B, Gadzijev E, et al (1999) Effects of early enterai nutrition on intestinal permeability and the development of multiple organ failure after multiple injury. Intensive Care Med 25: 157–161.PubMedCrossRefGoogle Scholar
  56. 56.
    Kehlet H (1997) Multimodal approach to control postoperative pathophysiology and rehabilitation. Br J Anaesth 78: 606–617PubMedCrossRefGoogle Scholar
  57. 57.
    Moiniche S, Bulow S, Hesselfeldt P, et al (1995) Convalescence and hospital stay after colonic surgery with balanced analgesia, early oral feeding, and enforced mobilisation. Eur J Surg 161: 283–288.PubMedGoogle Scholar
  58. 58.
    Brodner G, Pogatzki E, Van Aken H, et al (1998) A multimodal approach to control postoperative pathophysiology and rehabilitation in patients undergoing abdominothoracic esophagectomy. Anesth Analg 86: 228–234PubMedGoogle Scholar
  59. 59.
    Kehlet H (2000) Accelerated postoperative recovery. Book of proceedings. 12th World Congress of anesthesiologists. Montreal, Canada, pp 200Google Scholar

Copyright information

© Springer-Verlag Italia 2002

Authors and Affiliations

  • V. Novak-Jankovič
    • 1
  • V. Paver-Eržen
    • 1
  1. 1.Clinical Department of Anaesthesiology and Intensive CareUniversity Medical CentreLjubljanaSlovenia

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