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Peri-operative endothelial dysfunction in patients undergoing minor abdominal surgery

An observational study

Ekeloef, Sarah; Godthaab, Camilla; Schou-Pedersen, Anne Marie V.; Lykkesfeldt, Jens; Gögenur, Ismail

European Journal of Anaesthesiology (EJA): February 2019 - Volume 36 - Issue 2 - p 130–134
doi: 10.1097/EJA.0000000000000935
Perioperative medicine

BACKGROUND Myocardial 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.

OBJECTIVES This study aimed to assess the acute peri-operative changes in endothelial function after minor elective abdominal surgery.

DESIGN A prospective, observational, single-centre study.

SETTING A university hospital from February 2016 to January 2017.

PATIENTS Sixty patients undergoing elective minor abdominal surgery.

MAIN OUTCOME MEASURES The 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.

RESULTS RHI 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.

CONCLUSION Elective minor abdominal surgery impaired systemic endothelial function early after surgery.

TRIAL REGISTRATION identifier: NCT02690233

From the Center for Surgical Science, Department of Surgery, Zealand University Hospital, Koege (SE, CG, IG), and Faculty of Health & Medical Sciences, University of Copenhagen, Frederiksberg, Denmark (AMVS-P, JL)

Correspondence to Sarah Ekeloef, Center for Surgical Science, Department of Surgery, Zealand University Hospital, Lykkebækvej1, Koege 4600, Denmark Tel: +45 22712874; e-mail:

Published online 13 December 2018

© 2019 European Society of Anaesthesiology