Myocardial blood flow under general anaesthesia with sevoflurane in type 2 diabetic patients: a pilot studyReport as inadecuate




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Cardiovascular Diabetology

, 13:62

First Online: 23 March 2014Received: 17 March 2014Accepted: 20 March 2014

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

KeywordsType 2 diabetes mellitus Myocardial blood flow Anaesthesia Hyperaemia AbbreviationsBMIBody mass index

CPTCold pressor test

CVRCoronary vascular resistance

DBPDiastolic blood pressure

HRHeart rate

HRVHeart rate variability

HDLHigh-density lipoprotein cholesterol

LDLLow-density lipoprotein cholesterol

MBFMyocardial blood flow

MCEMyocardial contrast echocardiography

MIMechanical index

ROIRegion of interest

RPPRate-pressure product

SBPSystolic blood pressure.

Electronic supplementary materialThe online version of this article doi:10.1186-1475-2840-13-62 contains supplementary material, which is available to authorized users.

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Author: Carolien SE Bulte - Charissa E van den Brom - Stephan A Loer - Christa Boer - R Arthur Bouwman

Source: https://link.springer.com/article/10.1186/1475-2840-13-62



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