Restoring microcirculation in anesthesia: Impact, usefulness and controversies

Publication date: Available online 3 April 2016 Source:Colombian Journal of Anesthesiology Author(s): Diana Patricia Ñáñez-Varona, Adolfo León Tróchez-Zuleta, William Andrés Vargas-Garzón Mentioning microcirculation and endothelial dysfunction to explain the pathophysiology of diseases whose relationship was not well understood is a recent phenomenon. Microcirculation is not only compromised by disease but can be altered by conditions that the anesthesiologist faces (agents and anesthetic techniques). There is significant and increasing evidence that anesthetic agents may alter it. The importance? In a state of hypoperfusion, it can be worsened by other factors (mechanical ventilation, vasoactive medications, sedatives, opioids). In shock's late stage, the support to tissue perfusion given by peripheral circulation is weak and disappears. Therefore, is it beneficial to direct targeted therapies only toward macrovascular goals? Methods for identifying early alteration and direct therapies for restoration are important. The clinical evaluation is rapid and reproducible, and measuring body temperature determines alteration indirectly. There are other methods to determine microcirculation objectively: nowadays, optical evaluation techniques using polarized orthogonal spectral light and sidestream dark-field are the best approach. In hemorrhagic shock the degree of organ dysfunction is determined by microvasculature's alteration. Compensatory mechanisms exist for ...
Source: Colombian Journal of Anesthesiology - Category: Anesthesiology Source Type: research