Current aspects of perioperative fluid handling in vascular surgery

Jacob, Matthias; Chappell, Daniel; Hollmann, Markus W.

doi:10.1097/aco.0b013e32831f1c65

Cited by 18 publications

(8 citation statements)

References 77 publications

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“…VL, but not ANH, was associated with elevation of ANP and shedding of sdc1 and hyaluronic acid [84]. The obvious recommendation, therefore, is to avoid volume loading as far as possible in favour of haemodilution to save blood for abetting any subsequent loss [84][85][86]. Interestingly, heparan sulphate concentrations were not increased in either protocol, a distinction to the changes noted in the study on CABG-linked release of ANP (see above).…”

Section: Figurementioning

confidence: 76%

Degradation of the endothelial glycocalyx in clinical settings: searching for the sheddases

Becker

Jacob

Leipert

et al. 2015

Brit J Clinical Pharma

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361

332

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The endothelial glycocalyx has a profound influence at the vascular wall on the transmission of shear stress, on the maintenance of a selective permeability barrier and a low hydraulic conductivity, and on attenuating firm adhesion of blood leukocytes and platelets. Major constituents of the glycocalyx, including syndecans, heparan sulphates and hyaluronan, are shed from the endothelial surface under various acute and chronic clinical conditions, the best characterized being ischaemia and hypoxia, sepsis and inflammation, atherosclerosis, diabetes, renal disease and haemorrhagic viral infections. Damage has also been detected by in vivo microscopic techniques. Matrix metalloproteases may shed syndecans and heparanase, released from activated mast cells, cleaves heparan sulphates from core proteins. According to new data, not only hyaluronidase but also the serine proteases thrombin, elastase, proteinase 3 and plasminogen, as well as cathepsin B lead to loss of hyaluronan from the endothelial surface layer, suggesting a wide array of potentially destructive conditions. Appropriately, pharmacological agents such as inhibitors of inflammation, antithrombin and inhibitors of metalloproteases display potential to attenuate shedding of the glycocalyx in various experimental models. Also, plasma components, especially albumin, stabilize the glycocalyx and contribute to the endothelial surface layer. Though symptoms of the above listed diseases and conditions correlate with sequelae expected from disturbance of the endothelial glycocalyx (oedema, inflammation, leukocyte and platelet adhesion, low reflow), therapeutic studies to prove a causal connection have yet to be designed. With respect to studies on humans, some clinical evidence exists for benefits from application of sulodexide, a preparation delivering precursors of the glycocalyx constituent heparan sulphate. At present, the simplest option for protecting the glycocalyx seems to be to ensure an adequate level of albumin. However, also in this case, definite proof of causality needs to be delivered.

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Section: Figurementioning

confidence: 76%

Degradation of the endothelial glycocalyx in clinical settings: searching for the sheddases

Becker

Jacob

Leipert

et al. 2015

Brit J Clinical Pharma

Self Cite

361

332

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“…Although several studies have reported the effects of increased perfusion pressure by administration of vasopressors, such as norepinephrine or phenylephrine, for septic shock [15][16][17][18] and vasodilatory state after cardiac surgery, 19 we are not aware of any study investigating the effects of normalizing arterial blood pressure on intestinal microcirculation in the setting of elective abdominal surgery. However, this is an important question in the perioperative period because several recent studies 20 have suggested that perioperative fluid administration should be goal directed, resulting in more restrictive use of intravenous crystalloid fluids. Furthermore, the use of colloids should be restricted mainly to replace intraoperative blood loss.…”

Section: Discussionmentioning

confidence: 99%

“…Furthermore, the use of colloids should be restricted mainly to replace intraoperative blood loss. 20,21 Consequently, hypotension occurring after induction and during maintenance of general anesthesia without significant blood loss should be treated with vasoconstrictor agents.…”

Section: Discussionmentioning

confidence: 99%

Hypotension during Fluid-restricted Abdominal Surgery

et al. 2011

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“…[16]. Ungezielte Volumenboli nach einer "Trial-and-Error"-Methode sind insgesamt kritisch zu betrachten [17], da jeder Patient einen individuellen präoperativen Volumenstatus aufweist, der klinisch kaum einzuschätzen ist [18].…”

Section: Merkeunclassified

Die fokussierte transthorakale Echokardiografie in der perioperativen Versorgung

Vojnar¹,

Zoremba²

2019

Anästhesiol Intensivmed Notfallmed Schmerzther

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ZusammenfassungMithilfe der fokussierten transthorakalen Echokardiografie (TTE) erhalten wir rasch und nichtinvasiv aktuelle Informationen zum hämodynamischen Status eines Patienten. Diese können nachfolgend unsere aktuelle Therapie und dadurch unser Risikomanagement beeinflussen. Postoperativ hat sich die TTE als Untersuchungsmethode im Aufwachraum und auf der Intensivstation bewährt, um lebensbedrohliche Ursachen für eine Kreislaufdepression zeitnah zu diagnostizieren. Akutpathologika wie eine Perikardtamponade oder die fulminante Pulmonalarterienembolie können so schnell erfasst und evtl. auch zeitintensive Transporte in eine CT vermieden werden. Auch präoperativ kann der Einsatz der TTE sinnvoll sein zur Beurteilung des Volumenstatus, der Pumpfunktion oder hämodynamisch relevanter Vitien. Vor allem bei Operationen mit hohem perioperativem Komplikationsrisiko können diese Erkenntnisse mit in eine „goal-directed therapy“ einfließen. Entsprechende Algorithmen für ein erweitertes hämodynamisches Monitoring und das Volumenmanagement existieren bereits in vielen Bereichen – sie werden aber häufig nicht konsequent umgesetzt und in die Abläufe der eigenen Klinik implementiert. Mit diesem Artikel legen wir Nutzen und Relevanz der hämodynamischen Evaluation mittels TTE in jeder Phase der Patientenversorgung dar. Darüber hinaus stellen wir einen möglichen Algorithmus für die Versorgung kritisch kranker Patienten vor, der auf den wichtigsten transthorakalen Untersuchungen und hämodynamischen Messverfahren basiert. Er soll im klinischen Alltag und insbesondere im Bereitschaftsdienst eine Hilfestellung für den sinnvollen Einsatz der TTE bieten.

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Current aspects of perioperative fluid handling in vascular surgery

Abstract: The basis of fluid therapy in vascular surgery is a careful differential indication of the respective classes of preparations. A goal-directed approach might help to avoid hypovolaemia.

Cited by 18 publications

References 77 publications

Degradation of the endothelial glycocalyx in clinical settings: searching for the sheddases

Degradation of the endothelial glycocalyx in clinical settings: searching for the sheddases

Hypotension during Fluid-restricted Abdominal Surgery

Die fokussierte transthorakale Echokardiografie in der perioperativen Versorgung

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