RESPOSTA METABÓLICA AO TRAUMA CIRÚRGICO
Keywords:
Surgery, Metabolism, Inflammatory response, Surgical stressAbstract
The effects of surgical trauma on the organism, which are widely studied by human and veterinary medicine, result in a complex neuroendocrine and immune responses triggered to restore homeostasis and preserve life. The metabolic response to trauma is characterized by increased secretion of hypophyseal hormones, activation of the sympathetic nervous system, and secretion of pro-inflammatory cytokines. This response aims to maintain tissue perfusion, control the proliferation of microorganisms, and mobilize substrates to ensure the integrity of cellular functions and promote tissue repair. Different factors can influence the intensity of the organism’s response to trauma, including magnitude and duration of stimuli, pre-existing infirmities or traumas, anaesthetic protocols, and surgical techniques applied. Exacerbated metabolic responses can cause post-operative complications, prolonged recovery time, and death. By identifying the main events related to the metabolic response to surgical trauma, it is possible to act to reduce the associated damages, improving quality and minimizing the risks of the postoperative period. Thus, the present paper aims to present a review describing the physiopathology and the consequences of the metabolic response to surgical trauma, in its different forms and origins, in the perioperative period.
References
ANGELE, M.K.; FAIST, E. Clinical review: Immunodepression in the surgical patient and increased susceptibility to infection. Critical Care, v.6, n.4, p.298-305, 2002.
BEN-ELIYAHU, S. The promotion of tumor metastasis by surery and stress: Immunological basis and implications for psychoneuroimmunology. Brain, Behavior, and Immunity, v.17, n.1, p.27-36, 2003.
BOGOSSIAN, A.T.; BOGOSSIAN, L. Resposta orgânica ao trauma. In: VIEIRA, O.M.; CHAVES, C.P.; MANSO, J.E.F.; EULÁLIO, J.M.R. Clínica Cirúrgica – Fundamentos teóricos e práticos. 1ª ed., São Paulo: Editora Atheneu, p.49-58, 2000.
BROCHNER, A.C.; TOFT, P. Pathophysiology of the systemic inflammatory response after major accidental trauma. Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine, v.17, n.43, p.1-10, 2009.
BURTON, D.; NICHOLSON, G.; HALL, G. Endocrine and metabolic response to surgery. Continuing education in anaesthesia, critical care & pain, v.4, n.5, p.144-147, 2004.
CARLI, F. Physiologic considerations of enhanced recovery after surgery (ERAS) programs: implications of the stress response. Canadian Journal of Anesthesia, v.62, n.2, p.110-119, 2015.
CANNON, W.B. Stresses and strains of homeostasis. The American Journal of the Medical Sciences, v.189, p.1-14, 1935.
CARVALHO, C.A.L.B.; CARVALHO, A.A.; PREZA, A.O.G.; NOGUEIRA, P.L.B.; MENDES, K.B.V.; DOCK-NASCIMENTO, D.B.; AGUILAR-NASCIMENTO, J.E. Metabolic and Inflammatory Benefits of Reducing Preoperative Fasting Time in Pediatric Surgery. Revista do Colégio Brasileiro de Cirurgiões, v.47, p.1-10, 2020.
CHO, J.M.; LAPORTA, A.J.; CLARK, J.R.; SCHOFIELD, M.J.; HAMMOND, S.L.; MALLORY, P.L. Response of serum cytokines in patients undergoing laparoscopic cholecystectomy. Surgical Endoscopy, v.8, n.12, p.1380-1384, 1994.
CHURCH, D.B.; NICHOLSON, A.I.; ILKIW, J.E.; EMSLIE, D.R. Effect of non-adrenal illness, anaesthesia and surgery on plasma cortisol concentrations in dogs. Research in Veterinary Science, v.56, n.1, p.129-131, 1994.
CLARK, J.D.; SHI, X.; LI, X.; QIAO, Y.; LIANG, D.Y.; ANGST, M.S.; YEOMANS, D.C. Morphine reduces local cytokine expression and neutrophil infiltration after incision. Molecular Pain: SAGE Journals, v.3, n.28, p.1-12, 2007.
