Cardiovascular optimization for high-risk surgery.

Abstract

Controversy still exists concerning the strategy of targeting so-called supranormal levels of oxygen delivery as a means of improving outcome from high-risk surgery. The pathogenesis of postoperative morbidity is not fully defined; however, it seems likely that the gastrointestinal tract plays a pivotal role, particularly as a source of endotoxin, which is a potent stimulator of the inflammatory response. Delayed recovery of gastrointestinal function also is a major contributor to postoperative morbidity. Demonstration of a significant reduction in gut ischemia, endotoxemia, postoperative inflammatory response, and morbidity in a high-risk general surgical population as a result of perioperative hemodynamic optimization would be a highly worthwhile study.