Anesth Pain Med.  2006 Jul;1(1):29-35.

The Effect of Diabetes Mellitus on Vasoconstrictor Requirement and Hemodynamic Parameters in Patients Undergoing Off Pump Coronary Artery Bypass Graft Surgery

• Kim DH
• Oh YJ
• Shim JK
• Kim CS
• Lee HS
• Kwak YL

Abstract

BACKGROUND: Autonomic neuropathy is frequently developed in patients with diabetets mellitus (DM) and is associated with increased perioperative hemodynamic instability. This study investigated the effect of DM on vasoconstrictor requirement and hemodynamic parameters in patients undergoing off pump coronary artery bypass graft surgery (OPCAB).
METHODS
Seventy four patients undergoing OPCAB were divided into two groups; patients without DM (control, n = 51) and patients with DM (n = 23). Hemodynamic parameters were recorded at 10 min after induction of anesthesia (T1), at 10 min after stabilizer application for anastomosis of the left anterior descending coronary artery (T2), the obtuse marginalis branch (T3) and the right coronary artery (T4) and at 10 min after sternum closure (T5). The amount of norepinephrine requirement during the period of induction of anesthesia and grafting was also recorded.
RESULTS
Pulmonary capillary wedge pressure (PCWP) and mean pulmonary arterial pressure at T3, PCWP and central venous pressure at T4 were significantly higher in the DH group. Mixed venous oxygen saturation at T2 and T4 and cardiac output at T3 were also significantly lower in the DH group. Significantly greater amount of norepinephrine was infused during the induction of anesthesia in the DH group.
CONCLUSIONS
Patients with coronary artery occlusive disease and concomitant DM required significantly greater amount of vasoconstrictor during the induction of anesthesia to maintain stable mean arterial pressure. In addition, more pronounced hemodynamic instability was observed during the period of grafing in these patients undergoing OPCAB.

Keyword

diabetes mellitus; hemodynamic instability; off pump coronary artery bypass graft surgery; vasoconstrictor

MeSH Terms

Anesthesia
Arterial Pressure
Cardiac Output
Central Venous Pressure
Coronary Artery Bypass, Off-Pump*
Coronary Vessels
Diabetes Mellitus*
Hemodynamics*
Humans
Norepinephrine
Oxygen
Pulmonary Wedge Pressure
Sternum
Transplants*
Norepinephrine
Oxygen