TY - JOUR

T1 - Peri-operative endothelial dysfunction in patients undergoing minor abdominal surgery

T2 - An observational study

AU - Busch, Sarah Victoria Ekeløf

AU - Godthaab, Camilla

AU - Schou-Pedersen, Anne Marie Voigt

AU - Lykkesfeldt, Jens

AU - Gögenur, Ismael

PY - 2019/2

Y1 - 2019/2

N2 - 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.

AB - 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.

U2 - 10.1097/EJA.0000000000000935

DO - 10.1097/EJA.0000000000000935

M3 - Journal article

C2 - 30543557

VL - 36

SP - 130

EP - 134

JO - European Journal of Anaesthesiology, Supplement

JF - European Journal of Anaesthesiology, Supplement

SN - 0952-1941

IS - 2

ER -