The prevalence of cardiovascular autonomic neuropathy and its influence on post induction hemodynamic variables in patients with and without diabetes; A prospective cohort study
Cardiovascular autonomic neuropathy (CAN) is a known complication of diabetes, but is also diagnosed in patients without diabetes. CAN may be related to perioperative hemodynamic instability. Our objective was to investigate if patients with diabetes would have a higher prevalence of CAN compared to...
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| creator | Polderman, Jorinde A W Sperna Weiland, Nicolaas H Klaver, Michel H Biginski, Judy Horninge, Marijn Hollmann, Markus W DeVries, J Hans Immink, Rogier V Preckel, Benedikt Hermanides, Jeroen |
| description | Cardiovascular autonomic neuropathy (CAN) is a known complication of diabetes, but is also diagnosed in patients without diabetes. CAN may be related to perioperative hemodynamic instability. Our objective was to investigate if patients with diabetes would have a higher prevalence of CAN compared to patients without diabetes undergoing surgery. We further studied its relation to changes in post-induction hemodynamic variables.
We prospectively included 82 adult patients, 55 with DM, 27 without DM, scheduled for major abdominal or cardiac surgery. Patients performed four autonomic function tests on the day before surgery. Primary outcomes were the prevalence of CAN and the relation between CAN and severe post-induction hypotension, defined as mean arterial pressure (MAP) < 50 mmHg or ≥ 50% decrease from baseline. Secondary outcomes were the relation between CAN, intraoperative hypotension, MAP < 65 mmHg for more than 13 minutes, and the use of vasopressor therapy.
The prevalence of CAN in patients with or without DM was 71% versus 63%, (p = 0.437). CAN was not associated with severe post induction hypotension (CAN+ vs. CAN-: 21% vs. 19.2%, p = 0.819) nor with intraoperative hypotension (16% vs. 15%, p = 0.937). Patients with definite CAN received more norepinephrine in the perioperative period compared to patients with mild CAN or no CAN (0.07 mcg kg-1 min-1 (0.05-0.08) vs. 0.03 (0.01-0.07) vs. 0.02 (0.01-0.06) respectively, p = 0.001).
The majority of patients studied had mild to moderate CAN, regardless of the presence of DM. Assessing CAN before surgery did not identify patients at risk for post induction and intraoperative hypotension in our cohort.
Dutch Trial Registry (www.trialregister.nl) NTR4976. |
| doi_str_mv | 10.1371/journal.pone.0207384 |
| format | Article |
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We prospectively included 82 adult patients, 55 with DM, 27 without DM, scheduled for major abdominal or cardiac surgery. Patients performed four autonomic function tests on the day before surgery. Primary outcomes were the prevalence of CAN and the relation between CAN and severe post-induction hypotension, defined as mean arterial pressure (MAP) < 50 mmHg or ≥ 50% decrease from baseline. Secondary outcomes were the relation between CAN, intraoperative hypotension, MAP < 65 mmHg for more than 13 minutes, and the use of vasopressor therapy.
The prevalence of CAN in patients with or without DM was 71% versus 63%, (p = 0.437). CAN was not associated with severe post induction hypotension (CAN+ vs. CAN-: 21% vs. 19.2%, p = 0.819) nor with intraoperative hypotension (16% vs. 15%, p = 0.937). Patients with definite CAN received more norepinephrine in the perioperative period compared to patients with mild CAN or no CAN (0.07 mcg kg-1 min-1 (0.05-0.08) vs. 0.03 (0.01-0.07) vs. 0.02 (0.01-0.06) respectively, p = 0.001).
The majority of patients studied had mild to moderate CAN, regardless of the presence of DM. Assessing CAN before surgery did not identify patients at risk for post induction and intraoperative hypotension in our cohort.
