caa a22 4500 47580158X CHVBK 20180406123738.0 cr unu---uuuuu 170329e20000601xx s 000 0 eng 10.1007/s002689910111 doi (NATIONALLICENCE)springer-10.1007/s002689910111 Kehlet Henrik Department of Surgical Gastroenterology 435, Hvidovre University Hospital, DK-2650 Hvidovre, Denmark, Denmark aut Manipulation of the Metabolic Response in Clinical Practice [Elektronische Daten] [Henrik Kehlet] Abstract.: Surgical injury is followed by profound changes in endocrine metabolic function and various host defense mechanisms leading to catabolism, immunosuppression, ileus, impaired pulmonary function, and hypoxemia. These physiologic changes are supposed to be involved in the pathogenesis of postoperative morbidity. Effective afferent neural blockade with continuous epidural local anesthetic techniques inhibits a major part of the endocrine metabolic response, leading to improved protein economy but without important effects on inflammatory or immunologic responses. In contrast, pain treatment with other modalities such as nonsteroidal antiinflammatory drugs (NSAIDs) and opioids has only a small inhibitory effect on endocrine metabolic responses. Preoperative high-dose glucocorticoid therapy provides additional pain relief and improves pulmonary function, but it reduces the inflammatory response (acute-phase proteins, cytokines, hyperthermia) and immune function. Minimally invasive surgery leaves the endocrine metabolic responses largely unaltered but reduces the inflammatory response and immune suppression. Thus several techniques are available to modify the stress responses in elective surgery patients. The effect of these techniques to alter endocrine metabolic and inflammatory responses during severe surgical illness has not been established. Neural blockade and minimally invasive surgery have improved outcome following elective surgery, especially when integrated into a multimodal postoperative rehabilitation program. Application of this knowledge from pathophysiologic responses to uncomplicated surgical injury should be explored in patients with severe surgical illness. 2000 by the Société Internationale de Chir, 2000 World Journal of Surgery Springer-Verlag 24/6(2000-06-01), 690-695 0364-2313 24:6<690 2000 24 268 https://doi.org/10.1007/s002689910111 text/html Onlinezugriff via DOI 1 research-article jats NATIONALLICENCE 856 40 https://doi.org/10.1007/s002689910111 text/html Onlinezugriff via DOI NATIONALLICENCE 100 1- Kehlet Henrik Department of Surgical Gastroenterology 435, Hvidovre University Hospital, DK-2650 Hvidovre, Denmark, Denmark aut NATIONALLICENCE 773 0- World Journal of Surgery Springer-Verlag 24/6(2000-06-01), 690-695 0364-2313 24:6<690 2000 24 268 Metadata rights reserved Springer special CC-BY-NC licence nationallicence BK010053 XK010053 XK010000 NATIONALLICENCE NATIONALLICENCE NL-springer