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

Ah-Reum Cho, Hyeon-Jeong Lee, Hyae-Jin Kim, Wangseok Do, Soeun Jeon, Seung-Hoon Baek, Eun-Soo Kim, Jae-Young Kwon, Hae-Kyu Kim, Ah-Reum Cho, Hyeon-Jeong Lee, Hyae-Jin Kim, Wangseok Do, Soeun Jeon, Seung-Hoon Baek, Eun-Soo Kim, Jae-Young Kwon, Hae-Kyu Kim

Abstract

Background: The purpose of this study was to investigate the effect of general anesthesia on microvascular reactivity and tissue oxygen saturation (StO2) using near-infrared spectroscopy in conjunction with vascular occlusion tests (VOT). Age-related changes of microvascular reactivity, that is, the capacity of capillary recruitment, were examined. Methods: This prospective observational study was performed on 60 patients without comorbidities who underwent elective surgery under general anesthesia. Baseline StO2 on thenar eminence, hemodynamics, and laboratory profile were monitored before (T0) and 30 min after general anesthesia (T1). During VOT, occlusion slope representing oxygen consumption of muscle and recovery slope representing microvascular reactivity were also collected at T0 and T1. Results: Baseline StO2 and minimum / maximum StO2 during VOT increased under general anesthesia. Occlusion slope decreased while the recovery slope increased under general anesthesia. To observe aging effect, Receiver operating characteristic analysis was performed and age less than 65 years old showed a fair performance in predicting the increase of microvascular reactivity after the induction of anesthesia (AUC 0.733, 95% CI 0.594-0.845, P= 0.003). For age-related analyses, 27 patients of younger group (< 65 years) and 26 patients of older group (≥ 65 years) were divided. Recovery slope significantly increased under general anesthesia in younger group (2.44 [1.91-2.81] % ∙ sec-1 at T0 and 3.59 [2.58-3.51] % ∙ sec-1 at T1, P <0.001), but not in older group (2.61 [2.21-3.20] % ∙ sec-1 at T0, 2.63 [1.90-3.60] % ∙ sec-1 at T1, P = 0.949). Conclusions: General anesthesia could improve StO2 through increase of microvascular reactivity and decrease of tissue metabolism. However, microvascular reactivity to capillary recruitment under general anesthesia significantly improves in younger patients, not in older patients.

Keywords: Aging; anesthesia, inhalation; cardiovascular physiology; microcirculation; spectroscopy, near-infrared.

Conflict of interest statement

Competing Interests: The authors have declared that no competing interest exists.

© The author(s).

Figures

Figure 1
Figure 1
Receiver operating characteristic curve for age to predict the increase of recovery slope under general anesthesia. If age was lower than 65 years old, the increase of recovery slope under general anesthesia was predicted with a sensitivity of 85.7% and a specificity of 61.1%.
Figure 2
Figure 2
Changes in tissue oxygen saturation (StO2) during vascular occlusion test (VOT) before and after induction of general anesthesia in the younger and the older groups. A repeated measures ANOVA revealed significantly different StO2 values between before and after the induction of anesthesia, with a significant Bonferroni post hoc test for the differences at all the time points.

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