Abstract
BackgroundIn type 2 diabetic patients, cardiac events in the perioperative period may be associated with diminished myocardial vasomotor function and endothelial dysfunction. The influence of sevoflurane anaesthesia on myocardial endothelial dysfunction in type 2 diabetic mellitus is investigated in this pilot study.MethodsSix males with type 2 diabetes mellitus and eight healthy controls were included. Using myocardial contrast echocardiography, myocardial blood flow (MBF) was measured at rest, during adenosine-induced hyperaemia (endothelium-independent vasodilation) and after sympathetic stimulation by the cold pressor test (endothelium-dependent vasodilation). Measurements were performed before and after induction of sevoflurane anaesthesia.ResultsSevoflurane anaesthesia decreased resting MBF in diabetics but not in controls (P = 0.03), while baseline MBF did not differ between diabetics and controls. Without anaesthesia, adenosine-induced hyperaemia increased MBF in both groups compared to resting values. Adenosine combined with sevoflurane resulted in a lower hyperaemic MBF in both groups compared to no anaesthesia. Differences in MBF in response to adenosine before and after sevoflurane administration were larger in diabetic patients, however not statistically significant in this pilot group (P = 0.08). Myocardial blood flow parameters after the cold pressor test were not different between groups.ConclusionThese pilot data in type 2 diabetic patients show that sevoflurane anaesthesia decreases resting myocardial blood flow compared to healthy controls. Further, we observed a trend towards a lower endothelium-independent vasodilation capacity in diabetic patients under sevoflurane anaesthesia. Endothelium-dependent vasodilation was not affected by sevoflurane in diabetic patients. These data provide preliminary insight into myocardial responses in type 2 diabetic patients under general anaesthesia.Trial registrationhttp://www.clinicialtrials.gov, NCT00866801
Highlights
In type 2 diabetic patients, cardiac events in the perioperative period may be associated with diminished myocardial vasomotor function and endothelial dysfunction
Adenosine-induced hyperaemia increased myocardial blood flow (MBF) in both groups compared to resting values
Differences in MBF response to adenosine before and after sevoflurane administration were larger in diabetic patients, this was not statistically significant in this pilot group (P = 0.08)
Summary
In type 2 diabetic patients, cardiac events in the perioperative period may be associated with diminished myocardial vasomotor function and endothelial dysfunction. Cardiovascular events such as myocardial ischemia are more likely to occur in patients with diabetes mellitus [2]. These perioperative cardiac events may be associated with abnormalities in myocardial blood flow (MBF) due Myocardial endothelial function can be evaluated by measuring vasodilator responses to sympathetic stimulation (primarily endothelium-dependent vasodilation) and to vascular smooth muscle relaxing agents, such as adenosine and dipyridamole (primarily endothelium-independent vasodilation). Myocardial responses to sympathetic stimulation were even further diminished in patients with an associated cardiac autonomic neuropathy [9]
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