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CARDIOVASCULAR ANESTHESIA

Cardiovascular Autonomic Dysfunction and Hemodynamic Response to Anesthetic Induction in Patients with Coronary Artery Disease and Diabetes Mellitus

Cornelius Keyl, MD^*, Peter Lemberger, MD^*, Klaus-Dieter Palitzsch, MD, Karin Hochmuth, MD^*, Andreas Liebold, MD, and Jonny Hobbhahn, MD^*

Departments of *Anesthesiology, Internal Medicine, and Heart Surgery, University Medical Center, Regensburg, Germany

Address correspondence and reprint requests to Dr. Cornelius Keyl, Department of Anesthesiology, University Medical Center, 93042 Regensburg, Germany. Address e-mail to Keyl{at}rkanaw1.ngate.uni-regensburg.de

Autonomic neuropathy is a major complication of diabetes mellitus and is reported to be associated with increased perioperative hemodynamic instability. We investigated the relationship between autonomic dysfunction and hemodynamic response to anesthetic induction in diabetic and nondiabetic patients with coronary artery disease. We studied 60 patients scheduled for coronary artery surgery, 30 suffering from diabetes mellitus. Preoperative evaluation included traditional cardiovascular autonomic function tests (coefficient of variation of 150 beat-to-beat intervals in heart rate at rest, heart rate response to deep breathing, and heart rate and arterial blood pressure response to standing), spectral analysis of blood pressure and heart rate variability (HRV), and the computation of spontaneous baroreflex sensitivity. After premedication with clorazepate, anesthesia was induced with sufentanil (0.5 µg/kg), etomidate (0.1–0.2 mg/kg), and vecuronium (0.1 mg/kg). Heart rate and blood pressure before anesthetic induction and before and after tracheal intubation were compared between groups. Autonomic function tests, spectral analysis of HRV, and spontaneous baroreflex sensitivity revealed significant differences between patient groups. Most diabetic patients (n = 23) had one or more abnormal test results, in contrast to most nondiabetic patients, who did not show signs of autonomic neuropathy (n = 23). There was no relationship between cardiovascular autonomic function and hemodynamic behavior during anesthetic induction. The blood pressure response to anesthetic induction was not different between patient groups, even when comparing the subgroups with and without abnormal autonomic function tests. These findings indicate that increased hemodynamic instability during anesthetic induction is not obligatory in patients with diabetes mellitus and autonomic dysfunction.

Implications: This study indicates that increased hemodynamic instability during anesthetic induction is not obligatory in patients with coronary artery disease and autonomic dysfunction.

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