Abstract
BackgroundThe glycocalyx layer is a key structure in the endothelium. Tourniquet-induced ischemic periods are used during orthopedic surgery, and the reactive oxygen species generated after ischemia-reperfusion may mediate the shedding of the glycocalyx. Here, we describe the effects of tourniquet-induced ischemia-reperfusion and compare the effects of sevoflurane and propofol on the release of endothelial biomarkers after ischemia-reperfusion in knee-ligament surgery.MethodsThis pilot, single-center, blinded, randomized, controlled trial included 16 healthy patients. After spinal anesthesia, hypnosis was achieved with sevoflurane or propofol according to randomization. During the perioperative period, five venous blood samples were collected for quantification of syndecan-1, heparan sulfate, and thrombomodulin from blood serum by using ELISA assays kits. Sample size calculation was performed to detect a 25% change in the mean concentration of syndecan-1 with an alpha of 0.05 and power of 80%.ResultsFor our primary outcome, a two-way ANOVA with post-hoc Bonferroni correction analysis showed no differences in syndecan-1 concentrations between the sevoflurane and propofol groups at any time point. In the sevoflurane group, we noted an increase in syndecan-1 concentrations 90 min after tourniquet release in the sevoflurane group from 34.6 ± 24.4 ng/mL to 47.9 ± 29.8 ng/mL (Wilcoxon test, p < 0.01) that was not observed in patients randomized to the propofol group. The two-way ANOVA showed no intergroup differences in heparan sulfate and thrombomodulin levels.ConclusionsSuperficial endothelial damage without alterations in the cell layer integrity was observed after tourniquet knee-ligament surgery. There was no elevation in serum endothelial biomarkers in the propofol group patients. Sevoflurane did not show the protective effect observed in in vitro and in vivo studies.Trial registrationThe trial was registered in www.clinicaltrials.gov (ref: NCT03772054, Registered 11 December 2018).
Highlights
The glycocalyx layer is a key structure in the endothelium
In a two-way ANOVA with Bonferroni correction, we found no differences in the plasma levels of syndecan-1 between the sevoflurane and propofol groups at any time
When we analyzed the changes in syndecan-1 levels across different times in each group, we found that the syndecan-1 level was elevated 90 min after tourniquet release in comparison to the baseline values in the sevoflurane group
Summary
The glycocalyx layer is a key structure in the endothelium. Tourniquet-induced ischemic periods are used during orthopedic surgery, and the reactive oxygen species generated after ischemia-reperfusion may mediate the shedding of the glycocalyx. We describe the effects of tourniquet-induced ischemia-reperfusion and compare the effects of sevoflurane and propofol on the release of endothelial biomarkers after ischemia-reperfusion in knee-ligament surgery. The glycocalyx layer is a key structure in the regulation of the endothelium. A highly sulfated matrix of glycosaminoglycans bound to proteoglycans and glycoproteins acts as a pre-endothelial barrier for macromolecules such as albumin [2, 3], adding a chemical interaction component to the fluid-molecular exchange between blood and the interstitial space [4, 5]. The endothelial damage is recognized as the hallmark of different pathologies [2, 7] and is associated with worse outcomes in acute coronary syndrome [8, 9], acute distress respiratory syndrome [10], and sepsis [11]
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