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Microvascular dysfunction in the surgical patient

Vellinga, Namkje ARa,b; Ince, Cana; Boerma, E Christiaana,b

Current Opinion in Critical Care:
doi: 10.1097/MCC.0b013e32833a0633
Postoperative problems: Edited by Rupert Pearse
Abstract

Purpose of review: This review aims to describe recent research on perioperative microvascular alterations, with an emphasis on direct visualization of the human microcirculation.

Recent findings: Despite systemic haemodynamic optimization, perioperative complications are still occurring. In surgery, recent studies on both direct visualization of the microcirculation and indirect quantification of organ perfusion revealed that both the surgical procedure itself and perioperative interventions like anaesthesia, cardiopulmonary bypass, vasoactive drugs and fluid therapy may influence organ perfusion at the microvascular level. As in sepsis and heart failure, these perioperative microcirculatory abnormalities were associated with prognosis. However, whether these microcirculatory alterations are culprit or bystander in the process of developing perioperative complications remains to be established.

Summary: Recent research has elucidated the incidence of perioperative microvascular alterations, as well as its association with prognosis. Future research should further unravel the fascinating and complex interplay between the microcirculation and perioperative interventions.

Author Information

aDepartment of Translational Physiology, Academic Medical Center, Amsterdam, The Netherlands

bDepartment of Intensive Care, Medical Center Leeuwarden, Leeuwarden, The Netherlands

Correspondence to E. Christiaan Boerma, Medical Center Leeuwarden, Department of Intensive Care, P.O. Box 888, 8901 BR Leeuwarden, The Netherlands Tel: +31 582866737; fax: +31 582866715; e-mail: e.boerma@chello.nl

© 2010 Lippincott Williams & Wilkins, Inc.