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

Abstract

Background: In 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.

Methods: Six 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.

Results: Sevoflurane 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.

Conclusion: These 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 registration: http://www.clinicialtrials.gov, NCT00866801.

Figure 1

Myocardial blood flow measured with contrast echocardiography. Myocardial blood flow at rest (A) and after adenosine infusion (B) and cold pressor testing (C) in healthy controls and diabetic patients. Dot plots indicate median ± range. CPT = cold pressor test; MBF = myocardial blood flow. A Wilcoxon signed-rank test was used for within group comparisons of myocardial blood flow results (baseline versus sevoflurane). Changes in myocardial blood flow responses before and during sevoflurane administration were compared between controls and diabetics using a Mann–Whitney U test.