The impact of autonomic dysfunction on peri‐operative cardiovascular complications

Lankhorst, Stephanie; Keet, Sander W.M.; Bulte, Carolien S. E.; Boer, Christa

doi:10.1111/anae.12904

Cited by 30 publications

(23 citation statements)

References 51 publications

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“…In particular, it was more apparent in the uncontrolled diabetic patients with reduced heart rate. [14] On the other hand, decrease in the cerebral saturation and heart rate in our study has not been previously reported in other cardiac surgery studies, which is an interesting aspect of the current study. Manipulation of nodal areas, which controls the heart rate in the right atrium during cannulation, may cause arrhythmia and heart rate alterations.…”

Section: Discussioncontrasting

confidence: 51%

Does uncontrolled diabetes mellitus affect cerebral hemodynamics in heart surgery?

Özgök¹

2020

Turk Gogus Kalp Dama

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Bu çalışmada, koroner arter baypas greftleme yapılan hastalarda çeşitli nöromonitörler ile kötü kan glukoz kontrolünün ameliyat sırası serebral sistem üzerine etkisi araştırıldı. Ça lış m a pla nı: Ocak 2011-Aralık 2011 tarihleri arasında elektif koroner arter baypas greftleme planlanan toplam 40 erişkin hasta (31 erkek, 9 kadın; ort. yaş 58.8±9.2 yıl; dağılım, 38-78 yıl) çalışmaya alındı. Hastalar hemoglobin A1c düzeylerine göre şu şekilde dört gruba ayrıldı: Grup 1, diyabetik olmayan kontroller (n=11); Grup 2, hemoglobin A1c düzeyi <%7 olanlar (n=10); Grup 3, hemoglobin A1c düzeyi %7 ila %10 olanlar (n=11) ve Grup 4, hemoglobin A1c düzeyi ≥%10 olanlar (n=8). Yakın kızılötesi spektroskopi ve transkraniyal Doppler ile serebral monitörizasyon yapıldı. Ölçüm dönemleri şu şekilde belirlendi: Anestezi indüksiyonundan önce (periyod 1), indüksiyondan 10 dk. sonra (periyod 2), kanülasyon sırasında (periyod 3), kardiyopulmoner baypastan 10 dk. sonra (periyod 4), kardiyopulmoner baypas sırasında 32°C'de (periyod 5), kardiyopulmoner bypass sırasında 36°C'de (periyod 6) ve operasyon sonunda (periyod 7). Bul gu lar: Grup 1'e kıyasla Grup 4'te kanülasyon periyodunda yakın kızılötesi spektroskopi değerlerinde hem sağ (p<0.001) hem de sol (p= 0.002) taraflarda ve ortalama transkraniyal Doppler kan akış hızında (p= 0.002) anlamlı fark bulundu. Kanülasyon periyodunda Grup 4'te kalp hızı anlamlı düzeyde düşüktü. Tüm ölçüm periyotlarında yakın kızılötesi spektroskopi değerleri ve transkraniyal Doppler kan akış hızı Grup 4'te azalmıştı. So nuç: Çalışma sonuçlarımız, açık kalp ameliyatı geçiren ciddi diyabetli hastalarda kanülasyon periyodunda muhtemel otonom nöropati nedeniyle kalp hızının düştüğünü ve serebral kan akımı ve oksijenasyonun azaldığını göstermektedir. Bu hastalarda, özellikle kanülasyon periyodunda, hem serebral hem de diğer organların perfüzyonları yakından izlenmeli ve gerekli girişimler yapılmalıdır. Anah tar söz cük ler: Kardiyak anestezi, kalp cerrahisi, diyabetes mellitus, yakın kızılötesi spektroskopi, transkraniyal Doppler.

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Section: Discussioncontrasting

confidence: 51%

Does uncontrolled diabetes mellitus affect cerebral hemodynamics in heart surgery?

