Microvascular Reactivity Measured by Dynamic Near-infrared Spectroscopy Following Induction of General Anesthesia in Healthy Patients: Observation of Age-related Change

Cho, Ah-Reum; Lee, Hyeon-Jeong; Kim, Hyae-Jin; Do, Wangseok; Jeon, Soeun; Baek, Sun‐Yong; Kim, Eun-Soo; Kwon, Jae‐Young; Kim, Hae-Kyu

doi:10.7150/ijms.52433

Cited by 5 publications

(16 citation statements)

References 19 publications

(24 reference statements)

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“…DA decreased, as compared to pre-induction baseline values, indicating reduced local tissue oxygen consumption. One study found an increased RA after induction with propofol and remifentanil in patients younger than 65 years, but not in older patients [15], and no change was found in the other study after anesthesia induction with either propofol and remifentanil or etomidate and remifentanil [16].…”

Section: Includedmentioning

confidence: 91%

See 1 more Smart Citation

The use of a vascular occlusion test combined with near-infrared spectroscopy in perioperative care: a systematic review

Niezen

Massari

Vos

et al. 2022

J Clin Monit Comput

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In the perioperative phase oxygen delivery and consumption can be influenced by different factors, i.e. type of surgery, anesthetic and cardiovascular drugs, or fluids. By combining near-infrared spectroscopy (NIRS) monitoring of regional tissue oxygen saturation (StO 2 ) with an ischemic provocation test, the vascular occlusion test (VOT), local tissue oxygen consumption and vascular reactivity at the microcirculatory level can be assessed. This systematic review aims to give an overview of the clinical information that VOT-derived NIRS values can provide in the perioperative period. After performing a systematic literature search, we included 29 articles. It was not possible to perform a meta-analysis because of the lack of comparable data and the observational nature of the majority of the included articles. We have clustered the found articles in two groups: non-cardiac surgery and cardiac surgery. We found that VOT-derived NIRS values show a wide variability and are influenced by the effects of anesthetics, cardiovascular drugs, fluids, and by the type of surgery. Additionally, deviations in VOT-derived NIRS values are also associated with adverse patients' outcomes, such as postoperative complications, prolonged mechanical ventilation and prolonged hospital length of stay. However, given the variability in VOT-derived NIRS values, clinical applicability remains elusive. Future clinical interventional trials might provide additional insight into the potential of VOT associated with NIRS to optimize perioperative care by targeting specific interventions to optimize the function of the microvasculature.

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Section: Includedmentioning

confidence: 91%

“…We found two studies investigating the effect of anesthesia induction on the VOT-derived NIRS values in patients having non-cardiac surgery (Table 2). After induction of anesthesia with propofol and remifentanil [15,16], or with etomidate and remifentanil [16], the StO 2 increased and the…”

Section: Effects Of Anesthetic Drugs and Other Drugsmentioning

confidence: 99%

The use of a vascular occlusion test combined with near-infrared spectroscopy in perioperative care: a systematic review

Niezen

Massari

Vos

et al. 2022

J Clin Monit Comput

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“…Within the context of microcirculatory function analysis, parameters dynamically ascertained through alterations in tissue oxygen saturation (StO 2 ), as derived from near-infrared spectroscopy (NIRS) during temporary occlusion of blood flow (vascular occlusion tests [VOTs]), are preferred because of their noninvasiveness, cost-effectiveness, and high reproducibility [ 4 – 6 ]. NIRS provides continuous StO 2 measurements by exploiting the different absorption frequencies of oxygenated and deoxygenated hemoglobin [ 7 ].…”

Section: Introductionmentioning

confidence: 99%

“…NIRS specifically monitors blood vessels with a diameter smaller than 1 mm, such as arterioles, capillaries, and venules, as it is less likely for photons to emerge effectively in larger arteries and veins with high blood concentration [ 8 ]. During VOT, the downslope gradient of StO 2 during blood occlusion (the occlusion slope) represents metabolic demand and oxygen extraction, whereas the upslope gradient of StO 2 during reperfusion following deflation (recovery slope) reflects microvascular reactivity during reperfusion [ 6 ]. Numerous clinical studies have shown that critically ill patients and those undergoing major surgery typically experience both tissue hypoperfusion and a decline in microvascular reactivity [ 6 , 8 – 12 ].…”

