General Anesthesia or Spinal Anesthesia and Serum Endocan Release After Surgery: A Prospective Observational Study.

Background/Objectives: Awake procedures performed under spinal anesthesia (SA) have been associated with reduced hospitalization, costs, and postoperative complications compared with general anesthesia (GA). Endocan, an endothelial cell-specific proteoglycan, serves as a biomarker of endothelial activation and vascular dysfunction and may reflect the differential vascular and immunomodulatory effects of anesthetic techniques. This prospective observational study aimed to compare perioperative changes in circulating endocan levels between patients undergoing surgery under GA and SA. Methods: Eighty adult patients (aged 18-65 years, ASA I-II) scheduled for elective surgery were included and assigned to GA (n = 42) or SA (n = 38) based on standard clinical indications. Serum endocan levels were measured preoperatively, at 6 h, and at 24 h postoperatively using an ELISA assay. Results: In the GA group, endocan levels increased significantly from baseline (304.5 ± 80.7 pg/mL) to 6 h (511.5 ± 88.7 pg/mL, p < 0.001), and although partially decreased by 24 h (427.5 ± 87.9 pg/mL, p < 0.001), remained above baseline. In the SA group, endocan rose from baseline (320.7 ± 72.5 pg/mL) to 6 h (415.2 ± 79.5 pg/mL, p < 0.001) but returned near baseline at 24 h (352.6 ± 84.7 pg/mL, p = 0.233). Conclusions: These findings suggest that while surgery induces endothelial activation in both groups, GA is associated with a more sustained endothelial response than SA.