Peri-operative endothelial dysfunction in patients undergoing minor abdominal surgery: An observational study.

Eur JAnaesthesiol 2019 Feb;36(2):130-134. doi: 10.1097.

Peri-operative endothelial dysfunction in patients undergoing minor abdominal surgery: An observational study.

Ekeloef S1, Godthaab C, Schou-Pedersen AMV, Lykkesfeldt J, Gögenur I.

Author information

1
From the Center for Surgical Science, Department of Surgery, Zealand University Hospital, Koege (SE, CG, IG), and Faculty of Health & Medical Sciences, University of Copenhagen, Frederiksberg, Denmark (AMVS-P, JL).

Abstract

BACKGROUND:

Myocardial injury after noncardiac surgery is common and associated with major adverse cardiac events. Surgery induces acute endothelial dysfunction, which might be central in the pathophysiology of myocardial injury; however, the relationship between surgical stress and endothelial function remains incompletely understood.

OBJECTIVES:

This study aimed to assess the acute peri-operative changes in endothelial function after minor elective abdominal surgery.

DESIGN:

A prospective, observational, single-centre study.

SETTING:

A university hospital from February 2016 to January 2017.

PATIENTS:

Sixty patients undergoing elective minor abdominal surgery.

MAIN OUTCOME MEASURES:

The change in endothelial function, expressed as the reactive hyperaemia index (RHI), was assessed by non-invasive digital pulse tonometry. RHI, biomarkers of nitric oxide bioavailability and oxidative stress were assessed prior to and 4 h after surgery.

RESULTS:

RHI decreased significantly from 1.93 [95% confidence interval (95% CI 1.78 to 2.09)] before surgery to 1.76 (95% CI 1.64 to 1.90), P = 0.03, after surgery. The nitric oxide production, L-arginine/asymmetric dimethylarginine, decreased significantly from a ratio of 213.39 (95% CI 188.76 to 241.2) to a ratio of 193.3 (95% CI 171.82 to 217.54), P = 0.03. Plasma biopterins increased significantly after surgery, while the ratio between tetrahydrobiopterin and dihydrobiopterin was unchanged. Total ascorbic acid decreased significantly after surgery (P < 0.001), while its oxidation ratio was unchanged.

CONCLUSION:

Elective minor abdominal surgery impaired systemic endothelial function early after surgery.

TRIAL REGISTRATION:

Clinicaltrials.gov identifier: NCT02690233.

PMID:

30543557

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