The recent discovery of the “Mammalian Stress Mechanism” (MSM) [1,
2]enables the Unified Theory of Medicine postulated by Hans Selye. It
confers cohesive theories of anesthesia, analgesia, and allostasis that
enable the alteration of anesthetic technique to optimize surgical
outcome. The MSM continuously maintains and repairs the vertebrate
body in accord with stressful forces and stimuli. Three synergistic
pathways activate the MSM: the nociception pathway, the cognitive
pathway, and the tissue pathway. Emotional mechanisms modulate the
cognitive pathway, which explains allostasis. Surgery simultaneously
stimulates all three synergistic pathways, causing harmful MSM
hyperactivity that manifests as the Surgical Stress Syndrome. Anesthesia
inhibits the cognitive pathway. Analgesia inhibits the nociception
pathway. Synergistic combinations of anesthesia and analgesia minimize
MSM hyperactivity better than either alone. This principle improves
outcome, simplifies anesthetic technique, and minimizes polypharmacy
and drug toxicity. Stress theory can advance surgical safety, accelerate
recovery, minimize complications, reduce costs, enhance patient
comfort, and guide pharmaceutical development to discover treatments
that inhibit the tissue pathway, and thereby eliminate surgical stress
altogether.
1.
Coleman LS: 30 Years Lost in Anesthesia Theory. Cardiovasc Hematol Agents Med
Chem 2012.
2.
Coleman LS: 30 Years Lost in Medical Theory: Hans Selye's Unified Theory of
Medicine and the Stress Repair Mechanism. In Hypotheses in Clinical Medicine. Edited by
Shoja MM ea. New York, NY: Nova Biomedical; 2012