Dynamics of heart rate variability in patients with type 2 diabetes mellitus during spinal anaesthesia: prospective observational study

Su Hyun Lee, Dong Hoon Lee, Dong Hoon Ha, Young Jun Oh, Su Hyun Lee, Dong Hoon Lee, Dong Hoon Ha, Young Jun Oh

Abstract

Background: Little is known about the changes in autonomic function during spinal anaesthesia in type 2 diabetic patients. The purpose of the study was to assess the influence of spinal anaesthesia on the heart rate variability in type 2 diabetic patients according to the glycated hemoglobin (HbA1c) level.

Methods: Sixty-six patients who were scheduled for elective orthostatic lower limb surgery were assigned to three groups (n = 22, each) according to HbA1c; controlled diabetes mellitus (HbA1c < 7 %), uncontrolled diabetes mellitus (HbA1c > 7 %) and the control group. The heart rate variability was measured 10 min before (T0), and at10 min (T1), 20 min (T2) and 30 min (T3) after spinal anaesthesia.

Results: Before spinal anaesthesia, total, low-and high-frequency power were significantly lower in the uncontrolled diabetec group than in other group (p < 0.05). During spinal anaesthesia, total, low- and high-frequency powers were did not change in the uncontrolled diabetec group while the low-frequency power in the controlled diabetec group was significantly depressed (p < 0.05). The ratio of low-to high-frequency was comparable among the groups, while it was reduced at T1-2 than at T0 in all the groups. The blood pressures were higher in the uncontrolled diabetec group than in the other groups.

Conclusions: Spinal anaesthesia had an influence on the cardiac autonomic modulation in controlled diabetec patients, but not in uncontrolled diabetec patients. There were no differences in all haemodynamic variables during an adequate level of spinal anaesthesia in controlled and uncontrolled type 2 DM.

Trial registration: ClinicalTrials.gov NCT02137057.

Figures

Fig. 1
Fig. 1
Study process of showing this trial
Fig. 2
Fig. 2
Heart rate variability measurement (a) total power (b) low-frequency (LF) power (c) high-frequency (HF) power (d) LF/HF ratio. Data are mean with error bars showing SD. T0, 10 min before spinal anaesthesia; T1, 10 min; T2, 20 min; T3, 30 min after spinal anaeshthesia; normal group N (●),controlled DM group (□), uncontrolled DM group (○). *P < 0.05 compared to T0; †P < 0.05 compared to normal group; ‡P < 0.05 compared to controlled DM group

