Abstract
Tissue injury secondary to surgical lesion produces profound changes in endocrine-metabolic function and defence mechanisms in the patient (inflammatory, immunological), leading to an increase in catabolism, immunosuppression and postoperative morbidity. The best anaesthetic and surgical technique should be capable of modulating this response, especially in major surgery, where it can be most harmful and increase patient morbidity. Many of the changes that maintain homeostasis are controlled by the hypothalamicpituitary- adrenal axis. The autonomic-adrenal response is usually immediate, compared to the hypothalamus-pituitary gland, which is slower and longer lasting. Cytokine synthesis and release are the earliest stages in the response to tissue lesion. The most frequently studied cytokines in surgical stress response are IL-6 and TNF-α. Inflammatory mediator concentrations are direct indicators of perioperative stress, while haemodynamic changes are considered the indirect indicators of this response. Multiple anaesthetic techniques have been described to modify the stress response in patients undergoing elective surgery. The aim of this review is to present clinical evidence on perioperative stress modulation with different anesthetics. We also describe a different point of view in immunomodulation with the intraoperative management of haemodynamic responses with inhalational bolus of sevoflurane or with remifentanil intravenous bolus. The effects of sevoflurane used as an inhalational bolus to counteract patients’ intraoperative haemodynamic responses modulates the immune response the same than opioid remifentanil.
Keywords: Sevoflurane, remifentanil, inhalational bolus, stress response, endocrine response, sympathetic response, immune response, cytokines.
Current Pharmaceutical Design
Title:The Effects of Sevoflurane or Remifentanil on the Stress Response to Surgical Stimulus
Volume: 20 Issue: 34
Author(s): Estíbaliz Alsina, Emilio Matute, Ana Domínguez Ruiz-Huerta and Fernando Gilsanz
Affiliation:
Keywords: Sevoflurane, remifentanil, inhalational bolus, stress response, endocrine response, sympathetic response, immune response, cytokines.
Abstract: Tissue injury secondary to surgical lesion produces profound changes in endocrine-metabolic function and defence mechanisms in the patient (inflammatory, immunological), leading to an increase in catabolism, immunosuppression and postoperative morbidity. The best anaesthetic and surgical technique should be capable of modulating this response, especially in major surgery, where it can be most harmful and increase patient morbidity. Many of the changes that maintain homeostasis are controlled by the hypothalamicpituitary- adrenal axis. The autonomic-adrenal response is usually immediate, compared to the hypothalamus-pituitary gland, which is slower and longer lasting. Cytokine synthesis and release are the earliest stages in the response to tissue lesion. The most frequently studied cytokines in surgical stress response are IL-6 and TNF-α. Inflammatory mediator concentrations are direct indicators of perioperative stress, while haemodynamic changes are considered the indirect indicators of this response. Multiple anaesthetic techniques have been described to modify the stress response in patients undergoing elective surgery. The aim of this review is to present clinical evidence on perioperative stress modulation with different anesthetics. We also describe a different point of view in immunomodulation with the intraoperative management of haemodynamic responses with inhalational bolus of sevoflurane or with remifentanil intravenous bolus. The effects of sevoflurane used as an inhalational bolus to counteract patients’ intraoperative haemodynamic responses modulates the immune response the same than opioid remifentanil.