CORBEE, R.J.; KERKHOVEN, W.J.S. Nutritional support of dogs and cats after surgery or illness. Open Journal of Veterinary Medicine, v.4, n.4, p.44-57, 2014.
CRAIG, S.R.; LEAVER, H.A.; YAP, P.L.; PUGH, G.C.; WALKER, W.S. Acute phase responses following minimal access and conventional thoracic surgery. European Journal of Cardio-Thoracic Surgery, v.20, n.3, p.455-463, 2001.
DESBOROUGH, J.P.; HALL, G.M. Modification of the hormonal and metabolic response to surgery by narcotics and general anaesthesia. Baillire's Clinical Anaesthesiology, v.3, n.2, p.317-334, 1989.
DESBOROUGH, J.P. The stress response to trauma and surgery. British Journal of Anaesthesia, v.85, n.1, p.109-117, 2000.
DEVITT, C.M.; COX, R.E.; HAILEY, J.J. Duration, complications, stress, and pain of open ovariohysterectomy versus a simple method of laparoscopic-assisted ovariohysterectomy in dogs. Journal of the American Veterinary Medical Association, v.227, n.6, p.921-927, 2005.
DINEV, D.; GEORGIEV, P. Influence of halothane anaesthesia in horses with abdominal surgery upon some endocrine parameters. Trakia Journal of Sciences, v.1, n.3, p.26-31, 2003.
DOBSON, G.P. Trauma of major surgery: a global problem that is not going Away. International Journal of Surgery, v.81, p.47-54, 2020.
DRASKOVIC, B.; STANIC, D.; URAM-BENKA, A.; FABRI, I. Stress indicators during general anesthesia with opioid analgesics in children. Turkish Journal of Medical Sciences, v.44, n.6, p.1095-1102, 2014.
FINNERTY, C.C.; MABVUURE, N.T.; ALI, A.; KOZAR, R.A.; HERDON, D.N. The surgically induced stress response. Journal of parenteral and Enteral Nutriction, v.37, n.5, p.21-29, 2013.
FOX, S.M.; MELLOR, D.J.; FIRTH, E.C.; HODGE, H.; LAWOKO, C.R.O. Changes in plasma cortisol concentrations before, during and after analgesia, anaesthesia and anaesthesia plus ovariohysterectomy in bitches. Research in Veterinary Science, v.57, n.1, p.110-118, 1994.
FURUYA, K.; SHIMIZU, R.; HIRABAYASHI, Y.; ISHII, R.; FUKUDA, H. Stress hormone responses to major intra-abdominal surgery during and immediately after sevoflurane-nitrous oxide anaesthesia in elderly patients. Canadian Journal of Anaesthesiology, v.40, n.5, p.435-439, 1993.
GANN, D.S.; FOSTER, A.H. Respostas endócrinas e metabólicas à injúria. In: SCHWARTZ, S.I. Princípios de Cirurgia. 6ª ed., Rio de Janeiro: McGraw-Hill, p.4-43, 1996.
GIANNOUDIS, P.V.; DINOPOULOSA, H.; CHALIDISA, B.; HALL, G.M. Surgical stress response. International Journal of the Care of the Injured, v.37, n.5, p.3-9, 2006.
GOLDFARB, Y.; BEN-ELIYAHU, S. Surgery as a risk factor for breast cancer recurrence and metastasis: mediating mechanisms and clinical prophylactic approaches. Breast Disease, v.26, n.1, p.99-114, 2006.
GOTTSCHALK, A.; SHARMA, S.; FORD, J.; DURIEUX, M.E.; TIOURIRINE, M. The role of the perioperative period in recurrence after cancer surgery. Anesthesia & Analgesia, v.110, n.6, p.1636-1643, 2010.
GRUYS, E.; TOUSSAINT, M.J.M.; NIEWOLD, T.A.; KOOPMANS, S.J. Acute phase reaction and acute phase proteins. Journal of Zhejiang University Science, v.6, n.11, p.1045-1056, 2005.
