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ENHANCED RECOVERY AFTER SURGERY Modern understanding of the metabolic response to surgical injury and the mediators involved has led to a complete reappraisal of traditional perioperative care and the process known as ERAS. ERAS is evidence based on the stro...

FURTHER READING Ahl R, Matthiessen P , Sjölin G et al . E ff ects of betablocker therapy on mor - tality after elective colon cancer surgery: a Swedish nationwide cohort study . BMJ Open 2020; 10 : e036164. Bortolotti P , Faure E, Kipnis E. Inflammasomes in tiss...

Homeostasis Homeostasis is the concept of maintaining a constant internal environment that allows cellular processes to function optimally . Many aspects of surgery , trauma and injury a ff ect homeostasis and can lead to organ dysfunction. Traditionally the ...

Hypothermia Hypothermia results in increased production of adrenal steroids and catecholamines. When compared with normothermic controls, even mild hypothermia results in a two- to threefold increase in postoperative cardiac arrhythmias and increased cataboli...

INJURY There are several factors that prolong the acute-phase response to injury ( Table 1.1 ) and keep the patient in a - catabolic state. Other factors can exacerbate or compound the metabolic stress response both in elective surgery and in the emergency set...

Immobilisation Adreno-sympathetic activation Wound Hypothermia Hypotension Pain Cytokine cascade release Immobilisation Adreno-sympathetic activation Wound Hypothermia Hypotension Pain Cytokine cascade release Immobilisation Adreno-sympathetic activation Wound...

Immobility Immobility has long been recognised as a potent stimulus for inducing muscle wasting. Inactivity impairs the normal meal-derived amino acid stimulation of protein synthesis in skeletal muscle. Avoidance of unnecessary bed rest and active early mobil...

INTRODUCTION As surgeons we are inextricably linked with tissue injury and its e ff ects, both from the damage which operating inevitably causes and from the treatment of accidental traumatic injury . The body responds to significant local tissue injury , wheth...

Learning objectives To understand: How the body responds to accidental injury and surgery • Physiological and biochemical changes that occur during • injury and recovery Mediators and pathways of the metabolic response to • injury Learning objectives To unders...

MANAGING THE CATABOLIC STRESS RESPONSE There are several key elements that determine the extent of catabolism and thus govern the metabolic and nutritional care of the surgical patient. It must be remembered that, during the response to injury , not all tissu...

MEDIATORS OF THE METABOLIC RESPONSE TO INJURY Tissue damage and inflammation Tissue injury is sensed in several ways. Tissue damage causes the release of cellular and other molecular fragments known as damage-associated molecular patterns (DAMPs) or alarmins. ...

MEDIATORS OF THE METABOLIC RESPONSE TO INJURY Tissue damage and inflammation Tissue injury is sensed in several ways. Tissue damage causes the release of cellular and other molecular fragments known as damage-associated molecular patterns (DAMPs) or alarmins. ...

METABOLIC CHANGES AFTER SURGERY AND TRAUMA The catabolic phase begins at the time of injury and lasts for approximately 24–48 hours. It may be attenuated by proper resuscitation and is characterised by hypovolaemia, decreased basal metabolic rate, reduced car...

Modern surgical care The role of surgical critical care, including resuscitation and/ or organ support, must be to work alongside the metabolic e ff ects of injury while the patient is restored to a situation from which homeostatic mechanisms can achieve a re...

Neuroendocrine response to injury Patients also respond rapidly to injury by the classical neuroen docrine pathways of the stress response, consisting of a ff erent nociceptive neurones, the spinal cord, thalamus, hypothalamus and pituitary ( Figure 1.2 ). No...

RESPONSE It is important to recognise that, in general or population terms, the metabolic response to injury is graded: the more severe - the injury , the greater the response ( Figure 1.1 ). This concept applies not only to physiological and metabolic changes...

Starvation Figure 1.7 Factors that exacerbate the metabolic response to surgical injury include hypothermia, uncontrolled pain, starvation, immobilisation, sepsis and medical complications. Starvation During starvation, the body is faced with an obligate need ...

Systemic inflammation and tissue Systemic inflammation and tissue Systemic inflammation and tissue