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British Journal of Anaesthesia, 1995, Vol. 74, No. 6 661-666
© 1995 The Board of Management and Trustees of the British Journal of Anaesthesia

other

Perioperative plasma endothelin-1 concentrations and vasoconstriction during prolonged plastic surgical procedures

H. P. TUOMINEN, MD, N. E. SVARTLING, MD, PHD, I. T. TIKKANEN, MD, PHD, O. SAIJONMAA, MSC, PHD and S. ASKO-SELJAVAARA, MD, PHD

Department of Anaesthesiology, Töölo Hospital, Helsinki University Central Hospital Topeliuksenkatu 5, 00260 Helsinki, Finland
Department of Medicine, Helsinki University Central Hospital Finland
Minerva Institute for Medical Research Helsinki, Finland
Department of Plastic Surgery, Helsinki University Central Hospital Topeliuksenkatu 5, 00260 Helsinki, Finland

Present address, for correspondence: Kuukiventie 7 A, 00840 Helsinki, Finland

The role of endothelin-1, a potent vasoconstrictor released by vascular endothelium, in the vasoconstriction that develops after prolonged operations is not clear. This study was performed in order to determine if there was any relationship between endothelin-1 and the degree of vasoconstriction during prolonged plastic surgery. Plasma concentrations of endothelin-1, skin-forearm temperature gradient (Tgrad), rectal temperature, mean arterial pressure (MAP) and heart rate (HR) were measured at nine predetermined times before, during and after operation in nine women undergoing breast reconstruction with a pedicled transverse rectus abdominis musculocutaneous flap. Development of cutaneous or fat necrosis of the flap was assessed clinically and with ultrasound. Concentrations of endothelin-1 before induction were increased (median 8.9 (25–75% quartiles 5.5–12.5) pg ml–1). During operation they were approximately 3 pg ml–1 and after operation approximately 5 pg ml–1. Tgrad was approximately 4 °C before induction and after operation, indicating marked vasoconstriction; during operation it was about zero, indicating vasodilatation. There was a statistically significant correlation between endothelin-1 concentrations and Tgrad (Spearman non-linear correlation) (r = 0.32, P = 0.004) and between endothelin-1 and MAP (r = 0.25, P = 0.02), but not between endothelin-1 and HR or development of minor cutaneous or fat necrosis of the flap (five patients). We conclude that increased plasma concentration of endothelin-1 is associated with the extent of peripheral vasoconstriction.


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