Changes in the sublingual microcirculation following aortic surgery under balanced or total intravenous anaesthesia: a prospective observational study

Abstract

BackgroundIn vascular surgery with aortic cross-clamping, ischemia/reperfusion injury induces systemic haemodynamic and microcirculatory disturbances. Different anaesthetic regimens may have a varying impact on tissue perfusion. The aim of this study was to explore changes in microvascular perfusion in patients undergoing elective open abdominal aortic aneurysm repair under balanced or total intravenous anaesthesia.MethodsProspective observational study. Patients undergoing elective open infrarenal abdominal aortic aneurysm repair received balanced (desflurane + remifentanil, n = 20) or total intravenous anaesthesia (TIVA, propofol + remifentanil using target-controlled infusion, n = 20) according to the clinician’s decision. A goal-directed haemodynamic management was applied in all patients. Measurements were obtained before anaesthesia induction (baseline) and at end-surgery and included haemodynamics, arterial/venous blood gases, sublingual microvascular flow and density (incident dark field illumination imaging), peripheral muscle tissue oxygenation and microcirculatory reactivity (thenar near infrared spectroscopy with a vascular occlusion test).ResultsThe two groups did not differ for baseline characteristics, mean aortic-clamping time and requirement of vasoactive agents during surgery. Changes in mean arterial pressure, systemic vascular resistance index, haemoglobin and blood lactate levels were similar between the two groups, while the cardiac index increased at end-surgery in patients undergoing balanced anaesthesia. The sublingual microcirculation was globally unaltered in the TIVA group at end-surgery, while patients undergoing balanced anaesthesia showed an increase in the total and perfused small vessel densities (from 16.6 ± 4.2 to 19.1 ± 5.4 mm/mm2, p < 0.05). Changes in microvascular density were negatively correlated with changes in the systemic vascular resistance index. The area of reactive hyperaemia during the VOT increased in the balanced anaesthesia group (from 14.8 ± 8.1 to 25.6 ± 14.8%*min, p < 0.05). At end-surgery, the tissue haemoglobin index in the TIVA group was lower than that in the balanced anaesthesia group.ConclusionsIn patients undergoing elective open abdominal aortic aneurysm repair with a goal-directed hemodynamic management, indices of sublingual or peripheral microvascular perfusion/oxygenation were globally preserved with both balanced anaesthesia and TIVA. Patients undergoing balanced anaesthesia showed microvascular recruitment at end-surgery.Trial registrationNCT03510793, https://www.clinicaltrials.gov, date of registration April 27th 2018, retrospectively registered.

Understanding the Effects of Anesthesia on Cortical Electrophysiological Recordings: A Scoping Review

“…However, propofol is structurally unrelated to other hypnotic compounds. It induces hypnosis rapidly and reliably, and has additive or synergistic hypnotic effects with many other agents (like barbiturates, benzodiazepines, opioids and ketamine) commonly used in anesthesia [ 88 ].…”

Analysis of Brain Functions in Men with Prostate Cancer under Androgen Deprivation Therapy: A One-Year Longitudinal Study

“…We did not observe any differences regarding the outcomes of the study based on prior prostatectomy. However, we should be cautious about these results since the impact of general anaesthesia required for major surgery such as prostatectomy on cognitive impairment is controversial and complex [ 85 , 86 ]. Several studies have shown an association between exposure to surgery under general anaesthesia and the development of delayed neurocognitive recovery in only a subset of patients [ 85 , 87 ].…”

“…However, we should be cautious about these results since the impact of general anaesthesia required for major surgery such as prostatectomy on cognitive impairment is controversial and complex [ 85 , 86 ]. Several studies have shown an association between exposure to surgery under general anaesthesia and the development of delayed neurocognitive recovery in only a subset of patients [ 85 , 87 ]. There are conflicting data on the relationship between exposure to anaesthesia and the development of long-term neurocognitive disorders, or the development of dementia in the patient population with normal preoperative cognitive function.…”

Acute limb ischemia by a pulmonary vein stump thrombus after left lower lobectomy: a case report

“…From an anesthetic viewpoint, Kitajima et al reported the implementation of routine intravenous systemic heparinization following LUL after encountering a patient who developed cerebral infarction post-LUL. Along with this postoperative anticoagulant therapy, they changed the postoperative analgesia from epidural analgesia to intercostal nerve blocks with intravenous patient-controlled analgesia [ 13 ]. In this way, other methods of postoperative analgesia, such as continuous nerve blocks, may be utilized instead of epidural anesthesia if the risk factors for PV stump thrombus formation and prophylactic anticoagulation are established in the future.…”