PEDIATRIC SURGICAL STRESS RESPONSE AND ANESTHESIA

Abstract

Surgical trauma disturb the body homeostasis by inducing a combination of local response to tissue injury and generalized activation of systemic metabolic and hormonal pathways via afferent nerve pathways and the central nervous system. The local inflammatory responses and the parallel neurohumoral responses are not isolated but linked through complex signaling networks, some of which remain poorly understood. The stress response to surgical trauma occurs as a protective mechanism, by activating a series of endocrine, metabolic and immune processes which prevent disturbance of homeostasis. The magnitude of the response is broadly related to the site of injury (greater in regions with visceral pain afferents such as abdomen and thorax) and the extent of the trauma. The stress response to surgical trauma is different in premature, newborns, infants, and in children approaching puberty is the more similar as in adults. New anesthetic agents basically do not trigger the endocrine-metabolic response of the body. Endocrine-metabolic, immune and autonomic responses to surgical trauma can be modified using regional anesthetics techniques and the use of analgesics in general anesthesia. It is the duty of each anesthesiologist before the surgery according to the patient and the kind and length of the surgical intervention, to assess which anesthesia technique and which anesthesiological agents is selected for conducting the operation, in order to provide “stress – free” anesthesia.