Perioperative Stress Reduction with Intraspinal Opioids

Abstract

Progress in the care of surgical patients depends upon medical advancements that ultimately favor the development of new operative techniques. Nineteenth-century surgeons awaited the advent of modern anesthesia and antiseptic techniques, while twentieth-century surgeons had the advantages of blood typing, antibiotics, and hemodynamic monitoring techniques before devising the array of diagnostic and therapeutic procedures commonly, and safely, employed today. Throughout this evolutionary period, physicians have also recognized that postoperative care, with a less spectacular phylogeny, is nonetheless one of the most important determinants of overall operative outcome. Surgeons have always appreciated that of their patients who die from a major operation, most will die after the operation and not in the operating theater itself. It is the physiologic consequences of an operation that are frequently more dangerous than the procedure itself.