Dutch Trial Registry (www.trialregister.nl) NTR4976.</description><identifier>ISSN: 1932-6203</identifier><identifier>EISSN: 1932-6203</identifier><identifier>DOI: 10.1371/journal.pone.0207384</identifier><identifier>PMID: 30475825</identifier><language>eng</language><publisher>United States: Public Library of Science</publisher><subject>Adults ; Aged ; Anesthesiology ; Autonomic nervous system ; Autonomic neuropathies ; Biology and Life Sciences ; Blood Pressure ; Cardiac arrhythmia ; Cardiovascular Diseases - physiopathology ; Cardiovascular Diseases - surgery ; Cohort analysis ; Complications and side effects ; Diabetes ; Diabetes mellitus ; Diabetic Neuropathies - physiopathology ; Diabetic Neuropathies - surgery ; Diabetic neuropathy ; Diabetics ; Diagnosis ; Female ; Health aspects ; Heart attacks ; Heart rate ; Heart surgery ; Hemodynamics ; Humans ; Hypotension ; Male ; Medical research ; Medicine and Health Sciences ; Middle Aged ; Mortality ; Neuropathy ; Nitrous oxide ; Norepinephrine ; Patients ; Perioperative Period ; Physical Sciences ; Prevalence ; Prospective Studies ; Respiration ; Risk factors ; Stability ; Surgery</subject><ispartof>PloS one, 2018-11, Vol.13 (11), p.e0207384-e0207384</ispartof><rights>COPYRIGHT 2018 Public Library of Science</rights><rights>2018 Polderman et al. This is an open access article distributed under the terms of the Creative Commons Attribution License: http://creativecommons.org/licenses/by/4.0/ (the “License”), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.</rights><rights>2018 Polderman et al 2018 Polderman et al</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c692t-e10aef8bd23385f777248925845d78d0d37378a6fc1f4e900d9cd45461fc2813</citedby><cites>FETCH-LOGICAL-c692t-e10aef8bd23385f777248925845d78d0d37378a6fc1f4e900d9cd45461fc2813</cites><orcidid>0000-0002-2903-5990</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC6261040/pdf/$$EPDF$$P50$$Gpubmedcentral$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC6261040/$$EHTML$$P50$$Gpubmedcentral$$Hfree_for_read</linktohtml><link.rule.ids>230,314,727,780,784,864,885,2102,2928,23866,27924,27925,53791,53793,79600,79601</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/30475825$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><contributor>Puebla, Iratxe</contributor><creatorcontrib>Polderman, Jorinde A W</creatorcontrib><creatorcontrib>Sperna Weiland, Nicolaas H</creatorcontrib><creatorcontrib>Klaver, Michel H</creatorcontrib><creatorcontrib>Biginski, Judy</creatorcontrib><creatorcontrib>Horninge, Marijn</creatorcontrib><creatorcontrib>Hollmann, Markus W</creatorcontrib><creatorcontrib>DeVries, J Hans</creatorcontrib><creatorcontrib>Immink, Rogier V</creatorcontrib><creatorcontrib>Preckel, Benedikt</creatorcontrib><creatorcontrib>Hermanides, Jeroen</creatorcontrib><title>The prevalence of cardiovascular autonomic neuropathy and its influence on post induction hemodynamic variables in patients with and without diabetes; A prospective cohort study</title><title>PloS one</title><addtitle>PLoS One</addtitle><description>Cardiovascular autonomic neuropathy (CAN) is a known complication of diabetes, but is also diagnosed in patients without diabetes. CAN may be related to perioperative hemodynamic instability. Our objective was to investigate if patients with diabetes would have a higher prevalence of CAN compared to patients without diabetes undergoing surgery. We further studied its relation to changes in post-induction hemodynamic variables.
We prospectively included 82 adult patients, 55 with DM, 27 without DM, scheduled for major abdominal or cardiac surgery. Patients performed four autonomic function tests on the day before surgery. Primary outcomes were the prevalence of CAN and the relation between CAN and severe post-induction hypotension, defined as mean arterial pressure (MAP) < 50 mmHg or ≥ 50% decrease from baseline. Secondary outcomes were the relation between CAN, intraoperative hypotension, MAP < 65 mmHg for more than 13 minutes, and the use of vasopressor therapy.
The prevalence of CAN in patients with or without DM was 71% versus 63%, (p = 0.437). CAN was not associated with severe post induction hypotension (CAN+ vs. CAN-: 21% vs. 19.2%, p = 0.819) nor with intraoperative hypotension (16% vs. 15%, p = 0.937). Patients with definite CAN received more norepinephrine in the perioperative period compared to patients with mild CAN or no CAN (0.07 mcg kg-1 min-1 (0.05-0.08) vs. 0.03 (0.01-0.07) vs. 0.02 (0.01-0.06) respectively, p = 0.001).
