The Systemic Response to Surgical Trauma – A review

Better understanding of the systemic response to surgical trauma will enhance the perioperative care of the patient. This will enhance recovery; reduce morbidity, length of hospital stay and cost. The new insight of enhanced recovery is based on the physiological principles of minimizing surgical stress by limiting the initiating factors. This is manifested by avoiding the stress hormones using thoracic epidural anaesthesia and minimally invasive (laparoscopic) surgery; avoiding stressinduced diabetes (hyperglycaemia) by pre-operative anabolic setting of the patient and avoiding fasting; treating hyperglycaemia with insulin; postoperative pain control with epidural analgesia and, early postoperative feeding and mobilization.Survival is determined by physiology rather than anatomy. Enhanced recovery has challenged traditional perioperative care.