Hemorheology in Surgery—A Review

Abstract

The rheological behavior of blood and its components under physiologic and pathophysiologic conditions is reviewed, with a focus on the type and extent of pathohemorheological changes in surgical patients during hospitalization and thereafter, as well as their clinical consequences with regard to thromboembolic complications. During the operation and the postoperative period various hemorheological and hemostasiological alterations acquire clinical significance: 1. hyperreagibility of platelets with increased aggregation and adhesion tendency 2. changes in fibrinogen, albumin, and globulin concentrations, which affect viscosity and red cell aggregation 3. impairment of red cell deformability 4. increase in clotting factors 5. disturbance of fibrinolysis characterized by diminution of plasmatic plasmin and increase in antiplasmin activity In addition, anesthetic techniques have also been shown to affect hemorheological and hemostasiological parameters. The complex pattern of pathohemorheological and hemostasiological changes shows that thromboembolism in the course of surgical interventions is provoked by multifactorial disorders. Thrombosis prevention should, therefore, counteract both hemorheological and hemostasiological disturbances. Since pathohemorheological and pathohemostasiological changes are already detectable before, and increase during operation, preventive measures should start before the surgical intervention to obtain maximum benefit. Therapeutic possibilities for the avoidance of these multifactorial disturbances are discussed with particular reference to pentoxifylline, which satisfies the complex requirements of a hemorheologically and hemostasiologically active therapeutic agent.

Investigation of the effects of propofol and vitamin C administration on erythrocyte deformability in rats with streptozotocin-induced

“…Besides, metabolic changes and tissue perfusion due to cardiovascular problems may lead to inadequate recovery in plasma viscosity (41).…”

“…However, whether these agents change plasma rheology and/or anesthesia may result in deterioration of tissue perfusion remains controversial. Changes in plasma viscosity have been listed among the factors associated with anesthesia procedures responsible for deterioration of tissue and organ perfusion (16,17). After surgical procedures performed using general anesthesia, erythrocyte deformability and increased aggregation may be observed (17).…”

Effect of dexmedetomidine on erythrocyte deformability during ischemia-reperfusion injury of liver in diabetic rats

“…Additionally, it has been suggested that the impaired perfusion at the tissue level observed as a complication of diabetes mellitus is primarily due to the reduced erythrocyte deformability (33,34). Besides, metabolic changes and tissue perfusion due to cardiovascular problems may lead to an inadequate recovery in plasma viscosity (35).…”

Does vitamin C prevent the effects of high dose dexmedetomidine on rat erythrocyte deformability?

“…However, whether these agents change plasma rheology and/or anesthesia may result in deterioration of tissue perfusion remains controversial. Changes in plasma viscosity have been listed among the factors associated with anesthesia procedures responsible for deterioration of tissue and organ perfusion (2,3). Erythrocyte deformability and increased aggregation may be observed after surgical procedures performed under general anesthesia (3).…”

“…Disorders in the hemorheologic state may lead to an inadequate recovery in plasma viscosity (2). Erythrocyte deformability and plasma viscosity are important factors that affect organ and tissue perfusion (4).…”