Dynamics of heart rate variability in patients with type 2 diabetes mellitus during spinal anaesthesia: prospective observational study

Abstract

BackgroundLittle is known about the changes in autonomic function during spinal anaesthesia in type 2 diabetic patients. The purpose of the study was to assess the influence of spinal anaesthesia on the heart rate variability in type 2 diabetic patients according to the glycated hemoglobin (HbA1c) level.MethodsSixty-six patients who were scheduled for elective orthostatic lower limb surgery were assigned to three groups (n = 22, each) according to HbA1c; controlled diabetes mellitus (HbA1c < 7 %), uncontrolled diabetes mellitus (HbA1c > 7 %) and the control group. The heart rate variability was measured 10 min before (T0), and at10 min (T1), 20 min (T2) and 30 min (T3) after spinal anaesthesia.ResultsBefore spinal anaesthesia, total, low-and high-frequency power were significantly lower in the uncontrolled diabetec group than in other group (p < 0.05). During spinal anaesthesia, total, low- and high-frequency powers were did not change in the uncontrolled diabetec group while the low-frequency power in the controlled diabetec group was significantly depressed (p < 0.05). The ratio of low-to high-frequency was comparable among the groups, while it was reduced at T1-2 than at T0 in all the groups. The blood pressures were higher in the uncontrolled diabetec group than in the other groups.ConclusionsSpinal anaesthesia had an influence on the cardiac autonomic modulation in controlled diabetec patients, but not in uncontrolled diabetec patients. There were no differences in all haemodynamic variables during an adequate level of spinal anaesthesia in controlled and uncontrolled type 2 DM.Trial registrationClinicalTrials.gov NCT02137057Electronic supplementary materialThe online version of this article (doi:10.1186/s12871-015-0125-6) contains supplementary material, which is available to authorized users.

Heart rate variability as a predictor of hypotension after spinal anaesthesia in patients with diabetes mellitus

“…who studied the effect of SA on HRV parameters and found that patients with controlled diabetes had significantly decreased low frequency as compared to high frequency. [7]…”

Effect of clonidine on heart rate variability during spinal anesthesia: randomized clinical trial

“…LF showed a slight increase in T2 and a significant increase in T3 in group B. In group C, the LF showed a significant and progressive increase in T2 and T3 times, suggesting an activation of the sympathetic component (Table 3) [13][14][15][16][17].…”

“…In the analysis of heart rate variability in the chaos domain, the association of 2 or 3 methods reveals a more complex and more representative information of natural events (approximate entropy, Poincaré plot, DFA, correlation dimension, etc.). The joint analysis through 2 or more indexes allows to estimate the complex, regular or random behavior of the time series, bringing to light information and variables not evident by traditional methods [13]. Despite this, the importance and clinical applicability of these new methods has not yet been defined.…”

“…A search conducted by the authors in PubMed and Scopus found 88 articles that assessed changes in heart rate variability during the installation of subarachnoid anesthesia and its association with perioperative hypotension, the majority using linear methods in frequency or time domain [7][8][9][10][11][12][13][14][15][16][17].…”

Fractalidade e comportamento caótico da variabilidade da frequência cardíaca como preditores de hipotensão após raquianestesia: protocolo de ensaio clínico randomizado

“…The evaluation of Heart Rate Variability through ECG or heart rate meter is a validated technique used worldwide to evaluate the overall functioning of the autonomic nervous system or its sympathetic and parasympathetic components. Some studies demonstrate the changes in HRV during the installation of subarachnoid anesthesia 7 ; however, no studies were found describing changes in HRV during recovery from anesthesia, or the duration of sympathetic blockade. Figure 1 shows the evolution of the spectrogram during the perioperative period of a patient submitted to an orthopedic surgical procedure under spinal anesthesia.…”