HAKANSON, E.; RUTBERG, H.; JORFELDT, L.; WIKLUND, L. Endocrine and metabolic responses after standardized moderate surgical trauma: influence of age and sex. Clinical Physiology, v.4, n.6, p.461-473, 2008.
HILL, G.L.; DOUGLAS, R.G.; SCHROEDER, D. Metabolic basis for the management of patients undergoing major surgery. World Journal of Surgery, v.17, p.146-153, 1993.
HOGLUND, O.D.; HAGMAN, R.; OLSSON, K.; OLSSON, U.; LAGERSTEDT, A.S. Intraoperative changes in blood pressure, heart rate, plasma vasopressin and urinary noradrenalin during elective ovariohysterectomy in dogs: repeatability at removal of the 1st and 2nd ovary. Veterinary Surgery, v.43, n.7, p.852-859, 2014.
HORTA, R.S.; LAVALLE, G.E.; CUNHA, R.M.C.; MOURA, L.L.; ARAÚJO, R.B.; CASSALI, G.D. Influence of surgical technique on overall survival, disease free interval and new lesion development interval in dogs with mammary tumors. Advances in Breast Cancer Research, v.3, n.2, p.38-46, 2014.
HUME, D.M. The neuro-endocrine response to injury: present status of the problem. Annals of Surgery, v.138, n.4, p.548-557, 1953.
HUBER-LANG, M.; LAMBRIS, J.D.; WARD, P.A. Innate immune responses to trauma. Nature immunology, v.19, n.4, p.327-341, 2018.
KADOSAWA, T.; WATABE, A. The effects of surgery-induced immunosuppression and angiogenesis on tumour growth. The Veterinary Journal, v.205, n.2, p.175-179, 2015.
KAHVECI, K.; ORNEK, D.; DOGER, C.; AYDIN, G.B.; AKSOY, M.; EMRE, C.; DEVECI, A.; BOZKURT, M.; ÖZGÜN, G. The effect of anesthesia type on stress hormone response: Comparison of general versus epidural anestesia. Nigerian journal of clinical practice, v.17, n.4, p.523-527, 2013.
KAMISKA, J.; KOWALSKA, M.M.; NOWACKI, M.P.; CHWALISKI, M.G.; RYSISKA, A.; FUKSIEWICZ, M. CRP, TNFα, IL-1ra, IL-6, IL-8 and IL-10 in blood serum of colorectal cancer patients. Pathology & Oncology Research, v.6, n.1, p.38-41, 2000.
KEHLET, H. Manipulation of the metabolic response in clinical practice. World Journal of Surgery, v.24, n.6, p.690-695, 2000.
KRIKRI, A.; ALEXOPOULOS, V.; ZOUMAKIS, E.; KATSARONIS, P.; BALAFAS, E.; KOURAKLIS, G.; KARAYANNACOS, P.E.; CHOUSOS, G.P.; SKALKEAS, G. Laparoscopic vs. open abdominal surgery in male pigs: Marked differences in cortisol and catecholamine response depending on the size of surgical incision. Hormones, v.12, n.2, p.283-291, 2013.
LIN, E.; CALVANO, S.E.; LOWRY, S.F. Surgical research review: Inflammatory cytokines and cell response in surgery. Surgery, v.127, n.2, p.117-126, 2000.
LIU, Y.; ZHU, S.; WANG, K.; FENG, Z.; CHEN, Q. Effect of tramadol on immune responses and nociceptive thresholds in a rat model of incisional pain. Journal of Zhejiang University Science B, v.9, n.11, p.895-902, 2008.
LUKEWICH, M.K.; ROGERS, R.C.; LOMAX, A.E. Divergent neuroendocrine responses to localized and systemic inflammation. Seminars in Immunology, v.26, n.5, p.402-408, 2014.
MARCOVICH, R.; WILLIAMS, A.L.; SEIFMAN, B.D.; WOLF, J.S. A canine model to assess the biochemical stress response to laparoscopic and open surgery. Journal of Endourology, v.15, n.10, p.1005-1008, 2001.
