Impact of non-cardiovascular surgery on reactive hyperaemia and arterial endothelial function.

Vascular reactivity is a surrogate marker for atherosclerosis and is predictive of cardiovascular outcome. Non-cardiovascular surgery is associated with perioperative cardiovascular complications in high-risk patients. To evaluate the impact of non-cardiovascular surgery on reactive hyperaemia and arterial endothelial function and to investigate the relationships between endothelial dysfunction and invasive (laparotomy) or minimally invasive (laparoscopic) surgery, we prospectively evaluated 106 patients undergoing abdominal surgery under general anaesthesia (71 laparotomy, 35 laparoscopy). Measurements of blood pressure, heart rate and pain (on a visual analogue scale (VAS)) were undertaken. Brachial endothelium-dependent flow-mediated dilation (FMD), endothelium-independent dilation, nitroglycerin (NTG)-induced dilation and reactive hyperaemia were measured with high-resolution B-mode ultrasound on preoperative Day 1 (baseline), as well as 2 h and 1 and 7 days postoperatively. Blood pressure and heart rate were significantly higher 2 h postoperatively. Pain, as measured on the VAS, was higher (P < 0.01) and reactive hyperaemia and FMD were significantly lower (P < 0.001) at 2 h and 1 day postoperatively compared with values at baseline and on postoperative Day 7. By postoperative Day 7, FMD had recovered to baseline levels. Patients undergoing laparoscopic surgery had less FMD reduction on Days 1 and 7 (7.5 ± 1.5% and 7.9 ± 1.5%, respectively) compared with those undergoing laparotomy (6.4 ± 1.6% (P = 0.001) and 7.0 ± 1.6% (P = 0.006), respectively), consistent with potential cardiovascular benefit. Responses to NTG were stable throughout. Backward multivariate linear regression analysis indicated that FMD was independently related to age and VAS (model R = 0.486; F = 6.4; P < 0.001). Reactive hyperaemia and arterial endothelial function are significantly reduced in the early postoperative period, particularly after laparotomy compared with laparoscopy, which may be related to postoperative cardiovascular events.

[Changes of blood pressure and pulse rate and the microstructure of celiac ganglion in rabbits with damaged celiac ganglion induced by high intensity focused ultrasound and alcohol].

OBJECTIVE: To observe the changes of blood pressure (BP), pulse rate (PR) and the microstructure of celiac ganglion (CG) in rabbits with damaged CGs induced by alcohol and high intensity focused ultrasound. METHODS: Fourteen rabbits were randomly divided into two groups. The CGs of the rabbits in group A and group B were damaged by alcohol and high intensity focused ultrasound respectively. The changes of BP and PR 0, 1, 3, 5, and 10 minutes after the damage were recorded and compared. The microstructure changes of the damaged CGs were examined under optics microscope and electron microscope. RESULTS: Ganglionic morphology changes were obvious in both groups, with moved and concentrated karyons. In the CGs damaged by alcohol, the nucleolus still existed; some organelles could be identified; the myelination nerve fibre lost its myelin sheath or delaminated while the unmyelination nerve fibre exhibited vacuole formation. In the CGs damaged by high intensity focused ultrasound, all nucleolus disappeared, vacuole formed, intracellular membrane disappeared, axone locally necrotized. The BPs of the rabbits started to decrease three minutes after the alcohol treatment (P < 0.01), one minute after the high intensity focused ultrasound (P < 0.01). Significant differences of BP decline were observed between the two groups one minute after the CG damages. (P < 0.01). The PRs of the rabbits increased 5 minutes and 10 minutes after the high intensity focused ultrasound (P < 0.05, P < 0.01). CONCLUSION: Using high intensity focused ultrasound to damage CGs has more significant impacts on BPs and PRs than alcohol.