[Surgical physiopathology. New results of importance for optimization of the postoperative course]

Complications after major surgery may be related to factors in the surgical stress response with endocrine-metabolic and inflammatory changes. In order to prevent these complications, it is important to understand the stress reaction of each organ system. The inflammatory response may be partly prevented by a minimal invasive surgical technique or by preoperative administration of high-dose steroids. Prevention of the endocrine-metabolic changes is best achieved with neural blockade. Unimodal intervention cannot eliminate morbidity and mortality after major surgery. Thus, multi-modal intervention with attenuation of the surgical stress response, effective dynamic treatment of pain, enforced mobilisation, and nutrition should be employed when possible.