Endothelial Dysfunction in the Perioperative Setting

Abstract

Although perioperative macrovascular events (eg, myocardial infarction, stroke) are readily evident, their absolute incidence remains relatively low. In contrast, microvascular dysfunction and its role in perioperative morbidity is not easily measured. Microvascular dysfunction is likely to have a greater impact on noncardiovascular complications (eg, wound healing and end-organ failure), through impaired perfusion, than that which is readily appreciated. Inflammation and oxidative stress, such as that induced by surgical trauma, disrupts endothelial homeostasis thereby decreasing the bioavailability of nitric oxide. This predisposes blood vessels to vasoconstriction, inflammation, leukocyte adhesion, thrombosis-factors that contribute to perioperative cardiovascular events at both macrovascular and microvascular level. Current clinical strategies applicable to the perioperative setting that improve microvascular health include preoperative exercise therapy, pharmacologic interventions (eg, statins, newer beta-blockers) and attempts to stimulate mobilization and homing of bone marrow-derived endothelial progenitor cells. Many of these strategies are still in their infancy and large prospective trials that investigate the impact of these therapeutic options on postoperative outcome are eagerly awaited.

Perioperative Inflammation and Microcirculation in Surgery: Clinical Strategies for Improved Surgical Outcomes

“…Perioperative inflammation caused in reaction to surgical trauma causes a pro-inflammatory and pro-oxidant milieu that results in both functional and structural alterations in the endothelium. This may lead to microcirculation hemostatic dysregulation with impaired local tissue perfusion and consequent micro-and macrovascular-related postoperative complications (Figure 1) [14,15].…”

Cytokine response and reactive oxygen species production after low- and intermediate-risk surgery

“…Inflammation and oxidative stress, such as that induced by surgical trauma, disrupts endothelial homeostasis, which pre‐disposes blood vessels to vasoconstriction, inflammation, leukocyte adhesion and thrombosis, factors that contribute to perioperative cardiovascular events 39 . We have shown a correlation between morphine consumption and ROS production.…”

Type of anesthesia for cancer resection surgery: No differential impact on cancer recurrence in mouse models of breast cancer

“…While effects were not seen on cancer recurrence in these mouse models of breast cancer, we hypothesized that sevoflurane and intravenous propofol may have differential short-term effects on markers of stress and inflammation within the perioperative period (Fig 3A). As vascular integrity has been shown to be disrupted by perioperative events [34], we first explored the effect of anesthetic techniques on vascular permeability. Twenty-four hours after resection of MDA-MB-231 tumors, mice were injected systemically with fluorescein, which leaks into surrounding tissue when vascular integrity is lost.…”