Systemic Host Response in Awake Thoracic Surgery
Pp. 19-33 (15)
Federico Tacconi, Gianluca Vanni and Eugenio Pompeo
Systemic response to surgery entails the activation of hormonal, metabolic and inflammatory
pathways, and may affect postoperative outcome due to interaction with host’s immunity, metabolism,
organ function, coagulation, and wound healing.
In recent years, we have being actively involved with video-assisted thoracoscopic surgery performed
on spontaneously ventilating patients (awake VATS), with the use of just local- or locoregional
anesthesia techniques. Amongst the expected advantages of this approach, an attenuation of
postoperative response has been hypothesized, potentially contributing to a more physiological
recovery. In particular, our recent observation has showed that avoidance of one-lung ventilation may
result into attenuated release of stress hormones and systemic inflammation biomarkers including Creactive
protein and interleukin-6 in patients undergoing awake videothoracoscopic procedure. In this
chapter, we review the basic knowledge on systemic host response after surgery, whit particular
reference to our most recent evidences in this setting.
Local anesthesia, thoracic epidural anesthesia, SIRS, stress response, VATS.
Department of Thoracic Surgery, Policlinico Tor Vergata University, Rome, Italy.