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LETTER TO THE EDITOR

A Testable Hypothesis That May Explain the Morbidity and Mortality Caused by Surgical Stress

Department of Anesthesiology; Duke University Medical Center; Durham, North California; terri.monk{at}duke.edu (Monk, Weldon) The Cardiovascular Specialists LLC; Hyannis, Massachusetts (Saini) Aspect Medical Systems; Newton, Massachusetts (Sigl)

In Response:

We thank Dr. Coleman for his interest in our article and for his thoughtful comments (1).

An inflammatory response triggered by the stress of surgery and influenced by the cumulative deep hypnotic time is a possible mechanism we discussed in our report (2).

As proposed by Dr. Coleman, we encourage new investigations designed to determine whether different anesthetic strategies can affect long-term outcomes after surgery. Surgical stress and anesthetic effects are inevitably linked. Studies that randomize subjects to different anesthetic techniques may result in group differences in anesthetic hypnotic depth, potentially confounding the finding of a technique effect. For this reason, it is important to separate the potential effects of the anesthetic technique from that of anesthetic hypnotic depth. This separation may be accomplished by careful adherence to an anesthetic titration protocol such as the one used by Johansen et al. (3). Ideally, such careful clinical investigation will determine whether a specific anesthetic technique or strategy can provide a measurable outcome benefit in addition to reducing surgical stress.

REFERENCES

1. Coleman LS. A testable hypothesis that may explain the morbidity and mortality caused by surgical stress. Anesth Analg 2006;103:1589.[Free Full Text]
2. Monk TG, Saini V, Weldon BC, Sigl JC. Anesthetic management and one-year mortality after noncardiac surgery. Anesth Analg 2005;100:4–10.[Abstract/Free Full Text]
3. Johansen JW, Sebel PS, Sigl JC. Clinical impact of hypnotic-titration guidelines based on EEG bispectral index (BIS) monitoring during routine anesthetic care. J Clin Anesth 2000;12:433–43.[Web of Science][Medline]

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