Endocrine and metabolic response to surgery

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Surgery represents a major stress, the metabolic effects of which are more pronounced in infants than adults. In response to surgery, there is an increase in plasma concentrations of adrenaline, noradrenaline, insulin, glucagon, glucose, lactate, pyruvate and alanine. The response is directly proportional to the severity of surgical stress. Cortisol and prolactin levels are also increased postoperatively. Cytokines which mediate the host response to injury, are also implicated. Plasma levels of interleukin-6 and interleukin-8 are increased postoperatively and the increase is exaggerated when postoperative complications arise.

The metabolic complications induced by operative stress may be sufficient to upset the delicate metabolic balance in a sick surgical infant with limited body reserves and immature defence mechanisms. As a result, for similar surgical procedures, infants have a higher morbidity and mortality than adults. To minimize the metabolic consequences in children undergoing surgery, much emphasis is now placed on the need for correction of metabolic abnormalities preoperatively.

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