title: Myocardial blood flow under general anaesthesia with sevoflurane in type 2 diabetic patients: a pilot study.
abstract: BACKGROUND
  In 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.
  
  
  METHODS
  Six 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.
  
  
  RESULTS
  Sevoflurane 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.
  
  
  CONCLUSIONS
  These 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.
  
  
  BACKGROUND
  http://www.clinicialtrials.gov, NCT00866801.
authors.affiliation: Department of Anaesthesiology, Institute for Cardiovascular Research, VU University Medical Center, De Boelelaan 1117, 1081 HV Amsterdam, The Netherlands. c.bulte@vumc.nl.
authors.forename: Carolien S E
authors.initials: CS
authors.lastname: Bulte
authors.forename: Charissa E
authors.initials: CE
authors.lastname: van den Brom
authors.forename: Stephan A
authors.initials: SA
authors.lastname: Loer
authors.forename: Christa
authors.initials: C
authors.lastname: Boer
authors.forename: R Arthur
authors.initials: RA
authors.lastname: Bouwman
mesh_terms: D000328:Adult; D000368:Aged; D000768:Anesthesia, General / Q000009:adverse effects*; D001783:Blood Flow Velocity / Q000187:drug effects* / Q000502:physiology; D003326:Coronary Circulation / Q000187:drug effects* / Q000502:physiology; D003924:Diabetes Mellitus, Type 2 / Q000175:diagnosis / Q000503:physiopathology*; D005260:Female; D006801:Humans; D008297:Male; D008738:Methyl Ethers / Q000008:administration & dosage / Q000009:adverse effects*; D008875:Middle Aged; D010865:Pilot Projects; D000077149:Sevoflurane; D014664:Vasodilation / Q000187:drug effects* / Q000502:physiology
chemical_list: D008738:Methyl Ethers; D000077149:Sevoflurane