Pharmacological modification of the perioperative stress response in non-cardiac surgery

Publication date: Available online 7 April 2016 Source:Best Practice & Research Clinical Anaesthesiology Author(s): Hans-Joachim Priebe The perioperative period is associated with alterations in the neuroendocrine, metabolic, and immune systems, referred to as 'stress response'. The resultant increased sympathetic activity and elevated serum concentrations of catecholamines may adversely affect the cardiovascular system resulting in cardiovascular instability (hypertension, tachycardia, arrhythmia), morbidity (myocardial ischemia, myocardial infarction, stroke) and mortality (cardiac death, fatal stroke), particularly in patients at elevated cardiovascular risk and with reduced cardiovascular reserve. Various strategies have been employed to ameliorate the adverse perioperative cardiovascular sequelae of the perioperative stress response. Effective pharmacologic blunting of the stress response plays a crucial role in perioperative cardiac risk reduction strategies. In this context, the role of beta-adrenoceptor blockers, alpha2-adrenoceptor agonists and statins has extensively been examined. This chapter evaluates the available evidence with respect to treatment efficacy of these commonly prescribed drugs in patients undergoing non-cardiac surgery.
Source: Best Practice and Research Clinical Anaesthesiology - Category: Anesthesiology Source Type: research