Abstract

The vast majority of operations in western countries can be conducted safely. For anesthetic procedures or other therapeutic techniques to make a major impact on patient outcome, they must be applied with benefit to seriously ill patients—those with burns, major injury, sepsis or debilitating disease which limits physiologic reserve. The response to injury and infection can be considered a neuroendocrine reflex response involving afferent signals, efferent signals, and central controllers. Several techniques to modulate these signals have been described. The application of these techniques to the care of the critically ill could modulate the response to injury and favorably affect patient outcome.