Influence of endothelial glycocalyx degradation and surfactants on air embolism adhesion

Anesthesiology. 2006 Dec;105(6):1220-7. doi: 10.1097/00000542-200612000-00022.


Background: Microbubble adherence to endothelial cells is enhanced after damage to the glycocalyx. The authors tested the hypothesis that exogenous surfactants delivered intravascularly have differential effects on the rate of restoration of blood flow after heparinase-induced degradation of the endothelial glycocalyx.

Methods: Air microbubbles were injected into the rat cremaster microcirculation after perfusion with heparinase or saline and intravascular administration of either saline or one of two surfactants. The surfactants were Pluronic F-127 (Molecular Probes, Eugene, OR) and Perftoran (OJSC SPC Perftoran, Moscow, Russia). Embolism dimensions and dynamics were observed using intravital microscopy.

Results: Significant results were that bubbles embolized the largest diameter vessels after glycocalyx degradation. Bubbles embolized smaller vessels in the surfactant treatment groups. The incidence of bubble dislodgement and the magnitude of distal displacement were smallest after glycocalyx degradation alone and largest after surfactant alone. The time to bubble clearance and restoration of blood flow was longest with heparinase alone and shortest with Pluronic F-127 alone.

Conclusions: Degradation of the glycocalyx causes air bubbles to adhere to the endothelium more proximally in the arteriolar microcirculation. Surfactants added after glycocalyx degradation and before gas embolization promotes bubble lodging in the distal microcirculation. Surfactants may have a clinical role in reducing embolism bubble adhesion to endothelial cells undergoing glycocalyx disruption.

Publication types

  • Research Support, N.I.H., Extramural

MeSH terms

  • Animals
  • Blood Pressure / drug effects
  • Blood Pressure / physiology
  • Cell Adhesion / drug effects*
  • Data Interpretation, Statistical
  • Embolism, Air / pathology*
  • Endothelial Cells / metabolism
  • Endothelial Cells / physiology*
  • Fluorocarbons / pharmacology
  • Glycocalyx / metabolism
  • Glycocalyx / physiology*
  • Heart Rate / drug effects
  • Heart Rate / physiology
  • Heparin Lyase / chemistry
  • Kinetics
  • Male
  • Muscle Tonus / drug effects
  • Muscle Tonus / physiology
  • Muscle, Smooth, Vascular / drug effects
  • Muscle, Smooth, Vascular / physiology
  • Perfusion
  • Poloxamer / pharmacology
  • Rats
  • Rats, Wistar
  • Surface-Active Agents / pharmacology*


  • Fluorocarbons
  • Surface-Active Agents
  • Poloxamer
  • perftoran
  • Heparin Lyase