Anesth Pain Med.  2022 Jan;17(1):24-34. 10.17085/apm.22127.

Microcirculation during surgery

• Nam K
• Jeon Y

• KMID: 2526524
• DOI: http://doi.org/10.17085/apm.22127

Abstract

Throughout the long history of surgery, there has been great advancement in the hemodynamic management of surgical patients. Traditionally, hemodynamic management has focused on macrocirculatory monitoring and intervention to maintain appropriate oxygen delivery. However, even after optimization of macro-hemodynamic parameters, microcirculatory dysfunction, which is related to higher postoperative complications, occurs in some patients. Although the clinical significance of microcirculatory dysfunction has been well reported, little is known about interventions to recover microcirculation and prevent microcirculatory dysfunction. This may be at least partly caused by the fact that the feasibility of monitoring tools to evaluate microcirculation is still insufficient for use in routine clinical practice. However, considering recent advancements in these research fields, with more popular use of microcirculation monitoring and more clinical trials, clinicians may better understand and manage microcirculation in surgical patients in the future. In this review, we describe currently available methods for microcirculatory evaluation. The current knowledge on the clinical relevance of microcirculatory alterations has been summarized based on previous studies in various clinical settings. In the latter part, pharmacological and clinical interventions to improve or restore microcirculation are also presented.

Keyword

Hemodynamic monitoring; Intensive care; Microcirculation; Perioperative care; Surgery

Figure

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  Fig. 1. Direct inspection of microcirculation and video acquisition from the sublingual mucosa (A); images are stored in a computer, which is connected to a handheld vital microscope (B).

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  Fig. 2. Vascular occlusion test (A) and a schematic plot of the change in tissue oxygenation (B).

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  Fig. 3. A laser Doppler flowmetry device (MoorLDI, Moor Instruments Ltd., UK) for microcirculatory evaluation. Visualized objects such as the hand or foot is placed under the imager like X-ray shooting.

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