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Post‐operative endothelial dysfunction assessment using laser D oppler perfusion measurement in cardiac surgery patients
Author(s) -
GOMES V.,
GOMES M. B.,
TIBIRICA E.,
LESSA M. A.
Publication year - 2014
Publication title -
acta anaesthesiologica scandinavica
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.738
H-Index - 107
eISSN - 1399-6576
pISSN - 0001-5172
DOI - 10.1111/aas.12286
Subject(s) - medicine , microcirculation , cardiopulmonary bypass , endothelial dysfunction , laser doppler velocimetry , sodium nitroprusside , perfusion , vasodilation , anesthesia , reactive hyperemia , endothelium , nitric oxide , vasospasm , cardiology , surgery , blood flow , subarachnoid hemorrhage
Background Coronary artery bypass graft ( CABG ) surgery with cardiopulmonary bypass ( CPB ) is associated with systemic inflammatory response and endothelial dysfunction. Our hypothesis is that CPB ‐induced post‐operative endothelial dysfunction may be detected using laser D oppler perfusion monitoring ( LDPM ) in the skin microcirculation. Methods We used LDPM to investigate the subacute effects of the CPB on systemic microvascular reactivity among patients undergoing CABG surgery with CPB . Thirty patients were submitted to the study of skin microcirculation and blood sample collection at baseline (pre‐surgery) and at 7 days post‐surgical procedure. The skin microcirculation was evaluated by acetylcholine ( ACh ) and sodium nitroprusside ( SNP ) iontophoresis, and thermal hyperemia ( TH ). Plasma levels of nitrite/nitrate were also analyzed, and cytokine profiles were determined using a multiplex system. Results On‐pump CABG surgery induced a significant reduction of the increased microvascular dermal flux observed after cumulative doses of ACh iontophoresis and after TH . On‐pump CABG surgery did not induce any significant changes in the microvascular flux after cumulative doses of SNP . Patients still presented high levels of interleukin ( IL )‐6, IL ‐8, and C ‐reactive protein, and low bioavailability of nitric oxide 7 days after the CABG surgery with CPB . Conclusion We observed a significant impairment of systemic microvascular endothelial function and well‐preserved endothelium‐independent vasodilatation in the skin microcirculation of patients 1 week after CABG surgery with CPB . Our results suggest that LDPM is a useful tool for the assessment of on‐pump CABG ‐induced subacute post‐operative endothelial dysfunctions.