References

    1. Buse JB, Ginsberg HN, Bakris GL, Clark NG, Costa F, Eckel R, et al. Primary prevention of cardiovascular diseases in people with diabetes mellitus: a scientific statement from the American Heart Association and the American Diabetes Association. Circulation. 2007;115:114–26.
    1. Huang CJ, Kuok CH, Kuo TB, Hsu YW, Tsai PS. Pre-operative measurement of heart rate variability predicts hypotension during general anesthesia. Acta Anesthesiol Scand. 2006;50:542–548. doi: 10.1111/j.1399-6576.2006.001016.x.
    1. Latson TW, Ashmore TH, Reinhart DJ, Klein KW, Giesecke AH. Autonomic reflex dysfunction in patients presenting for elective surgery is associated with hypotension after anesthesia induction. Anesthesiology. 1994;80:326–337. doi: 10.1097/00000542-199402000-00013.
    1. Burgos LG, Ebert TJ, Asiddao C, Turner LA, Pattison CZ, Wang-Cheng R, et al. Increased intraoperative cardiovascular morbidity in diabetics with autonomic neuropathy. Anesthesiology. 1989;70:591–7.
    1. Stratton IM, Adler AI, Neil HA, Matthews DR, Manley SE, Cull CA, et al. Association of glycaemia with macrovascular and microvascular complications of type 2 diabetes (UKPDS 35): prospective observational study. Br Med J. 2000;321:405–12.
    1. Jordan J, Tank J. Complexity of impaired parasympathetic heart rate regulation in diabetes. Diabetes. 2014;63:1847–1849. doi: 10.2337/db14-0304.
    1. Inzucchi SE, Bergenstal RM, Buse JB, Diamant M, Ferrannini E, Nauck M, et al. Management of Hyperglycemia in Type 2 Diabetes, 2015: A Patient-Centered Approach: Update to a Position Statement of the American Diabetes Association and the European Association for the Study of Diabetes. Diabetes Care. 2015;38:140–9.
    1. Ghabach MB, El-Khatib MF, Zreik TG, Matta MS, Mouawad JJ, Karam CJ, et al. Effect of weight gain during pregnancy on heart rate variability and hypotension during caesarean section under spinal anesthesia. Anesthesia. 2011;66:1106–11. doi: 10.1111/j.1365-2044.2011.06873.x.
    1. Chatzimichali A, Zoumprouli A, Metaxari M, Apostolakis I, Daras T, Tzanakis N, et al. Heart rate variability may identify patients who will develop severe bradycardia during spinal anesthesia. Acta Anesthesiol Scand. 2011;55:234–41. doi: 10.1111/j.1399-6576.2010.02339.x.
    1. Kalopita S, Liatis S, Thomakos P, Vlahodimitris I, Stathi C, Katsilambros N, et al. Relationship between autonomic nervous system function and continuous interstitial glucose measurement in patients with type 2 diabetes. J Diabetes Res. 2014;2014:835392.
    1. Tarvainen MP, Laitinen TP, Lipponen JA, Cornforth DJ, Jelinek HF. Cardiac autonomic dysfunction in type 2 diabetes - effect of hyperglycemia and disease duration. Front Endocrinol (Lausanne) 2014;5:130.
    1. Kalopita S, Liatis S, Thomakos P, Vlahodimitris I, Stathi C, Katsilambros N, et al. Influence of type 2 diabetes on symbolic analysis and complexity of heart rate variability in men. Diabetol Metab Syndr. 2014;6:13.
    1. Singh JP, Larson MG, O'Donnell CJ, Wilson PF, Tsuji H, Lloyd-Jones DM, et al. Association of hyperglycemia with reduced heart rate variability (The Framingham Heart Study). Am J Cardiol. 2000;86:309–12.
    1. Hanss R, Ohnesorge H, Kaufmann M, Gaupp R, Ledowski T, Steinfath M, et al. Changes in heart rate variability may reflect sympatholysis during spinal anesthesia. Acta Anesthesiol Scand. 2007;51:1297–304.
    1. Hanss R, Bein B, Weseloh H, Bauer M, Cavus E, Steinfath M, et al. Heart rate variability predicts severe hypotension after spinal anesthesia. Anesthesiology. 2006;104:537–45.
    1. Heart rate variability: standards of measurement, physiological interpretation and clinical use Task Force of the European Society of Cardiology and the North American Society of Pacing and Electrophysiology. Circulation. 1996;93:1043–1065. doi: 10.1161/01.CIR.93.5.1043.
    1. Berntson GG, Bigger JT Jr, Eckberg DL, Grossman P, Kaufmann PG, Malik M, et al. Heart rate variability: origins, methods, and interpretive caveats. Psychophysiology. 1997;34:623–48.
    1. Pal GK, Adithan C, Ananthanarayanan PH, Pal P, Nanda N, Durgadevi T, et al. Sympathovagal imbalance contributes to prehypertension status and cardiovascular risks attributed by insulin resistance, inflammation, dyslipidemia and oxidative stress in first degree relatives of type 2 diabetics. PLoS One. 2013;8, e78072.
