Microcirculation and Anesthesia in Vascular Surgery

NCT03510793 | Completed

• 1 other identifier: Vasc2018
• Study Type: observational
• Target: 40
• Locations: 0 countries
• Sites: N/A

Brief Summary

Ischemia/reperfusion injury following aortic cross-clamping for vascular surgery leads to systemic hemodynamic and microcirculatory perturbances. The use of different anesthetic regimens may have an 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 anesthesia. Prospective observational study on 40 patients scheduled for elective open infrarenal abdominal aortic aneurysm repair, who received balanced (desflurane + remifentanil, n=20) or total intravenous anesthesia (TIVA, propofol + remifentanil using target-controlled infusion, n=20) according to the clinician's decision. A goal-directed hemodynamic management was applied in all patients. Hemodynamics and arterial/venous blood gases were compared before anesthesia induction (baseline) and at end-surgery. Changes in sublingual microvascular flow and density were assessed with incident dark field illumination imaging. Near infrared spectroscopy was applied on the thenar eminence with a vascular occlusion test (VOT) to assess variations in the peripheral muscle tissue oxygenation and microcirculatory reactivity.

Conditions

Ischemia Reperfusion Injury; Aortic Aneurysm; Anesthesia

Keywords

microcirculation; aortic aneurysm; anesthesia

Outcome Measures

Primary Outcomes (1)

• change in the microvascular flow index

  Variation in the microvascular flow index, which is a parameter of capillary blood flow quality, calculated for small (diameter \<20 microns) vessels in the sublingual microcirculation

  from baseline (before induction of anesthesia) to end-surgery (before anesthesia suspension)

Secondary Outcomes (3)

• change in microvascular density

  from baseline (before induction of anesthesia) to end-surgery (before anesthesia suspension)

• change in tissue oxygenation

  from baseline (before induction of anesthesia) to end-surgery (before anesthesia suspension)

• change in microvascular reactivity

  from baseline (before induction of anesthesia) to end-surgery (before anesthesia suspension)

Study Arms (2)

Balanced anesthesia

Patients receiving balanced anesthesia (desflurane + remifentanil) according to the attending physician's decision

Drug: balanced anesthesia

Total intravenous anesthesia

Patients receiving total intravenous anesthesia (TIVA) using propofol + remifentanil with target-controlled infusion according to the attending physician's decision.

Drug: Total intravenous anesthesia

Interventions

balanced anesthesia DRUG

patients undergoing open elective abdominal aortic aneurysm repair will receive balanced (desflurane + remifentanil) anaesthesia

Balanced anesthesia

Total intravenous anesthesia DRUG

patients undergoing open elective abdominal aortic aneurysm repair will receive total intravenous (propofol + remifentanil with target-controlled infusion) anesthesia

Total intravenous anesthesia

Eligibility Criteria

• Age: 18 Years+
• Sex: all
• Healthy Volunteers: No
• Age Groups: Adult (18-64), Older Adult (65+)
• Sampling Method: Probability Sample

Study Population

adult (\>18 years old) patients scheduled for elective open aortic aneurysm repair under general anesthesia, who will receive balanced or total intravenous anesthesia according to the attending physician's decision

You may qualify if:

• elective infrarenal abdominal aortic open repair
• protocol of intraoperative goal-directed therapy
• ASA class I-II-III

You may not qualify if:

• age of less than 18 years
• pregnancy
• Endovascular Aneurysm Repair (EVAR)
• concomitant infections
• trauma
• emergency surgery

Sponsors & Collaborators

• Università Politecnica delle Marche: lead

Related Publications (4)

• Petros AJ, Bogle RG, Pearson JD. Propofol stimulates nitric oxide release from cultured porcine aortic endothelial cells. Br J Pharmacol. 1993 May;109(1):6-7. doi: 10.1111/j.1476-5381.1993.tb13523.x.

  PMID: 8388302 RESULT

• Koch M, De Backer D, Vincent JL, Barvais L, Hennart D, Schmartz D. Effects of propofol on human microcirculation. Br J Anaesth. 2008 Oct;101(4):473-8. doi: 10.1093/bja/aen210. Epub 2008 Jul 23.

  PMID: 18653494 RESULT

• O'Riordan J, O'Beirne HA, Young Y, Bellamy MC. Effects of desflurane and isoflurane on splanchnic microcirculation during major surgery. Br J Anaesth. 1997 Jan;78(1):95-6. doi: 10.1093/bja/78.1.95.

  PMID: 9059215 RESULT

• Loggi S, Mininno N, Damiani E, Marini B, Adrario E, Scorcella C, Domizi R, Carsetti A, Pantanetti S, Pagliariccio G, Carbonari L, Donati A. Changes in the sublingual microcirculation following aortic surgery under balanced or total intravenous anaesthesia: a prospective observational study. BMC Anesthesiol. 2019 Jan 5;19(1):1. doi: 10.1186/s12871-018-0673-7.

  PMID: 30611197 DERIVED

MeSH Terms

Conditions

Reperfusion Injury; Aortic Aneurysm

Interventions

Balanced Anesthesia

Condition Hierarchy (Ancestors)

Vascular Diseases; Cardiovascular Diseases; Postoperative Complications; Pathologic Processes; Pathological Conditions, Signs and Symptoms; Aneurysm; Aortic Diseases

Intervention Hierarchy (Ancestors)

Anesthesia, General; Anesthesia; Anesthesia and Analgesia

Study Officials

• Abele Donati

  Università Politecnica delle Marche

  PRINCIPAL INVESTIGATOR

Study Design

• Study Type: observational
• Observational Model: CASE CONTROL
• Time Perspective: PROSPECTIVE
• Sponsor Type: OTHER
• Responsible Party: PRINCIPAL INVESTIGATOR
• PI Title: Professor

Study Record Dates

• First Submitted: April 24, 2018
• First Posted: April 27, 2018
• Study Start: September 1, 2013
• Primary Completion: November 30, 2017
• Study Completion: November 30, 2017
• Last Updated: May 3, 2018

Record last verified: 2018-04

Data Sharing

• IPD Sharing: Will not share