Perioperative hemodynamic monitoring and optimization: from macro- to microcirculation
| PhD ceremony: | Ms I.N. (Ilonka) de Keijzer |
| When: | September 10, 2025 |
| Start: | 14:30 |
| Supervisor: | prof. dr. M.M.R.F. (Michel) Struys |
| Co-supervisor: | dr. J.J. Vos |
| Where: | Academy building RUG / Student Information & Administration |
| Faculty: | Medical Sciences / UMCG |
Perioperative hemodynamic monitoring and optimization: from macro- to microcirculation
Hemodynamic monitoring has evolved significantly from ancient times and its primary goal is to ensure adequate oxygen delivery to organs. Continuous monitoring of organ specific delivery of oxygen remains difficult, and thus factors influencing delivery of oxygen are monitored instead. Finding a balance between oxygen delivery and organ perfusion remains a challenge perioperatively. In this thesis of Ilonka de Keijzer optimization of hemodynamic monitoring and management is explored.
First, we have found that the Hypotension Prediction Index reduced intraoperative hypotension more effectively than traditional methods. However, superiority over more intuitive models should be established.
Second, we found that norepinephrine showed a steeper dose-response curve in healthy volunteers under general anesthesia compared to awake volunteers and that cardiac index was restored at similar dosages as arterial blood pressure.
Third, an extensive review on the use of intraoperative fluids was published, advocating that fluids should be administered with the same caution as drugs.
Finally, we believe that flank oximetry should not be considered a surrogate for renal saturation, since it is unlikely that the renal tissue was within the reach of measurement of the flank sensor.