Effect of volatile and total intravenous anesthesia on syndecan-1 shedding after minimally invasive gastrectomy: a randomized trial

Na Young Kim, Ki Jun Kim, Ki-Young Lee, Hye Jung Shin, Jaein Cho, Da Jeong Nam, So Yeon Kim, Na Young Kim, Ki Jun Kim, Ki-Young Lee, Hye Jung Shin, Jaein Cho, Da Jeong Nam, So Yeon Kim

Abstract

This study aimed to compare the effects of volatile anesthesia and total intravenous anesthesia (TIVA) on syndecan-1 shedding in patients with gastric cancer undergoing minimally invasive gastrectomy. Patients were randomly assigned to either the Volatile (n = 68) or the TIVA (n = 68) group. Anesthesia was maintained with sevoflurane/remifentanil or propofol/remifentanil in the Volatile and TIVA groups, respectively. Serum syndecan-1 was evaluated at pre-operation, end of operation, and postoperative day (POD) 1. Inflammatory markers including white blood cell (WBC) count, neutrophil-to-lymphocyte ratio (NLR), and C-reactive protein (CRP), were also measured at pre-operation, end of operation, and POD 1, 2, 3, and 5. The TIVA group showed significantly lower levels of syndecan-1 at the end of the operation compared to the Volatile group; however, no difference was seen between the groups at POD 1. The WBC count and NLR were significantly lower in the TIVA group at the end of the operation than the Volatile group, but there were no differences between the groups at POD 1, 2, 3, and 5. CRP levels were similar between the groups at all time points. In conclusion, despite TIVA being superior to volatile anesthesia in protecting endothelial glycocalyx during the operation, both did not prevent postoperative syndecan-1 shedding after gastrectomy.Clinical trial registration number: NCT04183296 (ClinicalTrial.gov, 03/12/2019).

Conflict of interest statement

The authors declare no competing interests.

Figures

Figure 1
Figure 1
Consort flow diagram of the study.
Figure 2
Figure 2
Intraoperative changes in (A) mean arterial pressure (MAP) and (B) heart rate (HR). Pneumo, pneumoperitoneum; OP, operation; TIVA, total intravenous anesthesia. Values are expressed as mean ± SD. *Bonferroni-corrected P < 0.05 versus Volatile group.
Figure 3
Figure 3
Perioperative changes in serum syndecan-1. OP, operation; POD, postoperative day; TIVA, total intravenous anesthesia. Values are expressed as mean ± SD. *Bonferroni-corrected P < 0.05 versus Volatile group. †Bonferroni-corrected P < 0.05 versus Pre-OP in each group.
Figure 4
Figure 4
Perioperative changes in (A) white blood cell (WBC) counts, (B) neutrophil/lymphocyte ratio (NLR), and (C) C-reactive protein (CRP). OP, operation; POD, postoperative day; TIVA, total intravenous anesthesia. Values are expressed as mean ± SD. *Bonferroni-corrected P < 0.05 versus Volatile group.
Figure 5
Figure 5
(A) Cumulative fentanyl dose administered via intravenous patient-controlled analgesia, and (B) use of rescue analgesics during the first 24 h after operation. TIVA, total intravenous anesthesia. Values are expressed as mean ± SD or percentage.

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