Autonomic changes in preoperative uncomplicated diabetic patients with postural changes

Area of Science:

• Cardiology
• Diabetology
• Anesthesiology

Background:

• Diabetic autonomic neuropathy is a common complication in anesthesia and surgery.
• Heart rate variability (HRV) analysis offers noninvasive monitoring of autonomic cardiac control.

Purpose of the Study:

• To investigate HRV changes in preoperative diabetic patients without overt autonomic dysfunction.
• To compare HRV between diabetic patients and matched controls across different body positions.

Main Methods:

• Power spectral analysis of HRV was used.
• HRV was measured in sitting and tilted positions (-15, 0, 15, 45 degrees).
• Diabetic patients (n=18) were compared with matched controls (n=18).

Main Results:

• Diabetic patients exhibited lower HRV than controls in all positions (absolute units).
• Normalized low-frequency power and LF/HF ratio increased with tilting in controls, but not in diabetics.
• Significant differences were observed at 45 degrees and sitting positions.

Conclusions:

• Subtle autonomic derangements exist in diabetic patients before clinical manifestation.
• High-degree tilting or sitting positions can exacerbate autonomic dysfunction in these patients.
• Careful intra- and perioperative management is crucial for diabetic patients.