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Microvascular reactivity monitored with near-infrared spectroscopy is impaired after induction of anaesthesia in cardiac surgery patients : an observational study

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Abstract
BACKGROUND: Induction of anaesthesia causes significant macrohaemodynamic changes, but little is known about its effects on the microcirculation. However, alterations in microvascular perfusion are known to be associated with impaired tissue oxygenation and organ dysfunction. Microvascular reactivity can be assessed with vascular occlusion testing, which evaluates the response of tissue oxygen saturation to transient ischaemia and reperfusion. OBJECTIVE: The aim of the current study was to evaluate the effects of an opioid-based anaesthesia induction on microvascular reactivity. We hypothesised that despite minimal blood pressure changes, microvascular function would be impaired. DESIGN: Prospective, observational study. SETTING: Single-centre, tertiary university teaching hospital, Belgium. PATIENTS: Thirty-five adult patients scheduled for elective coronary artery bypass grafting surgery. INTERVENTION: Microvascular reactivity was assessed before and 30 min after anaesthesia induction by means of vascular occlusion testing and near-infrared spectroscopy. MAIN OUTCOME MEASURES: Tissue oxygen saturations, desaturation rate, recovery time (time from release of cuff to the maximum value) and rate of recovery were determined. RESULTS: Data are expressed as median (minimum to maximum). Tissue oxygen saturation was higher after induction of anaesthesia [70 (54 to 78) vs. 73 (55 to 94)%, P = 0.015]. Oxygen consumption decreased after induction, appreciable by the higher minimum tissue oxygen saturation [45 (29 to 69) vs. 53 (28 to 81)%, P < 0.001] and the slower desaturation rate [11 (4 to 18) vs. 9 (5 to 16)% min(-1), P < 0.001]. After induction of anaesthesia, recovery times were longer [40 (20 to 120) vs. 48 (24 to 356) s, P = 0.004] and the rate of recovery was lower [114 (12 to 497) vs. 80 (3 to 271)% min(-1), P < 0.001]. CONCLUSION: After induction of anaesthesia, oxygen consumption was decreased. The longer recovery times and slower rates of recovery indicate impaired microvascular reactivity after induction of anaesthesia.
Keywords
PERIPHERAL VASCULAR-DISEASE, SKELETAL-MUSCLE OXYGENATION, CHRONIC, HEART-FAILURE, CARDIOPULMONARY BYPASS, MICROCIRCULATORY ALTERATIONS, HEALTHY-VOLUNTEERS, SEPTIC PATIENTS, OCCLUSION TEST, PROPOFOL, SATURATION

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Citation

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Chicago
Vandenbulcke, Lien, Koen Lapage, Katrien Vanderstraeten, Filip De Somer, Stefan De Hert, and Anneliese Moerman. 2017. “Microvascular Reactivity Monitored with Near-infrared Spectroscopy Is Impaired After Induction of Anaesthesia in Cardiac Surgery Patients : an Observational Study.” European Journal of Anaesthesiology 34 (10): 688–694.
APA
Vandenbulcke, L., Lapage, K., Vanderstraeten, K., De Somer, F., De Hert, S., & Moerman, A. (2017). Microvascular reactivity monitored with near-infrared spectroscopy is impaired after induction of anaesthesia in cardiac surgery patients : an observational study. EUROPEAN JOURNAL OF ANAESTHESIOLOGY, 34(10), 688–694.
Vancouver
1.
Vandenbulcke L, Lapage K, Vanderstraeten K, De Somer F, De Hert S, Moerman A. Microvascular reactivity monitored with near-infrared spectroscopy is impaired after induction of anaesthesia in cardiac surgery patients : an observational study. EUROPEAN JOURNAL OF ANAESTHESIOLOGY. 2017;34(10):688–94.
MLA
Vandenbulcke, Lien et al. “Microvascular Reactivity Monitored with Near-infrared Spectroscopy Is Impaired After Induction of Anaesthesia in Cardiac Surgery Patients : an Observational Study.” EUROPEAN JOURNAL OF ANAESTHESIOLOGY 34.10 (2017): 688–694. Print.
@article{8536606,
  abstract     = {BACKGROUND: Induction of anaesthesia causes significant macrohaemodynamic changes, but little is known about its effects on the microcirculation. However, alterations in microvascular perfusion are known to be associated with impaired tissue oxygenation and organ dysfunction. Microvascular reactivity can be assessed with vascular occlusion testing, which evaluates the response of tissue oxygen saturation to transient ischaemia and reperfusion. 
OBJECTIVE: The aim of the current study was to evaluate the effects of an opioid-based anaesthesia induction on microvascular reactivity. We hypothesised that despite minimal blood pressure changes, microvascular function would be impaired. 
DESIGN: Prospective, observational study. 
SETTING: Single-centre, tertiary university teaching hospital, Belgium. 
PATIENTS: Thirty-five adult patients scheduled for elective coronary artery bypass grafting surgery. 
INTERVENTION: Microvascular reactivity was assessed before and 30 min after anaesthesia induction by means of vascular occlusion testing and near-infrared spectroscopy. 
MAIN OUTCOME MEASURES: Tissue oxygen saturations, desaturation rate, recovery time (time from release of cuff to the maximum value) and rate of recovery were determined. 
RESULTS: Data are expressed as median (minimum to maximum). Tissue oxygen saturation was higher after induction of anaesthesia [70 (54 to 78) vs. 73 (55 to 94)%, P = 0.015]. Oxygen consumption decreased after induction, appreciable by the higher minimum tissue oxygen saturation [45 (29 to 69) vs. 53 (28 to 81)%, P < 0.001] and the slower desaturation rate [11 (4 to 18) vs. 9 (5 to 16)% min(-1), P < 0.001]. After induction of anaesthesia, recovery times were longer [40 (20 to 120) vs. 48 (24 to 356) s, P = 0.004] and the rate of recovery was lower [114 (12 to 497) vs. 80 (3 to 271)% min(-1), P < 0.001]. 
CONCLUSION: After induction of anaesthesia, oxygen consumption was decreased. The longer recovery times and slower rates of recovery indicate impaired microvascular reactivity after induction of anaesthesia.},
  author       = {Vandenbulcke, Lien and Lapage, Koen and Vanderstraeten, Katrien and De Somer, Filip and De Hert, Stefan and Moerman, Anneliese},
  issn         = {0265-0215},
  journal      = {EUROPEAN JOURNAL OF ANAESTHESIOLOGY},
  keywords     = {PERIPHERAL VASCULAR-DISEASE,SKELETAL-MUSCLE OXYGENATION,CHRONIC,HEART-FAILURE,CARDIOPULMONARY BYPASS,MICROCIRCULATORY ALTERATIONS,HEALTHY-VOLUNTEERS,SEPTIC PATIENTS,OCCLUSION TEST,PROPOFOL,SATURATION},
  language     = {eng},
  number       = {10},
  pages        = {688--694},
  title        = {Microvascular reactivity monitored with near-infrared spectroscopy is impaired after induction of anaesthesia in cardiac surgery patients : an observational study},
  url          = {http://dx.doi.org/10.1097/EJA.0000000000000684},
  volume       = {34},
  year         = {2017},
}

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