The majority of patients studied had mild to moderate CAN, regardless of the presence of DM. Assessing CAN before surgery did not identify patients at risk for post induction and intraoperative hypotension in our cohort.
Dutch Trial Registry (www.trialregister.nl) NTR4976.</description><subject>Adults</subject><subject>Aged</subject><subject>Anesthesiology</subject><subject>Autonomic nervous system</subject><subject>Autonomic neuropathies</subject><subject>Biology and Life Sciences</subject><subject>Blood Pressure</subject><subject>Cardiac arrhythmia</subject><subject>Cardiovascular Diseases - physiopathology</subject><subject>Cardiovascular Diseases - surgery</subject><subject>Cohort analysis</subject><subject>Complications and side effects</subject><subject>Diabetes</subject><subject>Diabetes mellitus</subject><subject>Diabetic Neuropathies - physiopathology</subject><subject>Diabetic Neuropathies - surgery</subject><subject>Diabetic neuropathy</subject><subject>Diabetics</subject><subject>Diagnosis</subject><subject>Female</subject><subject>Health aspects</subject><subject>Heart attacks</subject><subject>Heart rate</subject><subject>Heart surgery</subject><subject>Hemodynamics</subject><subject>Humans</subject><subject>Hypotension</subject><subject>Male</subject><subject>Medical research</subject><subject>Medicine and Health Sciences</subject><subject>Middle Aged</subject><subject>Mortality</subject><subject>Neuropathy</subject><subject>Nitrous oxide</subject><subject>Norepinephrine</subject><subject>Patients</subject><subject>Perioperative Period</subject><subject>Physical Sciences</subject><subject>Prevalence</subject><subject>Prospective Studies</subject><subject>Respiration</subject><subject>Risk 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prevalence of cardiovascular autonomic neuropathy and its influence on post induction hemodynamic variables in patients with and without diabetes; A prospective cohort study</title><author>Polderman, Jorinde A W ; Sperna Weiland, Nicolaas H ; Klaver, Michel H ; Biginski, Judy ; Horninge, Marijn ; Hollmann, Markus W ; DeVries, J Hans ; Immink, Rogier V ; Preckel, Benedikt ; Hermanides, Jeroen</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c692t-e10aef8bd23385f777248925845d78d0d37378a6fc1f4e900d9cd45461fc2813</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2018</creationdate><topic>Adults</topic><topic>Aged</topic><topic>Anesthesiology</topic><topic>Autonomic nervous system</topic><topic>Autonomic neuropathies</topic><topic>Biology and Life Sciences</topic><topic>Blood Pressure</topic><topic>Cardiac arrhythmia</topic><topic>Cardiovascular Diseases - physiopathology</topic><topic>Cardiovascular 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One</addtitle><date>2018-11-26</date><risdate>2018</risdate><volume>13</volume><issue>11</issue><spage>e0207384</spage><epage>e0207384</epage><pages>e0207384-e0207384</pages><issn>1932-6203</issn><eissn>1932-6203</eissn><abstract>Cardiovascular autonomic neuropathy (CAN) is a known complication of diabetes, but is also diagnosed in patients without diabetes. CAN may be related to perioperative hemodynamic instability. Our objective was to investigate if patients with diabetes would have a higher prevalence of CAN compared to patients without diabetes undergoing surgery. We further studied its relation to changes in post-induction hemodynamic variables.
We prospectively included 82 adult patients, 55 with DM, 27 without DM, scheduled for major abdominal or cardiac surgery. Patients performed four autonomic function tests on the day before surgery. Primary outcomes were the prevalence of CAN and the relation between CAN and severe post-induction hypotension, defined as mean arterial pressure (MAP) < 50 mmHg or ≥ 50% decrease from baseline. Secondary outcomes were the relation between CAN, intraoperative hypotension, MAP < 65 mmHg for more than 13 minutes, and the use of vasopressor therapy.
