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Abstract
<p class="first" id="d1223347e53">Major surgery is still associated with undesirable
sequelae such as pain, cardiopulmonary,
infective and thromboembolic complications, cerebral dysfunction, nausea and gastrointestinal
paralysis, fatigue and prolonged convalescence. The key pathogenic factor in postoperative
morbidity, excluding failures of surgical and anaesthetic technique, is the surgical
stress response with subsequent increased demands on organ function. These changes
in organ function are thought to be mediated by trauma-induced endocrine metabolic
changes and activation of several biological cascade systems (cytokines, complement,
arachidonic acid metabolites, nitric oxide, free oxygen radicals, etc). To understand
postoperative morbidity it is therefore necessary to understand the pathophysiological
role of the various components of the surgical stress response and to determine if
modification of such responses may improve surgical outcome. While no single technique
or drug regimen has been shown to eliminate postoperative morbidity and mortality,
multimodal interventions may lead to a major reduction in the undesirable sequelae
of surgical injury with improved recovery and reduction in postoperative morbidity
and overall costs.
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