    1. Akselrod S, Gordon D, Ubel FA, Shannon DC, Berger AC, Cohen RJ. Power spectrum analysis of heart rate fluctuation: a quantitative probe of beat-to-beat cardiovascular control. Science. 1981;213:220–222. doi: 10.1126/science.6166045.
    1. Nolan RP, Barry-Bianchi SM, Mechetiuc AE, Chen MH. Sex-based differences in the association between duration of type 2 diabetes and heart rate variability. Diab Vasc Dis Res. 2009;6:276–282. doi: 10.1177/1479164109339965.
    1. Tesfaye S, Chaturvedi N, Eaton SE, Ward JD, Manes C, Ionescu-Tirgoviste C, et al. Vascular risk factors and diabetic neuropathy. N Engl J Med. 2005;352:341–50.
    1. Cameron NE, Eaton SE, Cotter MA, Tesfaye S. Vascular factors and metabolic interactions in the pathogenesis of diabetic neuropathy. Diabetologia. 2001;44:1973–1988. doi: 10.1007/s001250100001.
    1. Yokoyama H, Yokota Y, Tada J, Kanno S. Diabetic neuropathy is closely associated with arterial stiffening and thickness in Type 2 diabetes. Diabet Med. 2007;24:1329–35. doi: 10.1111/j.1464-5491.2007.02278.x.
    1. Gottsater A, Ahlgren AR, Taimour S, Sundkvist G. Decreased heart rate variability may predict the progression of carotid atherosclerosis in type 2 diabetes. Clin Auton Res. 2006;16:228–234. doi: 10.1007/s10286-006-0345-4.
    1. Tesfaye S, Chaturvedi N, Eaton SE, Ward JD, Manes C, Ionescu-Tirgoviste C, et al. Heart rate variability is severely impaired among type 2 diabetic patients with hypertension. Diabetes Metab Res Rev. 2014;30:305–12.
    1. Chamberlain DP, Chamberlain BD. Changes in the skin temperature of the trunk and their relationship to sympathetic blockade during spinal anesthesia. Anesthesiology. 1986;65:139–143. doi: 10.1097/00000542-198608000-00002.
    1. Cruickshank K, Riste L, Anderson SG, Wright JS, Dunn G, Gosling RG. Aortic pulse-wave velocity and its relationship to mortality in diabetes and glucose intolerance: an integrated index of vascular function? Circulation. 2002;106:2085–2090. doi: 10.1161/01.CIR.0000033824.02722.F7.
    1. Vinik AI, Ziegler D. Diabetic cardiovascular autonomic neuropathy. Circulation. 2007;115:387–397. doi: 10.1161/CIRCULATIONAHA.106.634949.
    1. Vinik AI, Maser RE, Mitchell BD, Freeman R. Diabetic autonomic neuropathy. Diabetes Care. 2003;26:1553–1579. doi: 10.2337/diacare.26.5.1553.
    1. Amour J, Kersten JR. Diabetic cardiomyopathy and anesthesia: bench to bedside. Anesthesiology. 2008;108:524–530. doi: 10.1097/ALN.0b013e3181649369.
    1. Valensi P, Paries J, Attali JR, French Group for R. Study of Diabetic N Cardiac autonomic neuropathy in diabetic patients: influence of diabetes duration, obesity, and microangiopathic complications–the French multicenter study. Metabolism. 2003;52:815–820. doi: 10.1016/S0026-0495(03)00095-7.
    1. Maser RE, Lenhard MJ. Cardiovascular autonomic neuropathy due to diabetes mellitus: clinical manifestations, consequences, and treatment. J Clin Endocrinol Metab. 2005;90:5896–5903. doi: 10.1210/jc.2005-0754.
    1. Bilchick KC, Berger RD. Heart rate variability. J Cardiovasc Electrophysiol. 2006;17:691–694. doi: 10.1111/j.1540-8167.2006.00501.x.
    1. Liao D, Sloan RP, Cascio WE, Folsom AR, Liese AD, Evans GW, et al. Multiple metabolic syndrome is associated with lower heart rate variability. The Atherosclerosis Risk in Communities Study. Diabetes Care. 1998;21:2116–22.
    1. Rooke GA, Freund PR, Jacobson AF. Hemodynamic response and change in organ blood volume during spinal anesthesia in elderly men with cardiac disease. Anesth Analg. 1997;85:99–105.
    1. Meyhoff CS, Haarmark C, Kanters JK, Rasmussen LS. Is it possible to predict hypotension during onset of spinal anesthesia in elderly patients? Journal of Clinical Anesthesia. 2009;21:23–29. doi: 10.1016/j.jclinane.2008.06.015.
    1. Abhishekh HA, Nisarga P, Kisan R, Meghana A, Chandran S, Trichur R, et al. Influence of age and gender on autonomic regulation of heart. Journal of Clinical Monitoring and Computing. 2013;27:259–264. doi: 10.1007/s10877-012-9424-3.
    1. Gorman JM, Sloan RP. Heart rate variability in depressive and anxiety disorders. American Heart Journal. 2000;140:77–83. doi: 10.1067/mhj.2000.109981.
    1. Poyhonen M, Syvaoja S, Hartikainen J, Ruokonen E, Takala J. The effect of carbon dioxide, respiratory rate and tidal volume on human heart rate variability. Acta Anaesthesiologica Scandinavica. 2004;48:93–101. doi: 10.1111/j.1399-6576.2004.00272.x.

Source: PubMed

Patrocinadores e Colaboradores

Condições médicas

Intervenções de drogas

3
Se inscrever