Zusammenfassung
Hintergrund
Chirurgische Eingriffe und invasive Verfahren können beim Patienten eine inflammatorische Reaktion auslösen. Diese entzündliche Reaktion ist eine inhärente Antwort des Körpers auf die Intervention und kann sowohl nützlich als auch potenziell schädlich für den Organismus sein.
Fragestellung
Nicht nur Bakterien, sondern auch nichtinfektiöse Stimuli können eine inflammatorische Antwort von unterschiedlichem Ausmaß induzieren. In diesen Fällen ist die Aktivierung des Immunsystems nicht immer vorteilhaft für den Patienten und birgt das Risiko ungewollter, schädlicher Auswirkungen auf Wirtszellen, Gewebe oder sogar komplette Organsysteme. Ziel dieses Beitrags ist es, die ursächlichen Faktoren einer perioperativen Immunreaktion zu identifizieren und Interventionsmöglichkeiten aufzuzeigen.
Material und Methoden
Es wurde eine MEDLINE-Suche zur Inflammationsreaktion in der peri- und postoperativen Phase im Bereich der klinischen und der Grundlagenforschung durchgeführt.
Ergebnisse
Aktuelle Publikationen haben wesentliche Informationen darüber geliefert, auf welche Weise chirurgische Patienten von unkontrollierten Entzündungsreaktionen betroffen sein können. So können die Auswahl der verabreichten Anästhetika, das chirurgische Trauma selbst und eine supportive Therapie eine Modulation des Immunsystems während der perioperativen Phase bewirken. Die Auswirkungen auf den Patienten können vielfältig sein.
Schlussfolgerung
Dieser Beitrag diskutiert Ursachen und Auswirkungen inflammatorischer Prozesse in der perioperativen Phase. Darüber hinaus hebt er die Effekte perioperativ verabreichter Therapeutika und Anästhetika hervor. Das hierdurch erlangte Wissen erlaubt es dem Leser, qualifizierte Entscheidungen im perioperativen Setting zum Wohl des Patienten zu treffen.
Abstract
Background
Surgical interventions and invasive procedures can trigger an inflammatory reaction in patients. This inflammatory reaction is an inherent response by the body and can be triggered by different stimuli, including the surgical tissue trauma itself and also by the administration of drugs commonly used for the induction and maintenance of general anesthesia.
Objective
Immune system activation is mostly beneficial for the host defense against various exogenous pathogens during infectious disorders; however, if uncontrolled and overshooting or in the case of excessive immune system activation as a consequence of sterile inflammation, the inflammatory host response may also carry the risk for tissue and organ damage, which might severely threaten the patient. The aim of this article is to identify the causal factors of a perioperative immune reaction and to present interventional options.
Material and methods
An extensive MEDLINE search was carried out on the perioperative and postoperative inflammatory response in the field of clinical and basic research.
Results
Current publications provide essential information on how surgical patients may be affected by overshooting inflammatory responses. Thus, the choice of administered anesthetic agent and the surgical trauma itself in addition to a supportive therapy may modulate perioperative inflammation in the perioperative phase. The effects on the patient can be multifarious.
Conclusion
This article discusses the causes and effects of inflammatory processes in the perioperative phase. Additionally, it highlights the immunomodulatory effects of perioperatively administered therapeutics and anesthetics. Knowledge of this topic enables the reader to make qualified decisions in the perioperative setting to improve the individual patient outcome.
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J. Rossaint, A. Margraf und A. Zarbock geben an, dass kein Interessenkonflikt besteht.
Für diesen Beitrag wurden von den Autoren keine Studien an Menschen oder Tieren durchgeführt. Für die aufgeführten Studien gelten die jeweils dort angegebenen ethischen Richtlinien.
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Rossaint, J., Margraf, A. & Zarbock, A. Perioperative Inflammation. Anaesthesist 68, 421–427 (2019). https://doi.org/10.1007/s00101-019-0596-9
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DOI: https://doi.org/10.1007/s00101-019-0596-9