The effect of various doses of infusion solutions on the endothelial glycocalyx layer in laparoscopic cholecystectomy patients.

BACKGROUND: The endothelial glycocalyx is located on the luminal side of blood vessels and maintains vessel integrity. This study analysed how various dosages of infusion affected the secretion of atrial natriuretic peptide (ANP) and potential glycocalyx damage in patients undergoing laparoscopic cholecystectomy. We hypothesised that the liberal administration of Ringer's solution during the operation can cause iatrogenic hypervolemia with releasing of ANP and glycocalyx damage.

METHODS: The study included 90 patients with American Society of Anesthesiologists' (ASA) class I and II, in good cardiopulmonary health, who were assigned to one of three groups: Restrictive group, which received 1 mL/kg/hr intraoperatively and six hours postoperatively; Low liberal group, which received 5 mL/kg/hr of Ringer's solution intraoperatively and six hours postoperatively and High liberal group, which received 15 mL/kg/hr intraoperatively and 10 mL/kg/hr six hours postoperatively. We measured patients' concentrations of glycocalyx constituents, ANP, markers of kidney and liver function, C-reactive protein (CRP), and albumine at three time points. We also measured noinvasive hemodynamics, the correlation between ANP secretion and the concentration of glycocalyx components.

RESULTS: We found a significantly higher concentrations of hyaluronic acid and syndecan-1 and more ANP secretion in the High liberal group than in the other groups. We also observed a positive correlation between ANP secretion and glycocalyx constituent concentration. Markers of kidney and liver function were normal, suggesting preservation of splanchnic perfusion and global hemodynamics.

CONCLUSIONS: Measuring the endothelial glycocalyx constituents in circulating blood could be a marker of intraoperative volume overload during laparoscopic operations.