Frequently 2009 questions: There are many factors that cause inflammatory reactions after surgery, some of which are unavoidable. Inflammatory reactions can affect the function of various organs, what are the anti-inflammatory drugs? When to apply? What is the dosage and duration? Firstly, post-surgical inflammatory reaction is a broad concept involving many elements, and it is not a “disease” in itself. As I have said before, a moderate inflammatory response after surgery is actually beneficial to the body and tissue repair, and can play an important role in fighting disease and preventing further invasion by bacteria or viruses, so we must quit the notion that when we hear “inflammatory response”, it must be something bad and we must suppress it. The inflammatory response should be protected and allowed to play its proper role. Second, we are currently talking about the “excessive inflammatory response” and how we can deal with it. Excessive inflammatory response is often caused by surgery or trauma, and this kind of inflammatory response is beyond the scope of “body defense response”, which can bring excessive damage to the body and even lead to serious complications or death. This excessive inflammatory response can be caused by surgical trauma, such as prolonged blockage of blood flow to the liver during liver surgery, extensive resection and debridement, post-surgical infections, or excessive inflammatory response caused by complications such as leakage. At this point we have to prevent, block, or control it through various measures to ensure a good recovery of the patient. Therefore, the control of excessive inflammatory response is not only limited to pharmacological treatment, but also lies in avoiding or reducing the occurrence of such excessive inflammatory response as much as possible. We have mentioned some of the factors that can cause excessive inflammatory reactions, and we must pay attention to how to effectively avoid such reactions or minimize their occurrence before, during, and after surgery, which I think is the main concept to establish. We should not wait until the excessive inflammatory reaction has occurred and caused serious complications before we think of using any “medicine” to control it, but actually prevent or reduce the excessive postoperative inflammatory reaction throughout the whole patient treatment process. The “Multidisciplinary Expert Consensus on the Regulation of Excessive Inflammatory Response in the Perioperative Period of Hepatectomy”, which was proposed by multidisciplinary experts in China not long ago, has a more detailed description and can be used as a reference. The multidisciplinary expert consensus on the regulation of excessive inflammatory response in the perioperative period of hepatectomy recommends: 1. Excessive inflammatory response and its control are closely related to liver insufficiency or liver failure and serious complications of other organs after hepatectomy. 2. 2. Preoperative assessment should be performed for various risk factors that predispose to excessive inflammatory response. Quantitative scoring of liver reserve function, nutritional status and systemic functional status is of great reference significance. Pre-treatment of abnormal underlying conditions of patients before surgery is the basis for preventing the occurrence of excessive inflammatory reactions. 3.Intraoperative selection of appropriate anesthesia and maintenance of stable vital signs reduce the perturbation to the organism and decrease the systemic stress reaction. 4.Intraoperative follow the principle of minimally invasive and the concept of precise hepatectomy, choose the appropriate hepatic blood flow blocking technique and liver dissection method to reduce intraoperative bleeding, reduce the damage to liver tissue and preserve as much healthy liver tissue as possible to avoid the occurrence of postoperative liver insufficiency or liver failure. 5.Satisfactory postoperative analgesic treatment and maintenance of effective balance of the body’s internal environment, as well as appropriate nutritional support treatment can effectively reduce the stress of the body. Active management of various postoperative complications is the basis for preventing excessive postoperative inflammatory reactions. 6. For patients with underlying pathologies such as cirrhosis and large surgical trauma, postoperative hormones, various liver-protective drugs and ustekin and other drugs that inhibit inflammatory reactions should be actively and reasonably used to protect important organ functions and promote patients’ postoperative recovery. However, even if we make more thoughtful preparations and dispositions during the perioperative period of patients, excessive inflammatory reactions still cannot avoid occurring under some major surgeries and heavy traumas, then we have to use interventions, such as those that can be carried out through the reasonable use of drugs. The most powerful drug against inflammatory response after surgery should be cortisol hormone, and it is also mentioned in the Multidisciplinary Expert Consensus on the Regulation of Excessive Inflammatory Response in the Perioperative Period of Hepatectomy that after extensive liver resection surgery, many hospitals will advocate the use of certain doses of hormones for a short period of time to counteract the severe inflammatory response, which can sometimes have a good effect when applied reasonably; however, the use of hormones after surgery needs to be