title: Microvascular dysfunction in the surgical patient.
abstract: 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.
authors.affiliation: Department of Translational Physiology, Academic Medical Center, Amsterdam, The Netherlands.
authors.forename: Namkje A R
authors.initials: NA
authors.lastname: Vellinga
authors.forename: Can
authors.initials: C
authors.lastname: Ince
authors.forename: E Christiaan
authors.initials: EC
authors.lastname: Boerma
mesh_terms: 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