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Metabolic and the Surgical Stress Response Considerations to Improve Postoperative Recovery

  • Other Pain (A Kaye and N Vadivelu, Section Editors)
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Abstract

Purpose of Review

Enhanced recovery pathways are a multimodal, multidisciplinary approach to patient care that aims to reduce the surgical stress response and maintain organ function resulting in faster recovery and improved outcomes.

Recent Findings

A PubMed literature search was performed for articles that included the terms of metabolic surgical stress response considerations to improve postoperative recovery. The surgical stress response occurs due to direct and indirect injuries during surgery. Direct surgical injury can result from the dissection, retraction, resection, and/or manipulation of tissues, while indirect injury is secondary to events including hypotension, blood loss, and microvascular changes. Greater degrees of tissue injury will lead to higher levels of inflammatory mediator and cytokine release, which ultimately drives immunologic, metabolic, and hormonal processes in the body resulting in the stress response. These processes lead to altered glucose metabolism, protein catabolism, and hormonal dysregulation among other things, all which can impede recovery and increase morbidity. Fluid therapy has a direct effect on intravascular volume and cardiac output with a resultant effect on oxygen and nutrient delivery, so a balance must be maintained without excessively loading the patient with water and salt. All in all, attenuation of the surgical stress response and maintaining organ and thus whole-body homeostasis through enhanced recovery protocols can speed recovery and reduce complications.

Summary

The present investigation summarizes the clinical application of enhanced recovery pathways, and we will highlight the key elements that characterize the metabolic surgical stress response and improved postoperative recovery.

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Authors and Affiliations

  1. Department of Anesthesiology, LSU School of Medicine, Room 656, 1542 Tulane Ave., New Orleans, LA, 70112, USA

    Erik M. Helander, Bethany Menard, John Helmstetter, Viet H. Nguyen & Alan David Kaye

  2. Department of Anesthesiology, North Shore Hospital, 124 Shakespeare Rd., Takapuna, Auckland, 0620, New Zealand

    Michael P. Webb

  3. Department of Anesthesiology and Critical Care Medicine, Emory University Hospital, 550 Peachtree St NE, Atlanta, GA, 30308, USA

    Amit Prabhakar

  4. Department of Anesthesiology, LSU Health Shreveport, 1501 Kings Highway, Shreveport, LA, 71130, USA

    Elyse M. Cornett

  5. Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, 02115, USA

    Richard D. Urman

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All authors contributed equally to the manuscript and are involved in institutional protocols and policies for enhanced recovery pathways.

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Correspondence to Alan David Kaye.

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Erik M. Helander, Michael P. Webb, Bethany Menard, Amit Prabhakar, John Helmstetter, Elyse M. Cornett, and Viet H. Nguyen declare no conflict of interest. Alan Kaye is on the speaker bureau for the Merck and Depomed, Inc. Richard D. Urman received research funding from the Medtronic.

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Helander, E.M., Webb, M.P., Menard, B. et al. Metabolic and the Surgical Stress Response Considerations to Improve Postoperative Recovery. Curr Pain Headache Rep 23, 33 (2019). https://doi.org/10.1007/s11916-019-0770-4

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