Читать книгу Complications in Equine Surgery - Группа авторов - Страница 22

All surgery leads to systemic inflammatory response syndrome (SIRS). The majority of information is found in the human literature. It is assumed that similar effects can be found in the equine patient. The inflammatory response consists of hormonal, metabolic and immunological components. The more severe the surgical insult, the more severe the inflammatory response [80]. The hormonal response is characterized by various stress hormones. In people, adrenaline and cortisol levels are increased in the face of surgery, as are glucagon, growth hormone, aldosterone and antidiuretic hormone. The extent of surgical trauma correlates well with the levels of ACTH and cortisol [81]. If patients develop postoperative complications, other abnormalities can occur. In people, critically ill patients can have a cortisol deficiency. High dose therapy with glucocorticosteroids has been associated with increased mortality, while low doses may have beneficial effects by increasing their response to noradrenaline [82]. The metabolism is decreased in the first few hours after surgery. However, this is soon followed by a catabolic and hypermetabolic phase. This phase is characterized by break down of skeletal muscle and fat [83]. Oxygen delivery to the tissues is important during this hypermetabolic phase. The body reacts by vasodilating, increasing the heart rate, increasing cardiac output, and increasing the respiratory rate [84]. A leukocytosis occurs in the peripheral blood and granulocytes and macrophages accumulate in the damaged tissues [85]. Many pro‐inflammatory cytokines are released leading to inflammation. The amount of cytokine release is well correlated with both the magnitude and duration of surgery and the risk of postoperative complications. If the initial pro‐inflammatory response is exaggerated, sever systemic inflammatory response syndrome may occur.