Mass intraoperative endothelial glycocalyx shedding affects postoperative systemic inflammation response
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View abstract on PubMed
Summary
This summary is machine-generated.Off-pump coronary artery bypass graft surgery can cause early endothelial glycocalyx layer (EGL) shedding, increasing the risk of systemic inflammation response syndrome (SIRS). Sevoflurane anesthesia did not show a significant advantage over propofol in preserving EGL during OPCABG.
Area Of Science
- Cardiovascular Surgery
- Anesthesiology
- Inflammation Biology
Background
- Off-pump coronary artery bypass graft (OPCABG) surgery is associated with a high incidence of postoperative systemic inflammation response syndrome (SIRS).
- Perioperative disruption of the endothelial glycocalyx layer (EGL) is a potential predisposing factor for SIRS after OPCABG.
- This study investigates the timing of EGL shedding during OPCABG and its impact on postoperative SIRS, comparing sevoflurane and propofol anesthesia.
Purpose Of The Study
- To determine if EGL shedding occurs earlier during OPCABG and influences postoperative SIRS.
- To compare the EGL-preserving effects of sevoflurane versus propofol anesthesia during OPCABG.
- To analyze the correlation between EGL markers, inflammatory markers, and clinical outcomes.
Main Methods
- A randomized trial involving 50 patients undergoing OPCABG, assigned to sevoflurane-sufentanil or propofol-sufentanil anesthesia.
- Measurement of plasma syndecan-1, heparan sulfate (HS), atrial natriuretic peptide (ANP), IL-6, and cardiac troponin I (cTnI) at six time points.
- Assessment of SIRS criteria and Sequential Organ Failure Assessment (SOFA) scores.
Main Results
- No significant differences in syndecan-1, HS, IL-6, SIRS criteria, or SOFA scores were observed between the sevoflurane and propofol groups.
- Pooled analysis revealed significant increases in plasma syndecan-1 and IL-6 over time.
- Syndecan-1 levels correlated with graft anastomosis duration, ANP, and IL-6; IL-6 and SOFA scores correlated with SIRS, ICU days, and occurrence of SIRS.
Conclusions
- Early EGL shedding during OPCABG, particularly during graft anastomosis, significantly impacts postoperative SIRS and SOFA scores.
- Sevoflurane anesthesia did not demonstrate a clinical advantage in preserving the EGL compared to propofol.
- The findings highlight the role of EGL integrity in mitigating inflammatory responses following OPCABG.
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