Comprehensive surgical care: less recognized factors in successfull operative treatment

A surgery is a stressful event, physically and psychologically. All surgeries are traumas, and physical response to injury resembles responses to trauma. Two major systemic responses to surgery are the neuroendocrine response and the acute phase response. The neuroendocrine response results mainly because of the loss of blood volume (hypovolemia), which in turn may be caused by the surgical wound itself, the disruption of the vessel, or the loss due to malfunction of the digestive system. Blood volume depletion triggers the activation of the renin-angiotensin-aldosterone pathways that are intended to increase volume by reducing urine production and fluid retention [1‐4]. The cardiovascular system responses by maintaining cardiac output, mainly by increasing contractility and raising the heart rate. There is an activation of the coagulation system and contraction of the blood vessel to stop hemorrhage [4]. …