Department of thoracic surgery,Valiasr Hospital, Tehran university of medical science, Iran

Background Fluid therapy has an impact on glycocalyx shedding, however it's unknown how this treatment will affect it in glioma patients. In this work, we examined cerebral metabolism and glycocalyx shedding in patients with and without gliomas during colloid loading. Methods The normal brain group included patients who were receiving partial hepatectomy to treat liver cancer. The glioma brain group included patients who were undergoing general anaesthesia. Following the induction of anaesthesia, 15 mL/kg of hydroxyethyl starch (HES) loading was administered to all patients. Syndecan-1 and heparan sulphate levels in the jugular venous bulb were evaluated in both groups to assess glycocalyx shedding.The jugular vein oxygen saturation (SjvO2), arterial-jugular venous oxygen differences (CajvO2), glucose (A-JvGD), lactate (A-JvLD), the cerebral oxygen extraction ratio (CERO2), and the oxygen-glucose index were all examined as well. Results According to our findings, patients in the glioma brain group shed less basal syndecan-1 in plasma before to surgery than those in the normal brain group. Patients in the glioma brain group experienced a substantial rise in the hematocrit (Hct)-corrected syndecan-1 level following the administration of 15 mL/kg HES fluid (19.78 3.83 ng/mL) compared to the Hct-correct baseline syndecan-1 level (15.67 2.35 ng/mL). In a similar manner, the Hct-corrected syndecan-1 level in the patients in the normal brain group significantly rose following HES loading (34.71 12.83 ng/mL) compared to the baseline syndecan-1 level (26.07 12.52 ng/mL).Hct-corrected heparan sulphate levels, however, did not differ between or among groups at any time point. In the glioma brain group, SjvO2 was decreased and CajvO2 and CERO2 were higher after 30 min after HES loading, according to our findings. In the glioma brain group, intragroup analysis revealed that CERO2 and CajvO2 rose following general anaesthesia in comparison to the baseline levels. The normal brain group's cerebral metabolism, in contrast, remained unaltered during the perioperative period. Throughout the course of the trial, there were no appreciable variations in the oxygen-glucose index between the two groups. Conclusion Both the glioma brain and normal brain groups' responses to preoperative 15 mL/kg HES loading on systemic glycocalyx shedding were comparable, despite the fact that patients in the normal brain group having greater plasma syndecan-1 levels. Additionally, individuals with gliomas may experience a significant change in brain metabolism as a result of intraoperative anaesthesia treatment.

Glycocalyx, Syndecan-1, Heparan sulfate, Cerebral metabolism, Fluid therapy

Shahab Rafieian. The impact of hydroxyethyl starch loading on the shedding of the glycocalyx and the metabolism of the brain during surgery. Insights Journal of Surgery and Clinical Case Reports 2019.