The prevalence of CAN in patients with or without DM was 71% versus 63%, (p = 0.437). CAN was not associated with severe post induction hypotension (CAN+ vs. CAN-: 21% vs. 19.2%, p = 0.819) nor with intraoperative hypotension (16% vs. 15%, p = 0.937). Patients with definite CAN received more norepinephrine in the perioperative period compared to patients with mild CAN or no CAN (0.07 mcg kg-1 min-1 (0.05-0.08) vs. 0.03 (0.01-0.07) vs. 0.02 (0.01-0.06) respectively, p = 0.001).
The majority of patients studied had mild to moderate CAN, regardless of the presence of DM. Assessing CAN before surgery did not identify patients at risk for post induction and intraoperative hypotension in our cohort.
Dutch Trial Registry (www.trialregister.nl) NTR4976.</abstract><cop>United States</cop><pub>Public Library of Science</pub><pmid>30475825</pmid><doi>10.1371/journal.pone.0207384</doi><tpages>e0207384</tpages><orcidid>https://orcid.org/0000-0002-2903-5990</orcidid><oa>free_for_read</oa></addata></record> |
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| identifier | ISSN: 1932-6203 |
| ispartof | PloS one, 2018-11, Vol.13 (11), p.e0207384-e0207384 |
| issn | 1932-6203 1932-6203 |
| language | eng |
| recordid | cdi_plos_journals_2138067206 |
| source | MEDLINE; DOAJ Directory of Open Access Journals; Public Library of Science (PLoS) Journals Open Access; EZB-FREE-00999 freely available EZB journals; PubMed Central; Free Full-Text Journals in Chemistry |
| subjects | Adults Aged Anesthesiology Autonomic nervous system Autonomic neuropathies Biology and Life Sciences Blood Pressure Cardiac arrhythmia Cardiovascular Diseases - physiopathology Cardiovascular Diseases - surgery Cohort analysis Complications and side effects Diabetes Diabetes mellitus Diabetic Neuropathies - physiopathology Diabetic Neuropathies - surgery Diabetic neuropathy Diabetics Diagnosis Female Health aspects Heart attacks Heart rate Heart surgery Hemodynamics Humans Hypotension Male Medical research Medicine and Health Sciences Middle Aged Mortality Neuropathy Nitrous oxide Norepinephrine Patients Perioperative Period Physical Sciences Prevalence Prospective Studies Respiration Risk factors Stability Surgery |
| title | The prevalence of cardiovascular autonomic neuropathy and its influence on post induction hemodynamic variables in patients with and without diabetes; A prospective cohort study |
| url | https://sfx.bib-bvb.de/sfx_tum?ctx_ver=Z39.88-2004&ctx_enc=info:ofi/enc:UTF-8&ctx_tim=2025-01-03T09%3A09%3A57IST&url_ver=Z39.88-2004&url_ctx_fmt=infofi/fmt:kev:mtx:ctx&rfr_id=info:sid/primo.exlibrisgroup.com:primo3-Article-gale_plos_&rft_val_fmt=info:ofi/fmt:kev:mtx:journal&rft.genre=article&rft.atitle=The%20prevalence%20of%20cardiovascular%20autonomic%20neuropathy%20and%20its%20influence%20on%20post%20induction%20hemodynamic%20variables%20in%20patients%20with%20and%20without%20diabetes;%20A%20prospective%20cohort%20study&rft.jtitle=PloS%20one&rft.au=Polderman,%20Jorinde%20A%20W&rft.date=2018-11-26&rft.volume=13&rft.issue=11&rft.spage=e0207384&rft.epage=e0207384&rft.pages=e0207384-e0207384&rft.issn=1932-6203&rft.eissn=1932-6203&rft_id=info:doi/10.1371/journal.pone.0207384&rft_dat=%3Cgale_plos_%3EA563421852%3C/gale_plos_%3E%3Curl%3E%3C/url%3E&disable_directlink=true&sfx.directlink=off&sfx.report_link=0&rft_id=info:oai/&rft_pqid=2138067206&rft_id=info:pmid/30475825&rft_galeid=A563421852&rft_doaj_id=oai_doaj_org_article_2cd8acf202564072880a6b0cf217f38e&rfr_iscdi=true |