Department of Anesthesiology and Pain Medicine and Anesthesia and Pain Research Institute, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea.
Biostatistics Collaboration Unit, Yonsei University College of Medicine, Seoul, Republic of Korea.
Sci Rep. 2021 Jan 15;11(1):1511. doi: 10.1038/s41598-021-81012-1.
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).
本研究旨在比较挥发性麻醉和全凭静脉麻醉（TIVA）对接受微创胃癌切除术的患者中硫酸乙酰肝素蛋白聚糖-1（syndecan-1）脱落的影响。患者被随机分配至挥发性麻醉组（n=68）或 TIVA 组（n=68）。挥发性麻醉组和 TIVA 组分别以七氟醚/瑞芬太尼或丙泊酚/瑞芬太尼维持麻醉。在术前、手术结束时和术后第 1 天（POD）评估血清 syndecan-1。在术前、手术结束时和 POD 1、2、3 和 5 时还测量了包括白细胞（WBC）计数、中性粒细胞与淋巴细胞比值（NLR）和 C 反应蛋白（CRP）在内的炎症标志物。TIVA 组在手术结束时的 syndecan-1 水平明显低于挥发性麻醉组；然而，两组在 POD 1 时没有差异。TIVA 组在手术结束时的 WBC 计数和 NLR 明显低于挥发性麻醉组，但两组在 POD 1、2、3 和 5 时无差异。两组在所有时间点的 CRP 水平相似。总之，尽管 TIVA 在手术期间保护内皮糖萼方面优于挥发性麻醉，但两者均不能防止胃癌切除术后 syndecan-1 的脱落。临床试验注册号：NCT04183296（ClinicalTrials.gov，2019 年 3 月 12 日）。
