Vascular endothelial dysfunction and inflammatory states

Abstract

Endothelial cells are metabolically active structures lining the inner layer of blood vessels, lymphatic organs and the heart. They have autocrine and paracrine functions and produce various metabolites/substances responsible for vasomotor tone, vessel wall integrity, immunologic processes, pro-coagulation and anti-coagulation homeostasis. Endothelial dysfunction (ED) can be characterized by an abnormality in the physical integrity and/or the functional process of the endothelium which may result in alteration in vasoreactivity, leading to increased propensity for thrombus/plaque formation, leukocyte adhesion with inflammatory changes. ED leads to pathologic conditions such as peripheral vascular disease, cerebral vascular accident, venous thrombosis, cardiovascular disease, chronic kidney disease atherosclerosis, hypertension, diabetes mellitus and neoplasm. This chapter will review Endothelial dysfunction (ED) focusing on the impact it has on perioperative patients and highlighting anesthetic considerations.