very However, postoperative hormone use needs to be very careful, because hormones can bring many side effects, so they should be used appropriately, and the amount and time should be well controlled so that the complications of hormones do not appear. We at Peking Union Medical College Hospital rarely use glucocorticoids after liver resection surgery. In addition to hormones, there are other drugs that counteract inflammatory responses in clinical practice, mainly some part-time anti-inflammatory drugs, for example, Temploan, which is actually a broad-spectrum inhibitor of enzymes, but in terms of mechanism of action and practical application, we found that it has certain anti-inflammatory effects and can play a role in protecting postoperative liver function, and in a prospective, randomized, controlled clinical study, we confirmed that it is effective for post-surgical recovery and also that this effect is produced by inhibiting excessive inflammatory response. There are of course other part-time anti-inflammatory drugs that can be applied. Currently, specialized anti-inflammatory drugs are not commonly used in clinical practice. In general, for surgically traumatic procedures, such as larger liver resection hands, we recommend the appropriate application of anti-inflammatory drugs while dealing with the prevention and control of inflammatory reactions. Our department currently routinely uses Temploan. Through all these measures, the aim achieved is to reduce and control excessive inflammatory reactions, improve the patient’s postoperative status, and promote a better recovery. Question by chenyibin77: Where should inflammation management be located in the perioperative management? What is the recommended treatment for inflammation management? Prof. Mao Yirei: Regarding the first question, perioperative inflammation management may be mainly for those larger and more traumatic surgeries, but there are some surgeries with minor injuries where the postoperative inflammatory response is not heavy and the degree of concern is not very great, which means that even if you do not pay attention to the inflammatory response, the patient can recover smoothly with little or no effect, and the position of regulating the excessive inflammatory response is not very important at this time. The management of excessive inflammatory response in the perioperative period we are talking about is usually for patients with major surgery and severe trauma, where the inflammatory response can be so strong that if left unchecked and uncontrolled, it may cause many complications that are detrimental to the patient’s recovery and even lead to death. In this case, it is obvious that the control of excessive inflammatory reactions is very important, and it is no less important than other post-surgical treatments and therapeutic measures. The priority is determined by the patient’s specific situation at different stages of the procedure. The key is to have the concept of excessive postoperative inflammatory response, not to ignore it, and to keep the matter of dealing with inflammatory response in mind in order to strive for the best surgical outcome. Furthermore, postoperative complications and therapeutic measures are complementary. For example, if complications such as bleeding, bile leak or infection occur after surgery, the inflammatory response will be significantly aggravated; and the increase of excessive inflammatory response will in turn aggravate or promote complications or make it difficult to control complications, so we have to consider them comprehensively and deal with them in an integrated manner. If an excessive inflammatory response has already occurred, we can intervene through the rational use of drugs. The most powerful drug to combat inflammatory response after surgery should be cortisol hormone, and it is mentioned in the Multidisciplinary Expert Consensus on the Regulation of Excessive Inflammatory Response in the Perioperative Period of Hepatectomy that after extensive liver resection, many hospitals will advocate the use of certain doses of hormones for a short period of time to combat severe inflammatory response. However, the use of hormones after surgery needs to be very careful, because hormones can bring many side effects, so they should be used appropriately, and the amount and time should be well controlled, so that the complications of hormones cannot appear. We at Peking Union Medical College Hospital rarely use glucocorticoids after liver resection surgery. In addition to hormones, there are other drugs that counteract inflammatory responses in clinical practice, mainly some part-time anti-inflammatory drugs, for example, Temploan, which is actually a broad-spectrum inhibitor of enzymes, but in terms of mechanism of action and practical application, we found that it has certain anti-inflammatory effects and can play a role in protecting postoperative liver function, and in a prospective, randomized, controlled clinical study, we confirmed that it is effective for post-surgical recovery and also that this effect is produced by inhibiting excessive inflammatory response. There are of course other part-time anti-inflammatory drugs that can be applied. Currently, specialized anti-inflammatory drugs are not commonly used in clinical practice. In fact, the best way to deal with the excessive inflammatory response is to prevent its occurrence and minimize its extent, which is the most effective, economical and beneficial option for the patient.