Tesis por compendio de publicaciones[EN]For long years, it was thought that anaesthetic management did not influence
patient’s outcome. Surgical morbidity and long-term mortality were attributed to
patient’s comorbidity, malignance of the disease, risk infection and type of surgery.
Nowadays, there is an increasing evidence that intraoperative anaesthetic
management can influence long-term patient outcomes. In the last two decades,
surgical mortality rates have been falling and, in part, this is due to a huge
improvement in anaesthesia related factors and safety. For an anaesthesiologist,
perioperative care is no longer the simple fact of administrating the anaesthetic drug
and maintaining the patient “asleep”. Direct-guided fluid therapy, maintaining
intraoperative normothermia, minimizing blood transfusion and avoiding low mean
arterial pressure and deep hypnotic level are additional procedures the
anaesthesiologist is responsible for and that will probably improve patient’s outcome
and decrease surgical mortality.
Hypotension after induction of anaesthesia is quite common and more prevalent
during the late post-induction period and before skin incision (5-10 minutes after),
generally thought to be clinically irrelevant. Nowadays, there is some evidence that
small haemodynamic changes, such as hypotension, even for small periods, are
associated with poor patient outcomes, because they have the potential to cause
an ischemia–reperfusion injury which may be manifested as dysfunction of any vital
organ, like acute kidney and myocardial injury. Intra-operative management of
hypotension is usually guided by conventional monitoring (systolic blood pressure and
MAP) but these parameters could mask low levels of blood flow and oxygen delivery,
even for short periods, leading to major surgical complications and longer hospital
stays
