[Perioperative optimization using hemodynamically focused echocardiography in high-risk patients-A practice guide].

Area of Science:

• Anesthesiology
• Cardiovascular Physiology
• Critical Care Medicine

Background:

• Increasing number of high-risk patients undergoing surgery.
• Need for timely assessment of perioperative hemodynamics and organ oxygen supply (DO2).
• Limitations of current hemodynamic monitoring in identifying causes of cardiovascular impairment.

Purpose of the Study:

• Present a stepwise algorithm for perioperative echocardiography-based hemodynamic optimization.
• Guide anesthesiologists in managing high-risk noncardiac surgery patients.
• Utilize echocardiography on demand or as a planned intraoperative procedure.

Main Methods:

• Employing echocardiography as a bedside method for hemodynamic assessment.
• Focusing on echocardiography on demand during hemodynamic instability or nonresponse to treatment.
• Utilizing transesophageal echocardiography for planned intraoperative procedures.

Main Results:

• Echocardiography enables timely diagnosis of cardiac filling obstructions and volume status.
• Assessment of right and left heart function and heart valve function is facilitated.
• Bedside echocardiography provides rapid evaluation of hemodynamic parameters.

Conclusions:

• Integrating echocardiographic findings allows for differentiated cardiovascular assessment.
• Enables a pathophysiologically oriented and individualized hemodynamic treatment.
• Echocardiography is crucial for optimizing perioperative hemodynamic management in high-risk patients.