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

Abstract

BACKGROUNDMyocardial 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.OBJECTIVESThis study aimed to assess the acute peri-operative changes in endothelial function after minor elective abdominal surgery.DESIGNA prospective, observational, single-centre study.SETTINGA university hospital from February 2016 to January 2017.PATIENTSSixty patients undergoing elective minor abdominal surgery.MAIN OUTCOME MEASURESThe 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.RESULTSRHI 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.CONCLUSIONElective minor abdominal surgery impaired systemic endothelial function early after surgery.TRIAL REGISTRATIONClinicaltrials.gov identifier: NCT02690233.