Acta chirurgica Scandinavica. Supplementum
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Postoperative pulmonary complications are not uncommon, and the factors that contribute to lung dysfunction are well documented. Postoperative pain, spasm, and paralysis are all known to reduce lung function, although relief of pain does not completely restore function. Rather, diaphragmatic dysfunction has been found to persist even with adequate pain relief. ⋯ Muscle paralysis can also create or contribute to atelectasis. Microthromboembolism impedes perfusion distribution, adding to the other causes of a ventilation-perfusion mismatch. Different anesthetic techniques and intraoperative management may help prevent or reduce the incidence of postoperative lung complications.
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Gastrointestinal motility is normally inhibited for 2-3 days after abdominal surgery. The methods used for postoperative pain relief may themselves also influence gastrointestinal function. ⋯ Clinical studies show that epidural anesthesia does not delay gastric emptying or prolong intestinal transit time as much as parenteral and epidural opioids. Therefore, for postoperative pain relief after abdominal surgery, epidural anesthesia with local anesthetics seems the best alternative to avoid or minimize adverse effects on gastric emptying and intestinal motility.
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Anesthesia can have various effects on the outcome of surgery, especially gastrointestinal procedures. Many anesthetic agents, for example, produce a fall in lower esophageal sphincter pressure, which can allow reflux of gastric contents into the lower esophagus. ⋯ Anesthetic technique can affect the success of intestinal anastomosis; for example, intravenous induction agents and some inhalational anesthetics decrease regional blood flow, whereas regional anesthetics may act to increase colonic blood flow. Other aspects of anesthetic management are also discussed as they relate to surgical outcome; examples are the use of invasive monitoring in elderly patients, the importance of oxygen delivery to the anastomosis, and the effect of transfusion on survival after surgery for carcinoma.
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Acta Chir Scand Suppl · Jan 1989
ReviewThe stress response to surgery: release mechanisms and the modifying effect of pain relief.
This short review updates information on the release mechanisms of the systemic response to surgical injury and the modifying effect of pain relief. Initiation of the response is primarily due to afferent nerve impulses combined with release of humoral substances (such as prostaglandins, kinins, leukotrienes, interleukin-1, and tumor necrosis factor), while amplification factors include semi-starvation, infection, and hemorrhage. The relative role of the various signals in producing the complex injury response has not been finally determined, but the neural pathway is probably most important in releasing the classical endocrine catabolic response, while humoral factors are important for the hyperthermic response, changes in coagulation and fibrinolysis immunofunction, and capillary permeability. ⋯ Systemic opiate administration, as well as non-steroidal antiinflammatory drugs, exert only a small modifying effect on the response. Low-dose combined analgesic regimens may provide total pain relief, but exert no important effect on the stress response. In summary, pain alleviation itself may not necessarily lead to an important modification of the stress response, and a combined approach with inhibition of the neural and humoral release mechanisms is necessary for a pronounced inhibition or prevention of the response to surgical injury.
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Acta Chir Scand Suppl · Jan 1989
ReviewThe influence of anesthesia and postoperative analgesic management of lung function.
General anesthesia itself may influence postoperative lung function. It leads to a depression of the functional residual capacity, which, in combination with surgical trauma and postoperative pain, can provoke insufficient breathing, retention of bronchial secretions, and atelectasis. ⋯ After upper abdominal or thoracic surgery, postoperative epidural analgesia causes a significant increase of lung function as compared with systemic analgesia. The combination of regional anesthesia and general anesthesia intraoperatively appears to reduce lung function much less than general anesthesia alone.