Peri-operative cardiovascular optimization

Many studies show that post-operative mortality in identifiable subgroups of patients is higher than expected. Often the cause is obscure, but tissue hypoperfusion resulting in multiple organ dysfunction syndrome appears to be a major factor. A number of techniques are available to monitor and then to improve tissue perfusion by treatment with fluids and pharmacological agents (usually vasodilators and inotropes) to predefined values. Meta-analysis of 13 randomized, controlled studies enrolling 994 patients shows a significant reduction in mortality in the treatment group (odds ratio 0•35, 95% confidence interval 0•23–0•53). Implementing the proposed techniques on all suitable patients is controversial as this has major service implications and some questions remain unanswered. However, peri-operative cardiovascular optimization in selected groups of patients is shown to reduce the likelihood of mortality and morbidity for those patients and by reducing costs and hospital stay may help to streamline care for all surgical patients.