Effect of anaesthesia and surgery on immunological mechanism(June 1995) Stress response to trauma and surgery(June 2006) -The immunological

implications of anaesthesia practice relate to the possibility,that exposure to anaesthesia and surgery,by depressing a variety of both non-specific resistance mechanisms and specific immune responses,renders patients more liable to infections. -Surgery and trauma consistently elicits a characteristic neuroendocrine and cytokine response in proportion to the extent of injury or metabolic insult. -Components of the stress response I)Neuroendocrine *stimulated by painful afferent neural stimuli reaching the CNS *diminished/eliminated by dense neural blockade from a RA technique ii)Cytokine *stimulated by local tissue damage at the site of surgery itself *not eliminated by RA *diminished by minimally invasive surgery especially laparoscopy -Triggers of the neuroendocrine/cytokine response in patients after surgery *noxious stimuli(especially pain) *local inflammatory tissue factors esp.cytokine

*pain and anxiety *starvation *hypothermia and shivering *Haemorrhage *acidosis *hypoxemia *infection Consequences of the Neuroendocrine stress response i)Protein catabolism -surgery-negative nitrogen balance -catecholamines,cortisol,glucagon,IL-1,IL-6,involved in protelolysis and gluconeogenesis. -leads to weight loss and impaired wound healing ii)Carbohydrate metabolism -hyperglycemia and insulin resistance -due to catechalomaine,cortisol and glucagon iii)Fat metabolism -lipolysis stimulated by catecholamines->increased free fatty acids iv)CVS effects

-stimulate CVS-increased myocardial oxygen demand by increased heart rate and increased BP. -coronary artey vasoconstriction decreases supply of oxygen to myocardium,predisposes to MI. v)RS -decreased FRC -cause if postop pain,which reduces the depth and rate of breathing -when FRC<CC Airway closure occurs v/q mismatch hypoxia vi)GI effect -postop ileus-temporary impairment of motility after major surgery -delays resumption of external diet vii)Immune system immunosupression.