Optimization of intraoperative strategy (depth of anesthesia, hemodynamics, ventilation)
Seance of wednesday 25 march 2026 (L'Académie reçoit la SFAR (Société Française d'Anesthésie Réanimation))
DOI number : 10.26299/xzmd-9r80/emem.2026.13.03
Abstract
Major surgery induces a systemic inflammatory response associated with an increase in tissue oxygen demand. The inability to match oxygen delivery (DO₂) to this increased demand is a key determinant of postoperative outcomes.
This mismatch between oxygen supply and demand results not only from patient comorbidities and the severity of surgical trauma, but also from anesthetic management, which aims to prevent it through several complementary strategies.
Protective ventilation helps preserve gas exchange during the intraoperative period and in the immediate postoperative phase by limiting alveolar injury and preventing atelectasis. Intraoperative hemodynamic optimization aims to maintain adequate organ perfusion pressure and sufficient tissue oxygen delivery, based on individualized targets using macrocirculatory parameters such as arterial pressure, stroke volume, or cardiac output.
Finally, monitoring the depth of anesthesia helps avoid anesthetic overdosing, reduces its hemodynamic consequences, and may contribute to lowering the risk of delirium, particularly in patients with impaired cognitive reserve.
This mismatch between oxygen supply and demand results not only from patient comorbidities and the severity of surgical trauma, but also from anesthetic management, which aims to prevent it through several complementary strategies.
Protective ventilation helps preserve gas exchange during the intraoperative period and in the immediate postoperative phase by limiting alveolar injury and preventing atelectasis. Intraoperative hemodynamic optimization aims to maintain adequate organ perfusion pressure and sufficient tissue oxygen delivery, based on individualized targets using macrocirculatory parameters such as arterial pressure, stroke volume, or cardiac output.
Finally, monitoring the depth of anesthesia helps avoid anesthetic overdosing, reduces its hemodynamic consequences, and may contribute to lowering the risk of delirium, particularly in patients with impaired cognitive reserve.