Cardiovascular autonomic dysfunction and hemodynamic response to anesthetic induction in patients with coronary artery disease and diabetes mellitus

Autonomic neuropathy is a major complication of diabetes mellitus and is re ported to be associated with increased perioperative hemodynamic instabilit y. We investigated the relationship between autonomic dysfunction and hemod ynamic response to anesthetic induction in diabetic and nondiabetic patient s with coronary artery disease. We studied 60 patients scheduled for corona ry artery surgery, 30 suffering from diabetes mellitus. Preoperative evalua tion included traditional cardiovascular autonomic function tests (coeffici ent of variation of 150 beat-to-beat intervals in heart rate at rest, heart rate response to deep breathing, and heart rate and arterial blood pressur e response to standing), spectral analysis of blood pressure and heart rate variability (HRV), and the computation of spontaneous baroreflex sensitivi ty. After premedication with clorazepate, anesthesia was induced with sufen tanil (0.5 mu g/kg), etomidate (0.1-0.2 mg/kg), and vecuronium (0.1 mg/kg). Heart rate and blood pressure before anesthetic induction and before and a fter tracheal intubation were compared between groups. Autonomic function t ests, spectral analysis of HRV, and spontaneous baroreflex sensitivity reve aled significant differences between patient groups. Most diabetic patients (n = 23) had one or more abnormal test results, in contrast to most nondia betic patients, who did not show signs of autonomic neuropathy (n = 23). Th ere was no relationship between cardiovascular autonomic function and hemod ynamic behavior during anesthetic induction. The blood pressure response to anesthetic induction was not different between patient groups, even when c omparing the subgroups with and without abnormal autonomic function tests. These findings indicate that increased hemodynamic instability during anest hetic induction is not obligatory in patients with diabetes mellitus and au tonomic dysfunction. Implications: This study indicates that increased hemo dynamic instability during anesthetic induction is not obligatory in patien ts with coronary artery disease and autonomic dysfunction.