title: The physiologic perspective in fluid management in vascular anesthesiology.
abstract: Vascular surgery patients frequently suffer from atherosclerosis and peripheral arterial occlusive disease generating endothelial dysfunction. Furthermore, ischemia and reperfusion during surgery damage endothelial cells and, especially, the endothelial glycocalix. The damage of the glycocalix promotes an increase in permeability. Not only crystalloids, which freely diffuse between the intravascular and the interstitial compartment, but also colloidal fluids cross from the intravascular space in the interstitial space with the consequence of edema formation. Possible tissue edema may result in an impairment of tissue oxygenation, leading to wound healing disturbances and initiation of inflammatory responses up to tissue apoptosis. Particularly in vascular anesthesia, this possibly means that colloids only should be administered in acute volume resuscitation immediately after unclamping a big vessel for immediate volume restoration. Which colloidal fluid should be administered is still under intense discussion. From a theoretical physiologic point of view, iso-osmolar albumin is the best choice regarding volume effect, antioxidative properties, and protection against destruction of the glycocalix. Nonetheless, albumin experimentally has not lived up to its promise in the clinical setting. Thus, further well-conducted large randomized clinical trials are necessary to ascertain the optimal fluid therapy in vascular surgery patients.
authors.affiliation: Institute for Anesthesiology and Critical Care Medicine, II, Klinikum Wels, Austria. Electronic address: johann.knotzer@klinikum-wegr.at.
authors.forename: Hans
authors.initials: H
authors.lastname: Knotzer
authors.affiliation: Kantonsspital St. Gallen, St. Gallen, Switzerland.
authors.forename: Miodrag
authors.initials: M
authors.lastname: Filipovic
authors.affiliation: Kantonsspital Baden, Baden, Switzerland.
authors.forename: Martin
authors.initials: M
authors.lastname: Siegemund
authors.affiliation: Medical University Innsbruck, Innsbruck, Austria.
authors.forename: Axel
authors.initials: A
authors.lastname: Kleinsasser
mesh_terms: D000776:Anesthesiology / Q000379:methods*; D005440:Fluid Therapy / Q000379:methods*; D006801:Humans; D014656:Vascular Surgical Procedures / Q000379:methods*
keywords: cardiac and vascular surgery; fluid resuscitation; fluid shift; interstitial edema