title: Impact of non-cardiovascular surgery on reactive hyperaemia and arterial endothelial function.
abstract: Vascular reactivity is a surrogate marker for atherosclerosis and is predictive of cardiovascular outcome. Non-cardiovascular surgery is associated with perioperative cardiovascular complications in high-risk patients. To evaluate the impact of non-cardiovascular surgery on reactive hyperaemia and arterial endothelial function and to investigate the relationships between endothelial dysfunction and invasive (laparotomy) or minimally invasive (laparoscopic) surgery, we prospectively evaluated 106 patients undergoing abdominal surgery under general anaesthesia (71 laparotomy, 35 laparoscopy). Measurements of blood pressure, heart rate and pain (on a visual analogue scale (VAS)) were undertaken. Brachial endothelium-dependent flow-mediated dilation (FMD), endothelium-independent dilation, nitroglycerin (NTG)-induced dilation and reactive hyperaemia were measured with high-resolution B-mode ultrasound on preoperative Day 1 (baseline), as well as 2 h and 1 and 7 days postoperatively. Blood pressure and heart rate were significantly higher 2 h postoperatively. Pain, as measured on the VAS, was higher (P < 0.01) and reactive hyperaemia and FMD were significantly lower (P < 0.001) at 2 h and 1 day postoperatively compared with values at baseline and on postoperative Day 7. By postoperative Day 7, FMD had recovered to baseline levels. Patients undergoing laparoscopic surgery had less FMD reduction on Days 1 and 7 (7.5 ± 1.5% and 7.9 ± 1.5%, respectively) compared with those undergoing laparotomy (6.4 ± 1.6% (P = 0.001) and 7.0 ± 1.6% (P = 0.006), respectively), consistent with potential cardiovascular benefit. Responses to NTG were stable throughout. Backward multivariate linear regression analysis indicated that FMD was independently related to age and VAS (model R = 0.486; F = 6.4; P < 0.001). Reactive hyperaemia and arterial endothelial function are significantly reduced in the early postoperative period, particularly after laparotomy compared with laparoscopy, which may be related to postoperative cardiovascular events.
authors.affiliation: The Second Affiliated Hospital, Chongqing University of Medical Sciences, Chongqing, China.
authors.forename: Yan Jun
authors.initials: YJ
authors.lastname: Hu
authors.forename: An Ning
authors.initials: AN
authors.lastname: Wei
authors.forename: Ping
authors.initials: P
authors.lastname: Chook
authors.forename: Yuehui
authors.initials: Y
authors.lastname: Yin
authors.forename: William
authors.initials: W
authors.lastname: Cheng
authors.forename: Meng Jun
authors.initials: MJ
authors.lastname: Wu
authors.forename: David S
authors.initials: DS
authors.lastname: Celermajer
authors.forename: Kam Sang
authors.initials: KS
authors.lastname: Woo
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001783:Blood Flow Velocity / Q000187:drug effects / Q000502:physiology; D001794:Blood Pressure / Q000187:drug effects / Q000502:physiology; D001916:Brachial Artery / Q000187:drug effects / Q000503:physiopathology; D002318:Cardiovascular Diseases / Q000503:physiopathology* / Q000601:surgery*; D004730:Endothelium, Vascular / Q000187:drug effects / Q000503:physiopathology*; D005260:Female; D006339:Heart Rate / Q000187:drug effects / Q000502:physiology; D006801:Humans; D006940:Hyperemia / Q000503:physiopathology* / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D005996:Nitroglycerin / Q000494:pharmacology; D010146:Pain / Q000503:physiopathology; D011184:Postoperative Period; D014664:Vasodilation / Q000187:drug effects / Q000502:physiology
chemical_list: D005996:Nitroglycerin