Changes in the sublingual microcirculation following aortic surgery under balanced or total intravenous anaesthesia: a prospective observational study

Silvia Loggi, Nicoletta Mininno, Elisa Damiani, Benedetto Marini, Erica Adrario, Claudia Scorcella, Roberta Domizi, Andrea Carsetti, Simona Pantanetti, Gabriele Pagliariccio, Luciano Carbonari, Abele Donati, Silvia Loggi, Nicoletta Mininno, Elisa Damiani, Benedetto Marini, Erica Adrario, Claudia Scorcella, Roberta Domizi, Andrea Carsetti, Simona Pantanetti, Gabriele Pagliariccio, Luciano Carbonari, Abele Donati

Abstract

Background: In vascular surgery with aortic cross-clamping, ischemia/reperfusion injury induces systemic haemodynamic and microcirculatory disturbances. Different anaesthetic regimens may have a varying impact on tissue perfusion. The aim of this study was to explore changes in microvascular perfusion in patients undergoing elective open abdominal aortic aneurysm repair under balanced or total intravenous anaesthesia.

Methods: Prospective observational study. Patients undergoing elective open infrarenal abdominal aortic aneurysm repair received balanced (desflurane + remifentanil, n = 20) or total intravenous anaesthesia (TIVA, propofol + remifentanil using target-controlled infusion, n = 20) according to the clinician's decision. A goal-directed haemodynamic management was applied in all patients. Measurements were obtained before anaesthesia induction (baseline) and at end-surgery and included haemodynamics, arterial/venous blood gases, sublingual microvascular flow and density (incident dark field illumination imaging), peripheral muscle tissue oxygenation and microcirculatory reactivity (thenar near infrared spectroscopy with a vascular occlusion test).

Results: The two groups did not differ for baseline characteristics, mean aortic-clamping time and requirement of vasoactive agents during surgery. Changes in mean arterial pressure, systemic vascular resistance index, haemoglobin and blood lactate levels were similar between the two groups, while the cardiac index increased at end-surgery in patients undergoing balanced anaesthesia. The sublingual microcirculation was globally unaltered in the TIVA group at end-surgery, while patients undergoing balanced anaesthesia showed an increase in the total and perfused small vessel densities (from 16.6 ± 4.2 to 19.1 ± 5.4 mm/mm2, p < 0.05). Changes in microvascular density were negatively correlated with changes in the systemic vascular resistance index. The area of reactive hyperaemia during the VOT increased in the balanced anaesthesia group (from 14.8 ± 8.1 to 25.6 ± 14.8%*min, p < 0.05). At end-surgery, the tissue haemoglobin index in the TIVA group was lower than that in the balanced anaesthesia group.

Conclusions: In patients undergoing elective open abdominal aortic aneurysm repair with a goal-directed hemodynamic management, indices of sublingual or peripheral microvascular perfusion/oxygenation were globally preserved with both balanced anaesthesia and TIVA. Patients undergoing balanced anaesthesia showed microvascular recruitment at end-surgery.

Trial registration: NCT03510793 , https://www.clinicaltrials.gov, date of registration April 27th 2018, retrospectively registered.

Keywords: Anaesthesia; Aortic surgery; Haemodynamics; Ischemia/reperfusion injury; Microcirculation.

Conflict of interest statement

Ethics approval and consent to participate

The study was approved by our local ethic committee of Azienda Ospedaliera Universitaria “Ospedali Riuniti” of Ancona in Italy (www.clinicaltrials.gov, principal investigator: Prof. Abele Donati, date of registration: April 27th 2018, retrospectively registered). A written informed consent was obtained from all patients before enrolment.

Consent for publication

Not applicable.

Competing interests

The authors declare that they have no competing interests.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
Study flow diagram
Fig. 2
Fig. 2
Changes in sublingual microvascular parameters from baseline to end-surgery in the two groups of patients receiving balanced anaesthesia or total intravenous anaesthesia (TIVA)
Fig. 3
Fig. 3
Changes in NIRS-derived parameters from baseline to end-surgery in the two groups of patients receiving balanced anaesthesia or total intravenous anaesthesia (TIVA). StO2 tissue oxygen saturation, AUC StO2 area under the curve of StO2 (area of hyperaemia)
Fig. 4
Fig. 4
Changes in the tissue haemoglobin index (THI) from baseline to end-surgery in the two groups of patients receiving balanced anaesthesia or total intravenous anaesthesia (TIVA)

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