MULTIMODAL APPROACH TO CONTROL POSTOPERATIVE PATHOPHYSIOLOGY AND REHABILITATION

Major surgery is still associated with undesirable sequelae such as pa in, cardiopulmonary, infective and thromboembolic complications, cereb ral dysfunction, nausea and gastrointestinal paralysis, fatigue and pr olonged convalescence. The key pathogenic factor in postoperative morb idity, excluding failures of surgical and anaesthetic technique, is th e surgical stress response with subsequent increased demands on organ function. These changes in organ function are thought to be mediated b y trauma-induced endocrine metabolic changes and activation of several biological cascade systems (cytokines, complement, arachidonic acid m etabolites, nitric oxide, free oxygen radicals, etc). To understand po stoperative morbidity it is therefore necessary to understand the path ophysiological role of the various components of the surgical stress r esponse and to determine if modification of such responses may improve surgical outcome. While no single technique or drug regimen has been shown to eliminate postoperative morbidity and mortality, multimodal i nterventions may lead to a major reduction in the undesirable sequelae of surgical injury with improved recovery and reduction in postoperat ive morbidity and overall costs.