The Hemodynamic Effect Of Diabetic Autonomic Neuropathy During The Induction Of General Anerthesia

Objective:To study the effect of diabetes cardiovascular autonomic disease on hemodynamics by observing the changes of hemodynamics during the induction of general anesthesia.Methods :Thirty three cases of elective surgery in patients with type 2 diabetes mellitus, ASAâ…¡-â…¢, aged 23 to 76 years old, weight 40 to 86kg, divided into four groups, according to the results of cardiac autonomic nerve function test: group A include simplicity parasympathetic nerve damage patients, group B include simplicity sympathetic nerve damage patients, group C include both sympathetic and parasympathetic nerve damaged patients, and group D include neither sympathetic nor parasympathetic nerve damaged patients. Before the induction of anesthesia, all patients were transfused with Ringer's solution according to 4-2-1 rule. Anesthesia induction was completed by target control infusion with propofol and remifentanil. Mean arterial blood(MAP),heart rate(HR) before administration(T1);1 min after administration(T2),3 min after administration(T3), 5 min after administration(T4),just before intubations(T5),1 min after intubations(T6), 3 min after intubations(T7), 5 min after intubations(T8), 10 min after intubations(T9) were recorded. The highest HR(HR1), the lowest HR(HR2), the highest MAP(MAP1) and the lowest MAP(MAP2) during anesthesia induction were recorded.Results:There were no significant differences in four groups on patients' sexes, age, weight and combining with hypertension(P>0.05). The fasting blood sugar and postprandial blood sugar in group C were significantly higher than that in group A, B, D respectively(P<0.05). The MAP in all patients were decreased gradually after aesthesia induction, and were significantly lower at T5 compared with that at T1(P<0.05). After intubation, the MAP returned back to the level of T1(P>0.05); in the time of maintenance of anesthesia(T7 to T9), the MAP were decreased gradually to the leave of T5. By group comparison, MAP at T5,T8,T9 in group B and C were significant lower than that in group A and D respectively(P<0.05). The HR in group A and B were decreased gradually from T1 to T5, and the HR at T4 and T5 in group A and B were lower than that at T1 respectively(P<0.05). After intubations, the HR at T6 in group A were significantly higher than that at T5. By group comparison, the HR in group A at T1,T2,T9 were higher than that in group B, C and D respectively (P<0.05). There were no significant differences between MAP1 and MAP before induction(P>0.05), MAP2 were decreased gradually compared with MAP before induction in each group; By group comparison, MAP2 in group B and C were significant lower than that in group A and D(P<0.05). There were no significant differences between HR1 and HR before induction(P>0.05); By group comparison, HR1 in group C was significant lower than that in group A(P<0.05), HR2 in group A,B and D were significant lower than HR before induction(P<0.05), HR2 in group B and C were significant lower than that in group A(P<0.05).Conclusion: Patients with diabetic autonomic neuropathy would meet with greater hemodynamic fluctuation during the induction of general anesthesia with propofol and remifentanil,and diabetic autonomic neuropathy may result in a lower MAP and a slower HR, particularly in the sympathetic autonomic nerve damaged patients. Parasympathetic nervous system damage would bring a quicker HR, while but the sympathetic autonomic nerve would lead a lower HR.