Section: Introductionmentioning

confidence: 99%

Impaired Capillary Recruitment Capacity in Obesity: A Subgroup Analysis of Prospective Observational Study on Anesthesia Effects

Jeon,

Lee,

et al. 2023

Med Sci Monit

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Background This subgroup analysis of prospective observational research, involving 71 participants, compared the effects of anesthesia on microvascular reactivity in obese vs lean individuals using near-infrared spectroscopy and vascular occlusion tests. The correlation between the body mass index (BMI) and microvascular reactivity under general anesthesia was also investigated. Material/Methods This study enrolled adult patients classified as American Society of Anesthesiologists physical status I or II, undergoing elective surgery under general anesthesia. The microcirculatory variables measured before (Tpre) and 30 min following the induction of anesthesia (Tpost) were as follows: baseline tissue oxygen saturation (StO 2 ), occlusion slope (∇occl), and recovery slope (∇recov). The patients were grouped according to their BMI (lean [BMI <25 kg/m 2 ] vs obese [BMI ≥25 kg/m 2 ]). Data are presented as medians and interquartile ranges. Results There were 43 patients in the lean group and 28 in the obese group. At Tpre, baseline StO 2 , ∇occl, and ∇recov were not different between the 2 groups ( P =0.860, 0.659, and 0.518, respectively). At Tpost, the baseline StO 2 and ∇occl were not different between the 2 groups ( P =0.343 and 0.791); however, the ∇recov was lower in the obese group than in the lean group (3.245 [2.737, 3.977] vs 4.131 [3.491, 4.843], P =0.003). At Tpost, BMI showed a moderate correlation with ∇recov (correlation coefficient: −0.319, P =0.007). Conclusions In obese patients, capillary recruitment capacity during general anesthesia is compromised compared to lean patients.

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“…The endothelium produces nitric oxide and other gaseous transmitters that are mediators of endothelium function [ 11 , 12 ]. In humans, impaired endothelium-dependent relaxation (EDR) mechanisms have been implicated in studies showing that vasodilation of forearm and leg arteries, and microvasculature are reduced with age [ 13 , 14 , 15 , 16 , 17 ]. Similarly, studies in animal models of cardiovascular disease show reduced efficacy for EDR with ageing [ 18 , 19 , 20 ].…”

Section: Introductionmentioning

confidence: 99%

Characterization of Endothelium-Dependent Relaxation in the Saphenous Artery and Its Caudal Branches in Young and Old Adult Sprague Dawley Rats

2022

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Ageing is associated with reduced endothelium-derived nitric oxide (NO) production in the femoral artery of Sprague Dawley (SD) rats. In the current study, we examined endothelium-dependent relaxation (EDR) in the saphenous artery and its caudal branches. We used acetylcholine and the Proteinase-Activated receptor-2 (PAR2)-specific agonist (2fLIGRLO) with nitroarginine methylester (L-NAME) to assess EDR in two groups of male SD rats (age in weeks: young, 10–12; old, 27–29). Acetylcholine and 2fLIGRLO were potent NO-dependent relaxant agents in all arteries. For all arteries, EDR by acetylcholine decreased significantly in old compared to young SD rats. Interestingly, PAR2-induced EDR of proximal saphenous artery segments and caudal branches decreased significantly in old compared to young, but did not differ for the in-between middle and distal ends of the saphenous artery. L-NAME treatment increased subsequent contractions of proximal and middle segments of saphenous arteries by phenylephrine and U46619 in young, but not in old, SD rats. We conclude the SD saphenous artery and caudal branches exhibit regional characteristics that differ in response to specific EDR agonists, endothelial NO synthase inhibitor, and changes to endothelium function with increased age, which are, in part, attributed to decreased sensitivity of vascular smooth muscle to the gaseous transmitter NO.

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Microvascular Reactivity Measured by Dynamic Near-infrared Spectroscopy Following Induction of General Anesthesia in Healthy Patients: Observation of Age-related Change

Cited by 5 publications

References 19 publications

The use of a vascular occlusion test combined with near-infrared spectroscopy in perioperative care: a systematic review

The use of a vascular occlusion test combined with near-infrared spectroscopy in perioperative care: a systematic review

Impaired Capillary Recruitment Capacity in Obesity: A Subgroup Analysis of Prospective Observational Study on Anesthesia Effects

Characterization of Endothelium-Dependent Relaxation in the Saphenous Artery and Its Caudal Branches in Young and Old Adult Sprague Dawley Rats

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