Korean J Anesthesiol.  1995 Oct;29(4):573-576. 10.4097/kjae.1995.29.4.573.

Bradycardia and Hyprtension during General Anesthesia in a Diabetic Patient with Autonomic Neuropathy

• Ha JB
• Lee JN
• Cho IC
• Park YC

• KMID: 2145903
• DOI: http://doi.org/10.4097/kjae.1995.29.4.573

Abstract

The major risk factors for diabetics undergoing surgery are the end-organ diseases associated with diabetes. Autonomic neuropathy is relatively common in diabetic patients and associated with an increased risk of perioperative cardiovascular instability. We experienced a case of severe bradycardia and hypotension during general anesthesia for subtotal gastrectomy in a 59 year-old male diabetic patient. Anesthesia was induced with thiopental and vecuronium, and was maintained with nitrous oxide, oxygen and enflurane. Five minutes after induction, severe bradycardia and hypotension developed without specific events. The bradycardia was unresponsive to intravenous atropine and ephedrine, but the blood pressure was restored by administration of ephedrine. During operation his blood pressure was maintained in normal range but the bradycardia was not restored by additional administration of atropine. Postoperatively, myocardial infarcton was ruled out. The test performed after operation suggested that his cardiovascular autonomic nervous system was severely impaired. We think that cardiovascular autonomic dysfunction should be evaluated during preoperative period to plan the anesthetic management and to prevent severe cardiovascular complications in diabetic patients.

Keyword

Bradycardia; Hypotension; Diabetes mellitus; Autonomic neuropathy; General anesthesia

MeSH Terms

Anesthesia
Anesthesia, General*
Atropine
Autonomic Nervous System
Blood Pressure
Bradycardia*
Diabetes Mellitus
Enflurane
Ephedrine
Gastrectomy
Humans
Hypotension
Male
Middle Aged
Nitrous Oxide
Oxygen
Preoperative Period
Reference Values
Risk Factors
Thiopental
Vecuronium Bromide
Atropine
Enflurane
Ephedrine
Nitrous Oxide
Oxygen
Thiopental
Vecuronium Bromide