SU1.1-3 | Metabolic Response and Surgical Homeostasis — Glossary

Hepatic shift, driven mainly by IL-6, that raises C-reactive protein and fibrinogen and lowers albumin during injury/inflammation.

Adrenal mineralocorticoid that conserves sodium (and hence water) after injury via the renin-angiotensin-aldosterone system.

Posterior-pituitary hormone secreted after injury to conserve water and defend circulating volume.

A six-grade scale (I-VI, with an E suffix for emergencies) that grades a patient's systemic disease burden, not the difficulty of the operation.

Adrenaline and noradrenaline from the sympathoadrenal system, causing tachycardia, vasoconstriction and glycogenolysis.

Shock in which vasoconstriction and tachycardia maintain blood pressure despite hypoperfusion; hypotension is a late sign.

The dominant catabolic glucocorticoid of the injury response, promoting gluconeogenesis, proteolysis, lipolysis and insulin resistance.

Cortisol, catecholamines and glucagon, which oppose insulin and drive post-injury hyperglycaemia and catabolism.

Researcher who first described the ebb and flow phases of the metabolic response to injury from studies of fracture patients.

Post-injury hyperglycaemia caused by counter-regulatory hormones and peripheral insulin resistance, not true diabetes mellitus.

The early, short hypometabolic phase after injury — hypovolaemia, vasoconstriction, hypothermia and reduced metabolic rate (Cuthbertson).

Evidence-based perioperative bundles, first validated in colorectal surgery, that combine optimisation, minimally invasive technique, early feeding and mobilisation to speed recovery and shorten hospital stay.

The later hypermetabolic phase — catabolic first (fat/protein breakdown, fever) then anabolic (tissue rebuilding).

Maintenance of a stable internal environment (temperature, pH, osmolality, glucose, volume) within narrow limits through negative-feedback control.

The principal pro-inflammatory cytokine driving the hepatic acute-phase response after injury.

A genuine shared understanding in which the patient agrees to a procedure after being told its nature, benefits, risks and alternatives.

The period in the operating theatre from anaesthetic induction to the end of surgery, focused on anaesthesia, asepsis, correct-site surgery, normothermia and monitoring.

A I-IV scale grading the visible oropharyngeal structures to predict difficulty of intubation — an airway tool distinct from the ASA score.

The coordinated neuroendocrine, inflammatory and metabolic changes that follow significant trauma, surgery, burns or sepsis.

Combining several analgesic methods (e.g. regional blockade, paracetamol, opioids) to control postoperative pain while limiting the dose and side effects of any one drug.

State in which nitrogen (protein) loss exceeds intake, reflecting the catabolic muscle breakdown of the flow phase.

Maintenance of normal body temperature during surgery; hypothermia worsens bleeding, infection and the metabolic stress response.

The structured, coordinated management of a surgical patient across the whole episode — from the decision to operate, through the operation, to full recovery and discharge.

The recovery area where airway, breathing and circulation are monitored immediately after surgery until the patient is awake and stable.

The period from the end of the operation through recovery and the ward stay to discharge, focused on analgesia, fluids, VTE prophylaxis, mobilisation and complication surveillance.

Minimum fasting before anaesthesia to reduce aspiration risk: clear fluids 2 h, breast milk 4 h, formula/light meal 6 h, fatty food or meat 8 h.

The period from the decision to operate until transfer to theatre, focused on assessment, risk stratification, optimisation, consent, fasting and prophylaxis.

The pause before skin incision in which the whole team confirms the correct patient, procedure and operative site.

Early pro-inflammatory cytokine contributing to fever, catabolism and immune activation after injury.

Mechanical and/or pharmacological measures to prevent deep vein thrombosis and pulmonary embolism in immobile surgical patients, guided by a risk-assessment tool.

A clinical pre-test probability score for deep vein thrombosis or pulmonary embolism, used in VTE risk assessment.

A three-pause team checklist — Sign-In (before induction), Time-Out (before incision) and Sign-Out (before leaving theatre) — that prevents avoidable surgical harm.