Intraoperative endpoints of resuscitation

Abstract

Perioperative evaluation and management of the patient has become a major focus of the strategy needed to minimize the risk of complications and to decrease surgical mortality. The endpoints of intraoperative resuscitation depend on the patient’s preoperative condition, including comorbidities, and the type and duration of the surgery being performed. Certain physiological principles apply from the standpoint of the relationship between cellular oxygen delivery and consumption during major surgical procedures, depending on the depth and duration of anesthesia, the magnitude of the planned procedure, and on the risk stratification of the patients with its associated predicted mortality. Attention should be directed to the intraoperative variables that may affect the postoperative course of the patient. The degree and type of hemodynamic monitoring should be selected based on the preoperative condition of the patient and the type of surgery being performed. Simple endpoints that could assure a safe intraoperative and postoperative course in a standard low-risk patient, such as measurement of heart rate, blood pressure, central venous pressure, and urine output, may be inadequate in an operation in a high-risk patient associated with massive fluid shift and blood loss. The role of the oxygen delivery and consumption, arterial base deficit, lactate levels, venous oxygen saturation, and venous-to-arterial CO2 difference as endpoints of resuscitation is described and analyzed in detail. This chapter is based on the review of the best available evidence regarding intraoperative goal-directed therapy and the endpoints of intraoperative resuscitation.