Perioperative Care

The perioperative and postoperative management of surgical patients requires an integrative insight in cardiovascular physiology and the function of vital organs. In particular, the anesthetic regime, surgery, fluid resuscitation, shock, bleeding and metabolic alterations induce an acute and generalized stress response that may lead to tissue perfusion disturbances and unfavorable patient outcome.

In the research program Perioperative Care we investigate novel strategies for the diagnosis, prevention and treatment of cardiovascular complications related to alterations in tissue perfusion in the perioperative setting. We particularly focus on the interaction between tissue hypoperfusion, endothelial activation and hemostatic abnormalities and their relation to organ dysfunction by exploring underlying mechanisms using a translational approach. This research program is initiated in close collaboration with the departments of Physiology, Cardiology, Cardiosurgery, Vascular surgery and Intensive Care.

Contact

Are you interested in clinical research within the area of Perioperative Care? Please contact the research coordinator: 
Prof.dr. Christa Boer
+31 (0)20 4443830
H 6F034

Loss of microcirculatory perfusion during cardiopulmonary bypass

Cardiac surgery with cardiopulmonary bypass (CPB) is performed in about 14,000 patients per year in the Netherlands. Cardiac surgery is associated with inflammation and acute impairment of microcirculation perfusion, which may both contribute to postoperative organ failure. Recent studies by our group suggest that these microcirculatory derangements are paralleled by loss of endothelial barrier function, but the interdependency between inflammation, vascular leakage and disturbed microcirculation perfusion is poorly understood. An emerging molecular pathway that is thought to play a central role in this pathophysiological concept is the Angiopoietin (Ang)/Tie2 system. While there is evidence that Ang/Tie2 signaling is involved in vascular leakage and inflammation during sepsis, its role in CPB-induced microcirculatory alterations is unknown. 

This research line combines clinical and preclinical research to elucidate whether the CPB-related proinflammatory stimulus leads to vascular leakage and microvascular perfusion disturbances through an Ang/Tie 2-dependent mechanism.

The research is performed in collaboration with the department of Physiology of VUmc (dr. Geerten van Nieuw Amerongen), department of Intensive Care of the UMCG (dr. Matijs van Meurs) and the department of Pathology & Medical Biology of the University Groningen (prof.dr. G. Molema). 

Promovendi: Nick Koning en Nicole Dekker

Perioperative hemostasis and blood management

Anesthesia and surgery are associated with blood loss, which in some patients leads to impaired hemostasis, coagulopathy and allogeneic blood transfusion requirements. The main objective in this research line is to improve our clinical insights in factors that may enhance the risk for perioperative bleeding and blood transfusion. We particularly focus on preoperative risk factors and perioperative interventions that are of influence in blood loss (anemia, anticoagulation, hemodilution), and novel approaches to assess the risk for bleeding (point-of-care coagulation measurements).

The research is performed in collaboration with the department of Cardio-thoracic Surgery of VUmc (dr. Alexander Vonk and Lerau van Barneveld), the department of Vascular Surgery of VUmc (dr. Jan Blankensteijn, dr. Christine Vermeulen) and the department of Anesthesiology of the MC Leeuwarden (dr. Jaap de Vries, dr. Fellery de Lange).

Promovendi: Michael Meesters, Dennis Veerhoek en David Burtman

Preoperative and intraoperative risk factors for the surgical patient

Preoperative and intraoperative risk factors may influence the course of postoperative recovery in surgical patients. In this research line we seek for risk factors related to patient comorbidities that may be of influence on patient outcome, including the presence of autonomic dysfunction and prediabetes. Additionally, we investigate the influence of anesthetic management during awake craniotomies on patient outcome.

The research is performed in collaboration with the department of Cardiology of VUmc (dr. Cor Allaart), the department of Anesthesiology of the Catharina Ziekenhuis (dr. Arthur Bouwman), the department of Public and Occupational Health of VU/VUmc (dr. Evert Verhagen, prof.dr. Willem van Mechelen) and the department of Neurosurgery (dr. Philip de Witt Hamer).

Promovendi:Sander Keet, Noor Keulen en Yen-Mie Lai

Preservation of organ perfusion in the acute and perioperative setting

Anesthesia and surgery are accompanied by acute disturbances in patient hemodynamics and perfusion of the myocardium and kidneys. In this research line we aim to elaborate risk factors for impaired perioperative organ perfusion, and to relate alterations in tissue perfusion in the acute and perioperative setting with impaired, hemostasis, organ function and patient outcome.

The research is performed in collaboration with the department of Intensive Care of VUmc (dr. Monique de Waard), the department of Anesthesiology of the Westfriesgasthuis (dr. Jens-Peter Hering), the department of Anesthesiology of the Catharina Ziekenhuis (dr. Arthur Bouwman), the department of Emergency Medicine (dr. Prabath Nanyakarra) and department of Trauma Surgery (dr. Leo Geeraedts).

Promovendi:Carolien Bulte, Jurre Stens, Arinda Brinkman, Anne Duvekot, Chantal Boly and Victor Viersen

Preservation of vital functions in traumatic brain injury

We previously showed that patients with traumatic brain injury are prone to develop secondary injury, like hemostatic derangements, hypoxia and hypotension. This research line focuses on preservation of vital functions, including patient metabolism and hemostasis, during the acute care of patients with traumatic brain injury in the prehospital or emergency department setting. The final aim of our research is to define novel diagnostic or clinical approaches that may contribute to a reduction of secondary injury in victims of neurotrauma.

Promovendi:Bas Bossers en Simone Dekker.