Determinants of Catecholamine and Cortisol Responses to Lower Extremity Revascularization

Breslow, Michael J.; Parker, Stephen; Frank, Steven M.; Norris, Edward J.; Yates, H L; Raff, Hershel; Rock, Peter; Christopherson, Rose; Rosenfeld, Brian A.; Beattie, Charles

doi:10.1097/00000542-199312000-00010

Cited by 152 publications

(63 citation statements)

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“…O parto vaginal parece ser a via de eleição, pois o risco de sangramento no parto cesariano é maior, bem como a duração do estresse e das alterações endócrino-metabólicas e imunológicas, o que poderia resultar em risco aumentado de eventos trombóticos 15 . Contudo, o estresse do trabalho de parto desencadeia resposta neuroendócrina e metabólica semelhante a do estresse cirúrgico, resultando em ativação do eixo hipotálamo-hipofisário e conseqüente estado de hipercoagulabilidade [17][18][19] . Portanto, a escolha da técnica anestésica neste caso deve objetivar, além do conforto materno e bem estar fetal, a atenuação da resposta ao do estresse do trabalho de parto.…”

Section: Discussionunclassified

“…Vaginal delivery seems to be the method of choice because bleeding risk in C-section is higher, as well as stress and endocrine-metabolic and immune changes duration, which could result in increased risk for thrombotic events 15 . However, labor stress triggers neuroendocrine and metabolic response similar to surgical stress, resulting in hypothalamohypophysial axis activation and consequent hypercoagulability [17][18][19] . So, anesthetic technique in this case should aim at maternal comfort and fetal wellbeing in addition to attenuating labor stress response.…”

Section: P R O T E I N S D E F I C I E N C Y a S S O C I A T E D T O mentioning

confidence: 99%

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Analgesia de parto em paciente portadora de deficiência de proteína S: relato de caso

Stocche¹,

Garcia²,

Reis³

et al. 2004

Rev. Bras. Anestesiol.

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Section: Discussionunclassified

Section: P R O T E I N S D E F I C I E N C Y a S S O C I A T E D T O mentioning

confidence: 99%

Analgesia de parto em paciente portadora de deficiência de proteína S: relato de caso

Stocche¹,

Garcia²,

Reis³

et al. 2004

Rev. Bras. Anestesiol.

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“…In a study of regional block after knee arthroplasty, clinical signs of inflammation were reduced although there were no detectable changes in levels of measured cytokines 111 . Epidural anesthesia reduces the plasma levels of norepinephrine during surgery when compared to general anesthesia 112 . This holds true when combined general and epidural anesthesia is compared to general anesthesia alone 113 .…”

Section: Iiid1 the Effect Of Anesthetic Technique: General Versus Rementioning

confidence: 99%

Anesthesia, Microcirculation, and Wound Repair in Aging

Bentov¹,

Reed²

2014

Survey of Anesthesiology

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Age related changes in skin contribute to impaired wound healing after surgical procedures. Changes in skin with age include decline in thickness and composition, a decrease in the number of most cell types and diminished microcirculation. The microcirculation provides tissue perfusion, fluid homeostasis, and delivery of oxygen and other nutrients. It also controls temperature and the inflammatory response. Surgical incisions cause further disruption of the microvasculature of aged skin. Perioperative management can be modified to minimize insults to aged tissues. Judicious use of fluids, maintenance of normal body temperature, pain control and increased tissue oxygen tension are examples of adjustable variables that support the microcirculation. Anesthetic agents influence the microcirculation from a combination of effects on cardiac output, arterial pressure and local micro-vascular changes. We examine the role of anesthetic management in optimizing the microcirculation and potentially improving postoperative wound repair in older persons. I. BackgroundSurgical wound repair is a major problem in the older population 1 , who are at increased risk of wound dehiscence and infection 2 . As a specific example, surgical site infections (SSI) are common (about 500,000 cases annually in the United States), lead to worse patient outcome (patients who develop SSI are twice as likely to die 3 ), and are an enormous economic burden (1-10 billion dollars annually) 4 . Many factors contribute to age related changes in skin 5 and subsequent vulnerability to impaired wound healing and infection. Changes in skin with age ( Figure 1) include a decline in epidermal and dermal thickness and composition, as well as a decrease in the number of most resident cell types. The dermalepidermal junction is flattened and the microcirculation is diminished 6 . The latter is defined as blood flow through arterioles, capillaries and venules and is the key system that affects the entire skin surface. In the aging patient, the skin's microcirculation is reduced by 40% between the ages of 20 to 70 years 7 . The microcirculation provides tissue perfusion, fluid hemostasis, and delivery of oxygen and other nutrients. It also controls temperature and the inflammatory response. Surgical incisions cause disruption of the skin's microcirculation as manifested by local edema resulting from vasodilation and increased vascular permeability. Summary StatementAged skin is at increased risk of poor post-operative wound healing. Changes in the cutaneous microcirculation with aging contribute to this risk. This review examines the role of anesthesia management on microcirculatory function. In this review, we will use skin as a representative organ to describe age-related changes that negatively affect the microcirculation and have subsequent impacts on wound healing and the incidence of postoperative infection. We will then examine the role of anesthesia management in minimizing detrimental effects on the microcirculation. A greater understanding of...

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“…Descending cortical pathways inhibit nociception, so that their absence exaggerates nociception [473]. [474][475][476][477][478][479]. This explains the release of stress hormones (VWF, cortisol, epinephrine, glucagon, etc.)…”

Section: The Spinal Pathwaymentioning

confidence: 99%

Stress repair mechanism activity explains inflammation and apoptosis

Coleman¹

2012

ABB

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Determinants of Catecholamine and Cortisol Responses to Lower Extremity Revascularization

Cited by 152 publications

References 0 publications

Analgesia de parto em paciente portadora de deficiência de proteína S: relato de caso

Analgesia de parto em paciente portadora de deficiência de proteína S: relato de caso

Anesthesia, Microcirculation, and Wound Repair in Aging

Stress repair mechanism activity explains inflammation and apoptosis

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