Sublingual microcirculatory shock and loss of haemodynamic coherence during subarachnoid anaesthesia.

Dear Editor, Optimization of tissue perfusion is one of the primary goals of peri­ operative care and its adequacy is of­ ten assumed based on systemic mea­ sures, such as mean arterial pressure (MAP). However, microcirculatory al­ terations may occur even when global haemodynamic variables are within normal targets and are associated with the development of organ dysfunc­ tion. Indeed, perfusion­related com­ plications are a main cause of mor­ bidity and mortality in the surgical population, especially within the first thirty postoperative days [1, 2]. Although several studies have emerged in the last years providing important data that highlight the re­ lationship between intraoperative hypotension and organ injury [3, 4], intraoperative microcirculatory end­ points and the impact of microcircula­ tory­guided therapeutic interventions have not yet been well defined [5]. In this report, we present a case of intra­ operative loss of haemodynamic cohe­ rence in a patient with normal systemic haemodynamics during subarachnoid anaesthesia. A 51­year­old white woman with a body mass index of 33.3 kg m–2, American Society of Anesthesiologists Physical Status Classification II, and stable general condition was sched­ uled to undergo total knee arthroplas­ ty under subarachnoid anaesthesia. Her medical history was remarkable for well­controlled hypothyroidism DOI: https://doi.org/10.5114/ait.2023.128707