Microvascular dysfunction in the surgical patient.
OBJECTIVE
This review aims to describe recent research on perioperative microvascular alterations, with an emphasis on direct visualization of the human microcirculation.


RESULTS
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.


CONCLUSIONS
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.
Vellinga
Namkje A R
NA
Department of Translational Physiology, Academic Medical Center, Amsterdam, The Netherlands.
Ince
Can
C
Boerma
E Christiaan
EC
D000714:Anastomosis, Surgical; D002315:Cardiopulmonary Bypass / Q000009:adverse effects; D004730:Endothelium, Vascular / Q000473:pathology; D013502:General Surgery; D006439:Hemodynamics; D006801:Humans; D015994:Incidence; D008833:Microcirculation; D010477:Perfusion; D011183:Postoperative Complications / Q000209:etiology*; D011379:Prognosis; D012307:Risk Factors