The physiologic perspective in fluid management in vascular anesthesiology

Knotzer, Hans and Filipovic, Miodrag and Siegemund, Martin and Kleinsasser, Axel. (2014) The physiologic perspective in fluid management in vascular anesthesiology. Journal of Cardiothoracic and Vascular Anesthesia, 28 (6). pp. 1604-1608.

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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.
Faculties and Departments:03 Faculty of Medicine > Bereich Querschnittsfächer (Klinik) > Anästhesiologie > Anästhesiologie (Steiner)
03 Faculty of Medicine > Departement Klinische Forschung > Bereich Querschnittsfächer (Klinik) > Anästhesiologie > Anästhesiologie (Steiner)
UniBasel Contributors:Siegemund, Martin
Item Type:Article, refereed
Article Subtype:Research Article
Publisher:WB Saunders
Note:Publication type according to Uni Basel Research Database: Journal article
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Last Modified:05 Oct 2017 12:05
Deposited On:05 Oct 2017 12:05

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