• Moritz Flick, Luisa Briesenick, Sven Peine, Scheeren Thomas W L TWL, Jacques Duranteau, and Bernd Saugel.
• From the Department of Anesthesiology, Center of Anesthesiology and Intensive Care Medicine (MF, LB, BS), Institute for Transfusion Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany (SP), Department of Anesthesiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands (TWLS), Department of Anesthesia and Intensive Care, Hôpitaux Universitaires Paris Saclay, Université Paris Saclay, Le Kremlin Bicêtre, France (JD) and Outcomes Research Consortium, Cleveland, Ohio, USA (BS).
• Eur J Anaesthesiol. 2021 May 1; 38 (5): 459-467.

BackgroundIt is not clear whether moderate intraoperative blood loss and norepinephrine used to restore the macrocirculation impair the microcirculation and affect microcirculation/macrocirculation coherence.ObjectiveWe sought to investigate the effect of moderate intraoperative blood loss and norepinephrine therapy administered to treat intraoperative hypotension on the sublingual microcirculation.DesignProspective observational study.SettingUniversity Medical Center Hamburg-Eppendorf, Hamburg, Germany, from November 2018 to March 2019.PatientsThirty patients scheduled for open radical prostatectomy and 29 healthy volunteer blood donors.InterventionSimultaneous assessment of the macrocirculation using a noninvasive finger-cuff method and the sublingual microcirculation using vital microscopy.Main Outcome MeasuresThe main outcome measures were changes in the sublingual microcirculation caused by moderate intraoperative blood loss and norepinephrine therapy.ResultsGeneral anaesthesia decreased median [IQR] mean arterial pressure from 100 [90 to 104] to 79 [69 to 87] mmHg (P < 0.001), median heart rate from 69 [63 to 79] to 53 [44 to 62] beats per minute (P < 0.001), median cardiac index from 2.67 [2.42 to 3.17] to 2.09 [1.74 to 2.49] l min-1 m-2 (P < 0.001), and median microvascular flow index from 2.75 [2.66 to 2.85] to 2.50 [2.35 to 2.63] (P = 0.001). A median blood loss of 600 [438 to 913] ml until the time of prostate removal and norepinephrine therapy to treat intraoperative hypotension had no detrimental effect on the sublingual microcirculation: There were no clinically important changes in the microvascular flow index, the proportion of perfused vessels, the total vessel density, and the perfused vessel density. Blood donation resulted in no clinically important changes in any of the macrocirculatory or microcirculatory variables.ConclusionModerate intraoperative blood loss and norepinephrine therapy administered to treat intraoperative hypotension have no detrimental effect on the sublingual microcirculation and the coherence between the macrocirculation and microcirculation in patients having open radical prostatectomy.Copyright © 2021 European Society of Anaesthesiology and Intensive Care. Unauthorized reproduction of this article is prohibited.

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