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

Jorinde A W Polderman,Nicolaas H Sperna Weiland,Markus W Hollmann,Marijn Horninge,J Hans Devries,Jeroen Hermanides,Benedikt Preckel,Rogier V Immink,Judy Biginski,Michel H Klaver,Iratxe Puebla

doi:10.1371/journal.pone.0207384

Jorinde A W Polderman, Nicolaas H Sperna Weiland + Show 9 more

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https://doi.org/10.1371/journal.pone.0207384

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Journal: PloS one	Publication Date: Nov 26, 2018
Citations: 1	License type: CC BY 4.0

Abstract

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) < 50 mmHg or ≥ 50% decrease from baseline. Secondary outcomes were the relation between CAN, intraoperative hypotension, MAP < 65 mmHg for more than 13 minutes, and the use of vasopressor therapy.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.

Highlights

Cardiovascular autonomic neuropathy (CAN) is characterized by an imbalance of the parasympathetic and sympathetic tone resulting in loss of heart rate variability, resting tachycardia, orthostatic hypotension and sudden death.[1,2,3] One-third of the postoperative complications is due to a cardiac event.[4]
Our objective was to investigate if patients with diabetes would have a higher prevalence of CAN compared to patients without diabetes undergoing surgery
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)

Summary

Introduction

Cardiovascular autonomic neuropathy (CAN) is characterized by an imbalance of the parasympathetic and sympathetic tone resulting in loss of heart rate variability, resting tachycardia, orthostatic hypotension and sudden death.[1,2,3] One-third of the postoperative complications is due to a cardiac event.[4]. CAN is a well-known complication of DM.[12, 13] research is mainly focused on patients with DM, patients without DM are known to develop CAN and might have the same perioperative risks as patients with DM and CAN.[6, 14] The reported prevalence of CAN is highly variable in patients with and without DM and ranges from 0 to 100%, depending on the duration of DM, glycemic control and the population studied.[7, 8, 11, 15, 16]. We further studied its relation to changes in post-induction hemodynamic variables

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