Hypervolemia does not cause degradation of the endothelial glycocalyx layer during open hysterectomy performed under sevoflurane or propofol anesthesia

Abstract

Background: Fluid-induced hypervolemia may stimulate the release of natriuretic peptides and cause degradation (shedding) of the endothelial glycocalyx layer. Sevoflurane is believed to protect the glycocalyx, but the importance of using sevoflurane to prevent shedding during routine surgery is unclear. Methods: The plasma concentrations of brain natriuretic peptide and two biomarkers of glycocalyx shedding, syndecan-1, and heparan sulfate, were measured in 26 patients randomized to receive general anesthesia with sevoflurane or propofol during open abdominal hysterectomy. The fluid therapy consisted of 25 mL/kg (approximately 2 L) of Ringer´s lactate over 30 minutes. Blood hemoglobin and plasma albumin were used to indicate plasma volume expansion and capillary leakage. Results: The plasma concentrations of brain natriuretic peptide and shedding products showed low levels throughout the surgery (median brain natriuretic peptide, 21 ng/L; syndecan-1, 12.9 ng/mL; and heparan sulfate, 6.5 µg/mL), but the heparan sulfate concentration increased 2 hours post-operatively (to 17.3 µg/mL, P < .005). No differences were noted between the propofol and sevoflurane groups in any of the measured parameters. Albumin was apparently recruited to the bloodstream during the first 20 minutes, when the intravascular retention of infused fluid was almost 100%. The urine flow was <1 mL/min, despite the vigorous volume loading. Conclusions: No relevant elevations of brain natriuretic peptide or degradation products of the glycocalyx layer were observed when hypervolemia was induced during open abdominal hysterectomy performed with sevoflurane or propofol anesthesia. Plasma volume expansion from Ringer´s lactate was pronounced. How to cite this article: Nemme J, Krizhanovskii C, Ntika S, Sabelnikovs O, Vanags I, Hahn RG. Hypervolemia does not cause degradation of the endothelial glycocalyx layer during open hysterectomy performed under sevoflurane or propofol anesthesia.

Volume kinetic analysis of fluid retention after induction of general anesthesia

“…A total of 25 clinical patients scheduled for elective abdominal hysterectomy were recruited to an open label randomized parallel clinical trial with the primary aim to compare two anesthesia methods, sevoflurane and intravenous propofol, with regard to their influence the degradation of the endothelial glycocalyx layer [18]. Ethical approval (No.…”

“…After fasting overnight, patients were given general anesthesia induced with propofol but maintained with either sevoflurane as inhaled anesthetic (N = 13) or an intravenous propofol infusion (N = 12). The result of that comparison is described elsewhere [18].…”

“…The study was powered to detect a doubling of the plasma BNP concentration as a result of the volume loading, as described previously [18]. An effect size of 1.0 and power 90% at the P < 0.01 level yielded N = 20.…”

Science‐in‐brief: The role of the glycocalyx in critically ill patients with reference to the horse

“…Hypervolaemia has been postulated to damage the glycocalyx, at least partially by triggering the release of atrial natriuretic peptide (ANP) that caused an increase in vascular permeability and histological degradation of the glycocalyx in an animal model 19 . Findings in human patients with induced hypervolaemia (15‐25 mL/kg/h) during routine surgery are conflicting with some finding evidence of ANP release and glycocalyx shedding 20,21 while others did not 22 . However, almost all studies showed proportionate fluid retention following high volume infusions under general anaesthesia.…”

“…As mentioned, judicious fluid therapy and use of plasma or albumin have been proposed but require further investigation. Inhalation anaesthesia using sevoflurane has been suggested to have glycocalyx‐protecting or regenerating effects in some studies 39,40 but this was not confirmed by others 22,41 . Other drugs with possible benefits include corticosteroids, antithrombin, heparin and heparinoids 42 .…”