MILOSAVLJEVIC, S.B.; PAVLOVIC, A.P.; TRPKOVIC, S.V.; ILIC, A.N.; SEKULIC, A.D. Influence of spinal and general anesthesia on the metabolic, hormonal, and hemodynamic response in elective surgical patients. Medical Science Monitor, v.20, p.1833-1840, 2014.
NEEMAN, E.; BEN-ELIYAHU, S. Surgery and stress promote cancer metastasis: New outlooks on perioperative mediating mechanisms and immune involvement. Brain, Behavior, and Immunity, v.30, n.15, p.32-40, 2013.
PRETZSCH, E.; BOSCH, F.; RENZ, B.; WERNER, J.; ANGELE, M.; CHAUDRY, I.H. Operative trauma and blood loss - impact on tumor growth and recurrence. Shock, v.55, n.4, p.455-464, 2021.
SACERDOTE, P.; BIANCHI, M.; GASPANI, L.; MANFREDI, B.; MAUCIONE, A.; TERNO, G.; AMMATUNA, M.; PANERAI, A.E. The effects of tramadol and morphine on immune responses and pain after surgery in cancer patients. Anesthesia & Analgesia, v.90, n.6, p.1411-1414, 2000.
SANTAMARIA, L.B.; SCHIFILLITI, D.; LA TORRE, D.; FODALE, V. Drugs of anaesthesia and cancer. Surgical Oncology, v.19, n.2, p.63-81, 2010.
SHAKHAR, G.; BEN-ELIYAHU, S. Potential prophylactic measures against postoperative immunosuppression: could they reduce recurrence rates in oncological patients? Annals of Surgical Oncology, v.10, n.8, p.972-992, 2003.
SHEERAN, P.; HALL, G.M. Cytokines in anaesthesia. British Journal of Anaesthesia, v.78, n.2, p.201-219, 1997.
SIBANDA, S.; HUGHES, J.M.L.; PAWSON, P.E.; KELLY, G.; BELLENGER, C.R. The effects of preoperative extradural bupivacaine and morphine on the stress response in dogs undergoing femoro-tibial joint surgery. Veterinary Anaesthesia and Analgesia, v.33, n.2, p.246-257, 2006.
ŞIMSEK, T.; SIMSEK, H.U.; CANTURK, N.Z. Response to trauma and metabolic changes: posttraumatic metabolism. Turkish Journal of Surgery, v.30, n.3, p.153-159, 2014.
STOCCHE, R.M.; GARCIA, L.V.; KLAMT, J.G. Anestesia e resposta neuroendócrina e humoral ao estresse cirúrgico. Revista Brasileira de Anestesiologia, v.51, n.1, p.59-69, 2001.
TOFF, P.; TONNESEN, E. The systemic inflammatory response to anaesthesia and surgery. Current Anaesthesia & Critical Care, v.19, n.5/6, p.349-353, 2008.
TONNESEN, E.; BRINKLOV, M.M.; CHRISTENSEN, N.J.; OLESEN, A.S.; MADSEN, T. Natural killer cell activity and lymphocyte function during and after coronary artery bypass grafting in relation to the endocrine stress response. Anesthesiology, v.67, n.4, p.526-533, 1987.
WANG, S.; CHEN, Y.; LIN, H.; CHEN, L. Comparison of surgical stress response to laparoscopic and open radical cystectomy. World Journal of Urology, v.28, n.4, p.451-455, 2010.
WAYDHAS, C.; NAST-KOLB, D.; TRUPKA, A.; ZETTL, R.; KICKI, M.; WIESHOLLER, J.; SCHWEIBERER, L.; JOCHUM, M. Posttraumatic inflammatory response, secondary operations, and late multiple organ failure. Journal of Trauma and Acute Care Surgery, v.40, n.4, p.624-631, 1996.
WEISSMAN, C. The metabolic response to stress: an overview and update. Anesthesiology, v.73, n.2, p.308-327, 1990.
WILMORE, D.; KEHLET, K. Management of patients in fast track surgery. British Medical Journal, v.322, n.7284, p.473-476, 2001.
WILMORE, D.W. From Cuthbertson to fast-track surgery: 70 years of progress in reducing stress in surgical patients. Annals of Surgery, v.236, n.5, p.643-648, 2002.
