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Autonomic reflex dysfunction in patients presenting for elective surgery is associated with hypotension after
T W Latson1, T H Ashmore, D J Reinhart
1Department of Anesthesiology and Pain Management, University of Texas Southwestern Medical Center at Dallas 75235-9068.
Anesthesiology
|February 1, 1994
Summary
Autonomic reflex dysfunction, common in older surgical patients, significantly increases hypotension risk during anesthesia induction. This highlights the need for pre-operative autonomic function assessment.
Area of Science:
- Anesthesiology
- Autonomic Neuroscience
- Cardiovascular Physiology
Background:
- Autonomic reflex dysfunction is linked to post-anesthesia hypotension in diabetic patients.
- The association in non-diabetic patients with other causes of autonomic dysfunction is not well-established.
Purpose of the Study:
- To investigate if autonomic reflex dysfunction in a general surgical population predicts hypotension after anesthesia induction.
- To determine the prevalence of autonomic dysfunction in patients over 39 undergoing elective surgery.
Main Methods:
- Assessed autonomic function using Valsalva maneuver, heart rate variability, and response to standing in 26 patients >39 years.
- Anesthesia involved thiopental, fentanyl, N2O, vecuronium, and isoflurane.
- Monitored noninvasive blood pressure for 10 minutes post-induction and thereafter until skin incision.
Main Results:
- Hypotension (mean blood pressure < 70 mmHg) occurred in 12 patients.
- Patients with hypotension exhibited significantly more abnormal autonomic reflex function tests (P < 0.006).
- Autonomic nervous system dysfunction was associated with a 67-83% incidence of hypotension versus 9-17% in others.
Conclusions:
- Autonomic reflex dysfunction is relatively common in patients over 39 undergoing elective surgery.
- Pre-existing autonomic dysfunction is associated with a higher incidence of hypotension following the described anesthetic induction technique.