Intraoperative management and hemodynamic monitoring for major abdominal surgery : a narrative review

Background : Several trials suggest that postoperative outcomes may be improved by the use of hemodynamic monitoring, but a survey by the American Society of Anesthesiologists (ASA) and the European Society of Anaesthesiology (ESA) showed that cardiac output is monitored by only 34% of ASA and ESA respondents and central venous pressure is monitored by 73% of ASA respondents and 84% of ESA respondents. Moreover, 86.5% of ASA respondents and 98.1% of ESA respondents believe that their current hemodynamic management could be improved (1). The interaction of general anesthesia and surgical stress is the main problem and the leading cause for postoperative morbidity and mortality. The choice of a suitable hemodynamic monitoring system for patients at high anesthesiological risk is of crucial importance to reduce the incidence of major postoperative complications. The aim of the present review is to summarize the benefits of a defined path beginning before surgery, and discuss the available evidence supporting the efficacy and safety of an individualized hemodynamic approach for major abdominal surgery. Objective : To evaluate the clinical effectiveness of a perioperative hemodynamic therapy algorithm in high risk patients among the first researchers who adopted the combination of hemodynamic and oxygen transport parameters as targets during surgery. They found a correlation between these parameters and outcome (2). As a matter of fact, the identification and treatment of additional correctable problems (i.e. anemia and electrolyte disturbances) is fundamental for a successful anesthesia. The choice of the type of monitoring system necessary for a patient is guided primarily by the patient-related risk (i.e comorbidities) as well as the complexity of the proposed surgical procedure. Nowadays, a standard monitoring during surgery for low-risk patients is based on the recording of non-invasive blood pressure, heart rate by electrocardiographic tracing, peripheral oxygen saturation, depth of anesthesia (DOA) monitoring and capnometry. However, when patient-and surgery-related risks increase, an adequate and more accurate hemodynamic monitoring system should be taken into account. Moreover, the prediction or a prompt intervention to counter perioperative hemodynamic instability episodes, by achieving predefined goals, could help anesthesiologists improve postoperative outcomes.