title: Brachial artery reactivity and vascular reactive hyperemia for preoperative anaesthesia risk assessment - an observational study.
abstract: BACKGROUND
  Non-invasive measures of vascular reactivity have emerged to refine cardiovascular risk. However, limited data exists investigating vascular reactivity as a preoperative diagnostic tool for anesthesiologists. In this study, we compare the utility of two non-invasive techniques, Brachial Artery Reactivity Testing (BART) and Digital Thermal Monitoring (DTM), as surrogates for measuring vascular reactivity.
  
  
  METHODS
  Following IRB approval, 26 patients scheduled for major thoracic surgery (e.g. esophagectomy and pneumonectomy) were studied prospectively. BART [Flow mediated dilation (FMD) and Peak flow velocity (PFV)] and DTM [Temperature rebound (TR%)] were performed preoperatively at baseline using 5 minute blood pressure cuff occlusion of the upper arm. Statistical summaries were provided for the comparison of BART and DTM with select patient characteristics, and correlations were used to investigate the strength of the relationship between BART and DTM measurements.
  
  
  RESULTS
  Patients preoperatively diagnosed with hyperlipidemia were associated with lower FMD% values {Median (Range): 14.8 (2.3, 38.1) vs. 6.2 (0.0, 14.3); p = 0.006}. There were no significant associations between BART and DTM techniques in relation to cardiovascular risk factors or postoperative complications.
  
  
  CONCLUSIONS
  Our study suggests that impaired vascular reactivity as measured by BART is associated with the incidence of hyperlipidemia. Also, using a novel technique such as DTM may provide a simpler and more accessible point of care testing for vascular reactivity in a perioperative setting. Both non-invasive techniques assessing vascular function warrant further refinement to better assist preoperative optimization strategies aimed at improving perioperative vascular function.
authors: Department of Anaesthesiology and Intensive Care Medicine, University Hospital of Cologne, Cologne, Germany.
authors: Robert
authors: R
authors: Schier
authors: Department of Anaesthesiology and Intensive Care Medicine, University Hospital of Cologne, Cologne, Germany.
authors: Volker
authors: V
authors: Schick
authors: Department of Anesthesiology & Pain Medicine, The University of Texas M. D. Anderson Cancer Center, Houston, TX, USA.
authors: Ashley
authors: A
authors: Amsbaugh
authors: Department of Anesthesiology & Pain Medicine, The University of Texas M. D. Anderson Cancer Center, Houston, TX, USA.
authors: Jorge
authors: J
authors: Aguilar
authors: Department of Biostatistics, The University of Texas M. D. Anderson Cancer Center, Houston, TX, USA.
authors: Mike
authors: M
authors: Hernandez
authors: Department of Thoracic and Cardiovascular Surgery, The University of Texas M. D. Anderson Cancer Center, Houston, TX, USA.
authors: Reza J
authors: RJ
authors: Mehran
authors: Department of Anaesthesia and Pain Medicine, Peter MacCallum Cancer Centre and The University of Melbourne, Melbourne, Australia.
authors: Bernhard
authors: B
authors: Riedel
authors: Department of Anaesthesiology and Intensive Care Medicine, University Hospital of Cologne, Cologne, Germany.
authors: Jochen
authors: J
authors: Hinkelbein
mesh_terms: D000328:Adult; D000368:Aged; D000758:Anesthesia / Q000379:methods*; D001916:Brachial Artery / Q000378:metabolism; D002318:Cardiovascular Diseases / Q000209:etiology / Q000517:prevention & control*; D005260:Female; D006801:Humans; D006940:Hyperemia / Q000503:physiopathology; D006949:Hyperlipidemias / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D019095:Point-of-Care Systems; D011183:Postoperative Complications / Q000517:prevention & control*; D011300:Preoperative Care / Q000379:methods*; D011446:Prospective Studies; D018570:Risk Assessment / Q000379:methods; D012307:Risk Factors
keywords: Non-invasive diagnostic tool; Preoperative anesthesia assessment; Vascular function