[Pre-operative measurement of heart rate variability in diabetics: a method to estimate blood pressure stability during anaesthesia induction].
BACKGROUND
In diabetics severe hyopotension can occur during anaesthesia as a consequence of cardiovascular autonomic neuropathy (CAN). A simple approach to recognize CAN is heart rate variability (HRV) measured at rest. The aim of this study was to determine the relationship between pre-operatively measured HRV and blood pressure stability during induction phase of anaesthesia.


METHODS
A total of 35 diabetics undergoing an ophthalmosurgical procedure under general anaesthesia were investigated. HRV was examined one day before surgery by the following parameters: coefficient of variation (CV), root mean squared successive difference (RMSSD), and power spectrum. Anaesthesia was induced with thiopental and fentanyl and maintained with enflurane/N(2)O; tracheal intubation was performed after relaxation with vecuronium. Patients who developed a drop in systolic blood pressure below 90 mmHg during anaesthesia induction were assigned to group H (hypotensive), the other patients to group N (normotensive). The groups were compared regarding HRV and other variables.


RESULTS
Of all patients 13 developed hypotension during anaesthesia induction (group H). The groups were comparable regarding the demographic data. Parameters of HRV, with the exception of spectral power in low frequency (LF) band of power spectrum, were significantly lower in group H. The groups differed mainly in relation to spectral power in the mid-frequency (MF) band of the power spectrum, and especially regarding CV. In patients with normal CV incidence of hypotension after anaesthesia induction was 11%, but in patients with abnormally reduced CV, 65% (p=0.002).


CONCLUSIONS
The results confirm a significant relationship between HRV pre-operatively measured at rest and blood pressure stability during anaesthesia induction in diabetics. Particularly examination of CV, a simple test feasible within few minutes, may be useful in pre-operative risk stratification of these patients. Application of the time consuming traditional test combination to identify CAN seems to be unnecessary.
Knüttgen
D
D
Klinik für Anästhesiologie, Universität Witten/Herdecke, Lehrstuhl für Anästhesiologie II, Krankenhaus Köln-Merheim.
Trojan
S
S
Weber
M
M
Wolf
M
M
Wappler
F
F
D000368:Aged; D000768:Anesthesia, General; D001794:Blood Pressure / Q000502:physiology*; D003920:Diabetes Mellitus / Q000503:physiopathology*; D004562:Electrocardiography / Q000187:drug effects; D005260:Female; D006339:Heart Rate / Q000502:physiology*; D006801:Humans; D007022:Hypotension / Q000453:epidemiology / Q000209:etiology / Q000503:physiopathology; D007431:Intraoperative Complications / Q000453:epidemiology / Q000209:etiology / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D013508:Ophthalmologic Surgical Procedures; D011237:Predictive Value of Tests