The prevalence of cardiovascular autonomic neuropathy and its influence on post induction hemodynamic variables in patients with and without diabetes; A prospective cohort study

BackgroundCardiovascular autonomic neuropathy (CAN) is a known complication of diabetes, but is also diagnosed in patients without diabetes. CAN may be related to perioperative hemodynamic instability. Our objective was to investigate if patients with diabetes would have a higher prevalence of CAN compared to patients without diabetes undergoing surgery. We further studied its relation to changes in post-induction hemodynamic variables.MethodsWe prospectively included 82 adult patients, 55 with DM, 27 without DM, scheduled for major abdominal or cardiac surgery. Patients performed four autonomic function tests on the day before surgery. Primary outcomes were the prevalence of CAN and the relation between CAN and severe post-induction hypotension, defined as mean arterial pressure (MAP) ResultsThe prevalence of CAN in patients with or without DM was 71% versus 63%, (p = 0.437). CAN was not associated with severe post induction hypotension (CAN+ vs. CAN–: 21% vs. 19.2%, p = 0.819) nor with intraoperative hypotension (16% vs. 15%, p = 0.937). Patients with definite CAN received more norepinephrine in the perioperative period compared to patients with mild CAN or no CAN (0.07 mcg kg-1 min-1 (0.05–0.08) vs. 0.03 (0.01–0.07) vs. 0.02 (0.01–0.06) respectively, p = 0.001).ConclusionsThe majority of patients studied had mild to moderate CAN, regardless of the presence of DM. Assessing CAN before surgery did not identify patients at risk for post induction and intraoperative hypotension in our cohort.Trial registrationDutch Trial Registry (www.trialregister.nl) NTR4976.背景：心血管自主神经病变（Cardiovascular autonomic neuropathy, CAN）是公认的糖尿病并发症，但也可在无糖尿病的患者中被诊断出。CAN可能与围手术期血流动力学不稳定存在关联。本研究的目的为探讨接受手术的糖尿病患者，其CAN患病率是否高于非糖尿病患者。我们还进一步研究了CAN与诱导后血流动力学变量变化的相关性。 方法：本研究前瞻性纳入82例成年患者，其中55例患有糖尿病（diabetes mellitus, DM），27例无糖尿病，均计划接受腹部大手术或心脏手术。所有患者于术前1天完成四项自主神经功能测试。本研究的主要结局指标为CAN的患病率，以及CAN与严重诱导后低血压的关联；严重诱导后低血压被定义为平均动脉压（mean arterial pressure, MAP）。 结果：糖尿病患者与非糖尿病患者的CAN患病率分别为71%与63%（p=0.437）。CAN与严重诱导后低血压无显著关联（CAN阳性组 vs CAN阴性组：21% vs 19.2%，p=0.819），与术中低血压亦无显著关联（16% vs 15%，p=0.937）。确诊为CAN的患者围手术期使用去甲肾上腺素的剂量高于轻度CAN患者或无CAN患者（分别为0.07 μg·kg⁻¹·min⁻¹（0.05~0.08）、0.03（0.01~0.07）、0.02（0.01~0.06），p=0.001）。 结论：无论是否合并糖尿病，本研究纳入的大多数患者均存在轻中度心血管自主神经病变。术前评估CAN无法在本研究队列中识别出存在诱导后及术中低血压风险的患者。 试验注册：荷兰试验注册库（www.trialregister.nl）NTR4976。