Özgök¹

2020

Turk Gogus Kalp Dama

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“…[19] The inability of the ANS to activate effective circulatory reflexes to maintain hemodynamic stability is a feature of LCOS. While it is well-recognized that cardiovascular autonomic neuropathy in diabetic patients may result in unexpected hemodynamic instability during surgery, [20] very few studies have analyzed the impact of autonomic dysfunction on post/peri-operative outcomes in a general population or in cardiac surgery patients. [21, 22]…”

Section: Introductionmentioning

confidence: 99%

Baroreflex sensitivity and outcomes following coronary surgery

Ranucci¹,

Porta²,

Bari³

et al. 2017

PLoS ONE

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Postoperative atrial fibrillation, acute kidney dysfunction and low cardiac output following coronary surgery are associated with morbidity and mortality. The purpose of this study is to determine if the preoperative autonomic control is a determinant of these postoperative complications. This is a prospective cohort study on 150 adult patients undergoing surgical coronary revascularization with cardiopulmonary bypass. The patients received an autonomic control assessment after the induction of anesthesia. Baroreflex sensitivity was computed by spectral analysis and expressed as BRSαHF and BRSαLF for measure respectively in the high and low frequency domains. Atrial fibrillation was adjudicated at any postoperative time during the hospital stay. Acute kidney dysfunction was defined as any increase of serum creatinine levels from preoperative values within the first 48 hours after surgery, and acute kidney injury was adjudicated at a 50% increase. Low cardiac ouput syndrome was defined as the need for inotropic support > 48 hours. Thirty-eight (26.4%) patients experienced postoperative atrial fibrillation; 32 (22.2%) had acute kidney dysfunction and 5 (3.5%) acute kidney injury; 14(10%) had a low cardiac output state. No indices of baroreflex sensitivity were associated with atrial fibrillation or acute kidney injury. A low value of BRSαLF was associated with acute kidney dysfunction and low cardiac output state. A BRSαLF < 3 msec/mmHg was an independent risk factor for acute kidney dysfunction (odds ratio 3.0, 95% confidence interval 1.02–8.8, P = 0.045) and of low cardiac output state (odds ratio 17.0, 95% confidence interval 2.9–99, P = 0.002). Preoperative baroreflex sensitivity is linked to postoperative complications through a number of possible mechanisms, including an autonomic nervous system-mediated vasoconstriction, a poor response to hypotension, and an increased inflammatory reaction.

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“…Kardiyopulmoner arrest, hatta ölüm görülebilmektedir. Dolayısıyla KON bulgusu olan tüm hastaların postoperatif kardiyak komplikasyonlar açısından yakın takibi gerekmektedir 42 .…”

Section: Postoperatif Dönemunclassified

Anesthesia Management in Diabetic Cardiovascular Autonomic Neuropathy

Karacaer¹

2016

Arşiv Kaynak Tarama Dergisi

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Cardiovascular autonomic neuropathy is frequently observed in patients with diabetes mellitus and encompasses damage to the autonomic nerve fibers, resulting in abnormalities in heart rate control and vascular dynamics. There is an increased mortality and morbidity rate among these patients. A series of cardiovascular reflex tests known as Ewing's battery tests are used for diagnosis cardiac autonomic neuropathy and provide valuable information to the clinical assessment of these patients. As anesthesia has a major influence on perioperative autonomic function, the interplay between cardiovascular autonomic neuropathy and anesthesia may result in unexpected haemodynamic instability during surgery and postoperative recovery. A comprehensive preoperative assessment and perioperative cautious monitoring are necessary for successful anesthesia management.

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The impact of autonomic dysfunction on peri‐operative cardiovascular complications

Cited by 30 publications

References 51 publications

Does uncontrolled diabetes mellitus affect cerebral hemodynamics in heart surgery?

Does uncontrolled diabetes mellitus affect cerebral hemodynamics in heart surgery?

Baroreflex sensitivity and outcomes following coronary surgery

Anesthesia Management in Diabetic Cardiovascular Autonomic Neuropathy

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