Pavelescu D, Mirea L, Păduraru M, Beuran M, Chiotoroiu Al, Grinţescu I
Clinica ATI, Spitalul Clinic de Urgenţă "Floreasca", Bucureşti, Romania.
Chirurgia (Bucur). 2011 Nov-Dec;106(6):723-8.
A major issue of the surgical anesthetic team is the surgical stress response, with its organ disfunctions, and the postoperative pain with consequences regarding the physiopathologic and socio-economical impact associated with its inadequate therapy. According to the "fast-track" approach, multimodal analgesia has a central place, together with minimal invasive procedures. Opioid-local anesthetic association via thoracic epidural catheter, has become the "anesthetic golden standard", in major thoraco-abdominal surgery. Co-administration of i.v. non-steroid anti-inflammatory drugs, seriously decreases the inflammatory response to the surgical stress, allowing a faster recovery, an early social rehabilitation, and a decrease in morbidity and mortality associated with major neoplasic surgery.
手术麻醉团队面临的一个主要问题是手术应激反应及其导致的器官功能障碍，以及术后疼痛及其因治疗不足而产生的生理病理和社会经济影响。根据“快速康复”方法，多模式镇痛与微创操作一样占据核心地位。在大型胸腹部手术中，通过胸段硬膜外导管联合使用阿片类药物和局部麻醉药已成为“麻醉金标准”。静脉注射非甾体类抗炎药的联合使用可显著降低对手术应激的炎症反应，从而实现更快的恢复、早期的社会康复，并降低与重大肿瘤手术相关的发病率和死亡率。
