Lee Bahn, Shin Hye Jung, Kweon Ki Hong, Kim Na Young
Department of Anesthesiology and Pain Medicine, Anesthesia and Pain Research Institute, Yonsei University College of Medicine, Seoul, Korea.
Biostatistics Collaboration Unit, Department of Biomedical Systems Informatics, Yonsei University College of Medicine, Seoul, Korea.
Anesth Pain Med (Seoul). 2023 Apr;18(2):148-158. doi: 10.17085/apm.22240. Epub 2023 Apr 28.
The endothelial glycocalyx (EG) is an important structure that regulates vascular homeostasis. Deep inferior epigastric perforator (DIEP) flap is expected to cause substantial EG breakdown owing to the long procedural duration and ischemia- reperfusion injury. This prospective, randomized, controlled study aimed to compare syndecan-1 levels during sevoflurane-remifentanil and propofol-remifentanil anesthesia in patients who underwent DIEP flap breast reconstruction.
Fifty-one patients were randomized to either sevoflurane (n = 26) or propofol (n = 25) groups. Anesthesia was maintained with remifentanil in combination with either sevoflurane or propofol. The primary endpoint was the concentration of serum syndecan-1 measured at 1 h after surgery.
Fifty patients (98.0%) completed the study. Patients in the propofol group had significantly lower levels of syndecan-1 than patients in the sevoflurane group at 1 h after operation (23.8 ± 1.6 vs. 30.9 ± 1.7 ng/ml, respectively; Bonferroni corrected P = 0.012). There were no significant differences between groups in postoperative complications. The postoperative hospital stay was 8.4 ± 2.5 days in the sevoflurane group and 7.4 ± 1.0 days in the propofol group (P = 0.077).
Propofol-remifentanil anesthesia resulted in lesser increases in syndecan-1 levels compared to increases with sevoflurane-remifentanil anesthesia in patients who underwent DIEP flap reconstruction. Our results suggest that propofol-remifentanil anesthesia shows protective effects against EG damage during DIEP flap breast reconstruction in contrast to sevoflurane-remifentanil anesthesia.
内皮糖萼（EG）是调节血管稳态的重要结构。由于手术时间长和缺血再灌注损伤，预计腹壁下深动脉穿支（DIEP）皮瓣会导致大量EG破坏。这项前瞻性、随机、对照研究旨在比较接受DIEP皮瓣乳房重建患者在七氟醚-瑞芬太尼和丙泊酚-瑞芬太尼麻醉期间的syndecan-1水平。
51例患者随机分为七氟醚组（n = 26）或丙泊酚组（n = 25）。用瑞芬太尼联合七氟醚或丙泊酚维持麻醉。主要终点是术后1小时测得的血清syndecan-1浓度。
50例患者（98.0%）完成了研究。丙泊酚组患者术后1小时的syndecan-1水平显著低于七氟醚组（分别为23.8±1.6 vs. 30.9±1.7 ng/ml；Bonferroni校正P = 0.012）。两组术后并发症无显著差异。七氟醚组术后住院时间为8.4±2.5天，丙泊酚组为7.4±1.0天（P = 0.077）。
与接受DIEP皮瓣重建患者的七氟醚-瑞芬太尼麻醉相比，丙泊酚-瑞芬太尼麻醉导致syndecan-1水平升高幅度较小。我们的结果表明，与七氟醚-瑞芬太尼麻醉相比，丙泊酚-瑞芬太尼麻醉在DIEP皮瓣乳房重建期间对EG损伤具有保护作用。
