Systemic Host Response in Awake Thoracic Surgery

Systemic response to surgery entails the activation of hormonal, metabolic and inflammatory pathways, and may affect postoperative outcome due to interaction with host’s immunity, metabolism, organ function, coagulation, and wound healing.

In recent years, we have being actively involved with video-assisted thoracoscopic surgery performed on spontaneously ventilating patients (awake VATS), with the use of just local- or locoregional anesthesia techniques. Amongst the expected advantages of this approach, an attenuation of postoperative response has been hypothesized, potentially contributing to a more physiological recovery. In particular, our recent observation has showed that avoidance of one-lung ventilation may result into attenuated release of stress hormones and systemic inflammation biomarkers including Creactive protein and interleukin-6 in patients undergoing awake videothoracoscopic procedure. In this chapter, we review the basic knowledge on systemic host response after surgery, whit particular reference to our most recent evidences in this setting.

Keywords: Local anesthesia, thoracic epidural anesthesia, SIRS, stress response, VATS.