Desflurane-induced hemodynamic changes in patients with diabetic cardiovascular autonomic neuropathy.
10.4097/kjae.2009.57.5.560
- Author:
Deokkyu KIM
1
;
Eun Ah KIM
;
Myung Jo SEO
;
Hyungsun LIM
;
Seonghoon KO
;
Sang Kyi LEE
Author Information
1. Department of Anesthesiology and Pain Medicine, Chonbuk National University Medical School, Jeonju, Korea. shko@chonbuk.ac.kr
- Publication Type:Original Article
- Keywords:
Autonomic neuropathy;
Desflurane;
Diabetes mellitus;
Hypertension
- MeSH:
Arterial Pressure;
Diabetes Mellitus;
Heart Rate;
Hemodynamics;
Humans;
Hypertension;
Intubation;
Intubation, Intratracheal;
Isoflurane;
Nebulizers and Vaporizers;
Tachycardia;
Thiopental
- From:Korean Journal of Anesthesiology
2009;57(5):560-565
- CountryRepublic of Korea
- Language:Korean
-
Abstract:
BACKGROUND: Diabetic cardiovascular autonomic neuropathy (CAN) causes perioperative cardiovascular instability. A rapid increase in the desflurane concentration induces tachycardia and hypertension (HTN). This study examined the effects of the cardiovascular response to desflurane on patients with diabetic CAN. METHODS: Forty diabetes mellitus (DM) patients with CAN were divided two groups: one with HTN (DM+HTN group, n = 17) and one without HTN (DM group, n = 23). The control group (n = 20) was composed of healthy patients without DM or HTN. In each group, the concentration of desflurane inspired was increased abruptly to 12.0 vol% 2 minutes after a thiopental injection. The target was to produce an end-tidal concentration of desflurane of 10.0 vol%, which was maintained until the end of the study by adjusting the vaporizer dial setting. The heart rate (HR), mean arterial pressure (MAP), and cardiac index (CI) were measured. RESULTS: The HR, MAP and CI increased significantly in all three groups when compared with the baseline (P<0.05). Additionally, the HR and MAP showed did not differ among the three groups at any of sampling times. However, the CI of the DM group and the DM+HTN group differed when compared with the control group at 90 and 120 seconds after intubation (P<0.05). CONCLUSIONS: In diabetic patients with CAN, the hemodynamic responses to a rapid increase in desflurane concentration are similar to those in non-diabetic patients before endotracheal intubation. However, after endotracheal intubation, increments in CI are blunted in diabetic patients with CAN.
