ABSTRACT
Major surgery leads to an activation of inflammatory and endocrine responses resulting
in catabolism, immunosuppression, and adverse physiological effects in various organ
systems. In addition, hypothermia, opioid administration, immobilization, and semistarvation
may amplify the negative effects of the stress responses on perioperative organ physiology.
Currently available options to modify the stress response activation per se are epidural
local anesthetics, minimally invasive surgery, and a single high-dose glucocorticoid.
Recent studies indicate that the stress-induced perioperative impairment in various
organ functions may be profoundly reduced by multimodal rehabilitation programs aiming
to control perioperative pathophysiology and thereby improve recovery.
KEYWORDS
Surgical stress - postoperative complications - postoperative analgesia - minimally
invasive surgery