Export Options
About this article
Cite this article as:
Alsina Estíbaliz, Matute Emilio, Ruiz-Huerta Domínguez Ana and Gilsanz Fernando, The Effects of Sevoflurane or Remifentanil on the Stress Response to Surgical Stimulus, Current Pharmaceutical Design 2014; 20 (34) . https://dx.doi.org/10.2174/1381612820666140325105723
DOI https://dx.doi.org/10.2174/1381612820666140325105723 |
Print ISSN 1381-6128 |
Publisher Name Bentham Science Publisher |
Online ISSN 1873-4286 |
Call for Papers in Thematic Issues
"Tuberculosis Prevention, Diagnosis and Drug Discovery"
The Nobel Prize-winning discoveries of Mycobacterium tuberculosis and streptomycin have enabled an appropriate diagnosis and an effective treatment of tuberculosis (TB). Since then, many newer diagnosis methods and drugs have been saving millions of lives. Despite advances in the past, TB is still a leading cause of infectious disease mortality ...read more
Current Pharmaceutical challenges in the treatment and diagnosis of neurological dysfunctions
Neurological dysfunctions (MND, ALS, MS, PD, AD, HD, ALS, Autism, OCD etc..) present significant challenges in both diagnosis and treatment, often necessitating innovative approaches and therapeutic interventions. This thematic issue aims to explore the current pharmaceutical landscape surrounding neurological disorders, shedding light on the challenges faced by researchers, clinicians, and ...read more
Emerging and re-emerging diseases
Faced with a possible endemic situation of COVID-19, the world has experienced two important phenomena, the emergence of new infectious diseases and/or the resurgence of previously eradicated infectious diseases. Furthermore, the geographic distribution of such diseases has also undergone changes. This context, in turn, may have a strong relationship with ...read more
Melanoma and Non-Melanoma Skin Cancer Treatment: Standard of Care and Recent Advances
In this thematic issue, we aim to provide a standard of care of the diagnosis and treatment of melanoma and non-melanoma skin cancer. The editor will invite authors from different countries who will write review articles of melanoma and non-melanoma skin cancers. The Diagnosis, Staging, Surgical Treatment, Non-Surgical Treatment all ...read more
- Author Guidelines
- Graphical Abstracts
- Fabricating and Stating False Information
- Research Misconduct
- Post Publication Discussions and Corrections
- Publishing Ethics and Rectitude
- Increase Visibility of Your Article
- Archiving Policies
- Peer Review Workflow
- Order Your Article Before Print
- Promote Your Article
- Manuscript Transfer Facility
- Editorial Policies
- Allegations from Whistleblowers
- Announcements
Related Articles
-
Implication of Gut Microbiota in Human Health
CNS & Neurological Disorders - Drug Targets Targeting Vascular Niche by Parathyroid Hormone
Current Medicinal Chemistry The Yin and Yang of Inflammation
Current Molecular Medicine Ischemic and Oxidative Damage to the Hypothalamus May Be Responsible for Heat Stroke
Current Neuropharmacology Application of Proteomics in Cardiovascular Research
Current Proteomics Review of the Biological Activity of Maslinic Acid
Current Drug Targets Hypertension and Angiogenesis
Current Pharmaceutical Design Chios Gum Mastic: A Review of its Biological Activities
Current Medicinal Chemistry Cardiac Effects of HDL and Its Components on Diabetic Cardiomyopathy
Endocrine, Metabolic & Immune Disorders - Drug Targets Inflammation in Cardiovascular Disease and Regulation of the Actin Cytoskeleton in Inflammatory Cells: The Actin Cytoskeleton as a Target
Cardiovascular & Hematological Agents in Medicinal Chemistry Genes Involved in Hereditary Hearing Impairment
Current Genomics Homocysteine, Intracellular Signaling and Thrombotic Disorders
Current Medicinal Chemistry Adverse Drug Reactions in a Pulmonary Teaching Hospital: Incidence, Pattern, Seriousness, and Preventability
Current Drug Safety Development of Nitric Oxide Donors for the Treatment of Cardiovascular Diseases
Cardiovascular & Hematological Agents in Medicinal Chemistry Incretin-based Therapies for Type 2 Diabetes Mellitus: Effects on Insulin Resistance
Current Diabetes Reviews The Role of Interleukin-18 in the Development and Progression of Atherosclerosis
Current Medicinal Chemistry The Effect of Acute Hypoxia on Excitability in the Heart and the L-Type Calcium Channel as a Therapeutic Target
Current Drug Discovery Technologies Adverse Effects of Statins - Mechanisms and Consequences
Current Drug Safety Toll-like Receptors and Diabetes Complications: Recent Advances
Current Diabetes Reviews Clinical Approach to Diabetic Cardiomyopathy: A Review of Human Studies
Current Medicinal Chemistry