Cardiovascular optimization for high-risk surgery.
Controversy still exists concerning the strategy of targeting so-called supranormal levels of oxygen delivery as a means of improving outcome from high-risk surgery. The pathogenesis of postoperative morbidity is not fully defined; however, it seems likely that the gastrointestinal tract plays a pivotal role, particularly as a source of endotoxin, which is a potent stimulator of the inflammatory response. Delayed recovery of gastrointestinal function also is a major contributor to postoperative morbidity. Demonstration of a significant reduction in gut ischemia, endotoxemia, postoperative inflammatory response, and morbidity in a high-risk general surgical population as a result of perioperative hemodynamic optimization would be a highly worthwhile study.
Wilson
R J
RJ
Department of Anaesthetics and Intensive Care, York District Hospital, Wigginton Road, York YO31 8HE, UK. jonathan@critbase.demon.co.uk
Woods
I
I
D002316:Cardiotonic Agents / Q000627:therapeutic use; D002320:Cardiovascular Physiological Phenomena; D006439:Hemodynamics; D006801:Humans; D010100:Oxygen / Q000008:administration & dosage*; D011182:Postoperative Care / Q000379:methods; D011183:Postoperative Complications / Q000209:etiology* / Q000517:prevention & control; D011300:Preoperative Care / Q000379:methods*; D018570:Risk Assessment; D013514:Surgical Procedures, Operative / Q000009:adverse effects*; D016896:Treatment Outcome
D002316:Cardiotonic Agents; D010100:Oxygen