The catabolic response to surgery: how can it be modified by the anesthesiologist?

Despite profound advances in anesthesia care, feeding techniques, and drug development, the catabolic response to injury still represents a metabolic phenomenon in surgical patients, which deserves the attention of clinicians and researchers. Although there is evidence that single pharmacological interventions are able to modulate protein catabolism, nitrogen losses following surgery cannot be completely suppressed and organ function promptly restored. We believe that multimodal approaches combining analgesic, anesthetic and surgical strategies with the provision of specific nutrients and anabolic agents hold great promise for not only reducing the loss of body protein, but also for accelerating recovery, shortening the length of hospitalization, and reducing convalescence resulting in a major improvement in clinical outcome. Furthermore, the use of tracer methodologies will further increase our understanding of the pathophysiological changes induced by tissue trauma and will help to identify subgroups of patients who might particularly benefit from our therapeutical efforts.