Metaboličke promjene u perioperacijskom razdoblju

master's thesis

• Title (english): Metabolic changes during the perioperative period
• Author: Fran Cuvaj
• Mentor: Dinko Tonković (mentor)
• Committee member: Slobodan Mihaljević (predsjednik povjerenstva)
• Committee member: Daniela Bandić Pavlović (član povjerenstva)
• Committee member: Dinko Tonković (član povjerenstva)
• Granter: University of Zagreb; School of Medicine; (Department of Anaesthesiology, Resuscitation and Intensive Care in Surgical Specialities); Zagreb
• Defense date and country: 2020-07-17, Croatia
• Scientific / art field, discipline and subdiscipline: BIOMEDICINE AND HEALTHCARE; Clinical Medical Sciences; Intensive Care

Abstract

Perioperacijsko razdoblje se definira kao period prije,tijekom i nakon operacije. Obilježeno je stresnom reakcijom na kirurške stresore i posljedičnim metaboličkim promjenama. Kirurški stresori u perioperacijskom razdoblju su trauma tkiva, bol i negativne emocije povezane s operacijom, a aktiviraju stresnu reakciju direktnim i indirektnim putevima. Stresna reakcija tijekom perioperacijskog razdoblja je korisna pod uvjetom da je blaga i prolazna, ali ako je jaka ili produljena dovodi do štetnih posljedica. Stresna reakcija središnjeg živčanog sustava sastoji se od simpatoadrenomedularnog sustava te neuroendokrinog sustava, koji na stresni stimulus luče kataboličke hormone: katekolamine, glukokortikoide i glukagon, čime povećavaju opću stopu metabolizma, dovode do stres-hiperglikemije, katabolizma skeletnog mišićja i posljedične mišićne slabosti, lipolize i imunosupresije. Moderna perioperacijska skrb nastoji selekcionirati bolesnike s visokim rizikom metaboličkih promjena i posljedičnih perioperacijskih komplikacija te ih adekvatno pripremiti za operaciju metodama multimodalne prehabilitacije, kontrolom komorbiditeta te preoperativnom eliminacijom štetnih navika. Tijekom operacije koristi kirurške i anesteziološke metode u svrhu minimalne aktivacije stresne reakcije, odnosno maksimalne atenuacije pokrenute stresne reakcije. Nakon operacije perioperacijska skrb teži što bržem oporavku bolesnika ranom nutritivnom potporom, adekvatnom analgezijom i ranom rehabilitacijom radi reverzije posljedica stresne reakcije na bolesnikov metabolizam. Radi novih izazova u perioperacijskoj skrbi razvijeni su novi programi koji služe što kvalitetnijem oporavku bolesnika.

Abstract (english)

The perioperative period is defined as a period before, during and after a surgical procedure.It's characterized by a stress response to surgical stressors and subsequent metabolic changes. Surgical stressors during the perioperative period are tissue trauma, pain and negative emotions associated with surgery, which active the stress response via direct or indirect pathways. The stress response during the perioperative period is useful if it's mild and transitory, but if it's intense or prolonged it could lead to harmful consequences. The central nervous system stress response is comprised of the sympathoadrenomedullar system and the neuroendocrine system which, if stimulated by a stressor, release catabolic hormones: cathecolamine and glucocorticoids, which increase the metabolic rate, cause stress-hyperglycemia, skeletal muscle catabolism and subsequent muscle weakness, lypolysis and immunosupression. Modern perioperative care strives to select patients with high risk of metabolic changes and subsequent perioperative complications and adequately prepare them for surgery by multimodal prehabilitation, comorbidity control and reduction of bad health habits. During the surgical procedure it uses surgical and anesthetical methods for inhibiting the stress response or maximally attenuating it. After the procedure the perioperative care aspires to maximally speed up patient recovery by reducing pain, enabling eary patient feeding and early ambulation to reverse the effects of the stress response on the patient's metabolism. Because of new challenges in perioperative care new protocols have been developed to aid in improving the quality of patient recovery.

• Keywords: perioperacijsko razdoblje; stresna reakcija; kirurška trauma; kirurški metabolizam; perioperacijska skrb
• Keywords (english): perioperative period; stress response; surgical trauma; metabolism; nutritive support; prehabilitation
• Language: croatian
• URN:NBN: urn:nbn:hr:105:013275
• 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: 2021-07-30 13:11:49