Sustavni upalni odgovor u perioperativnom razdoblju

master's thesis

• Title (english): Systemic inflammatory response in the perioperative period
• Author: Lea Hasnaš
• Mentor: Vilena Vrbanović Mijatović (mentor)
• Committee member: Slobodan Mihaljević (predsjednik povjerenstva)
• Committee member: Dinko Tonković (član povjerenstva)
• Committee member: Vilena Vrbanović Mijatović (član povjerenstva)
• Granter: University of Zagreb; School of Medicine; (Department of Anaesthesiology, Resuscitation and Intensive Care in Surgical Specialities); Zagreb
• Defense date and country: 2024-07-12, Croatia
• Scientific / art field, discipline and subdiscipline: BIOMEDICINE AND HEALTHCARE; Clinical Medical Sciences; Anesthesiology and Reanimatology

Abstract

Operativni postupak vodi do složenog odgovora nativnog i adaptivnog imunosnog
sustava. Kirurški stresni odgovor na sistemskoj razini uzrokuje imunosupresiju, dok lokalno
nastaje upala potaknuta izlučivanjem alarmina. Pretjerano otpuštanje alarmina može dovesti do
nereguliranog postoperativnog upalnog odgovora s povećanim rizikom za razvoj infekcija,
sindroma sistemskog upalnog odgovora i sepse.
Na upalni odgovor mogu djelovati brojni čimbenici, ponajprije kirurški i anesteziološki
postupci. Trajanje operacije, manipulacija i oštećenje tkiva izravno su proporcionalni jačini
kirurškog stresnog odgovora zbog čega se savjetuje primjena minimalno invazivne kirurgije
kada je to moguće. Anestetici i anesteziološke tehnike uključeni su u kompleksnu interakciju s
perioperativnim imunosnim odgovorom. Imunosupresivan utjecaj inhalacijskih anestetika u
slučajevima pretjeranog upalnog odgovora ili ishemijsko-reperfuzijske ozljede može biti
poželjan. Međutim kod već imunokompromitiranih i onkoloških pacijenata treba tražiti načine
ublažavanja njihovog učinka na imunosni odgovor primjenom regionalne anestezije ili
propofola. Međutim, preporuka je brojnih autora provedba dodatnih istraživanja kako bi se
dosadašnja saznanja povezala s kliničkim implikacijama.
Učinci pojedinih anestetika i adjuvantnih lijekova kao i učinci pojedinih tehnika na imunološki
sustav u perioperativnom razdoblju trebali bi biti uključeni u anesteziološki postupak donošenja
odluka. Cilj je ovog rada ponuditi trenutna saznanja o imunomodulacijskom djelovanju
kirurškog i anesteziološkog postupka te kako ih modificirati u korist boljeg postoperativnog
ishoda.

Abstract (english)

The operative procedure leads to a complex response from the innate and adaptive
immune systems. The surgical stress response at the systemic level causes immunosuppression,
while locally, inflammation is triggered by the release of alarmins. Excessive release of
alarmins can lead to a dysregulated postoperative inflammatory response, increasing the risk of
developing infections, systemic inflammatory response syndrome, and sepsis.
Numerous factors can influence the inflammatory response, primarily surgical and anesthetic
procedures. The duration of surgery, tissue manipulation, and tissue damage are directly
proportional to the intensity of the surgical stress response, which is why minimally invasive
surgery is advised whenever possible. Anesthetics and anesthetic techniques are involved in the
complex interaction with the perioperative immune response. The immunosuppressive effect of
inhalational anesthetics in cases of excessive inflammatory response or ischemia-reperfusion
injury can be desirable. However, in immunocompromised and oncological patients, it is
necessary to seek ways to mitigate their impact on the immune response through the use of
regional anesthesia or propofol. Nonetheless, many authors recommend further research to
connect current knowledge with clinical implications.
The effects of specific anesthetics and adjuvant drugs, as well as the effects of certain techniques
on the immune system in the perioperative period, should be included in the anesthetic decisionmaking process. This paper aims to provide a review of current knowledge on the
immunomodulatory effects of surgical and anesthetic procedures and how to modify them to
achieve better postoperative outcomes.

• Keywords: anestetici; imunologija; upala; perioperativna skrb; sindrom sistemskog upalnog odgovora
• Keywords (english): anesthetics; immunology; inflammation; perioperative care; systemic inflammatory response syndrome
• Language: croatian
• URN:NBN: urn:nbn:hr:105:840485
• Study programme: Title: Medicine; Study programme type: university; Study level: integrated undergraduate and graduate; Academic / professional title: doktor/doktorica medicine (doktor/doktorica medicine)
• Type of resource: Text
• File origin: Born digital
• Access conditions: Open access
• Created on: 2024-06-24 12:58:38