Dysfunction of pre- and post-operative cardiac autonomic nervous system in elderly patients with diabetes mellitus

Zhang, Jun Long; Tu, Weifeng; Dai, Jianqiang; Lv, Qing; Yang, Xiaoqi

doi:10.1016/j.archger.2010.12.013

Cited by 6 publications

(4 citation statements)

References 21 publications

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“…In this study, the HRV decrease correlated with both the duration of surgery and the amount of blood loss and thus HRV was proposed as method to evaluate surgical stress. In addition, a recent study in 30 elderly patients undergoing major non-cardiac surgery also reported decreased postoperative HRV compared to the preoperative evaluation [19]. These findings are in agreement with the overall decrease in postoperative HRV measures observed in our study.…”

Section: Discussionsupporting

confidence: 93%

Decreased heart rate variability responses during early postoperative mobilization – an observational study

et al. 2015

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BackgroundIntact orthostatic blood pressure regulation is essential for early mobilization after surgery. However, postoperative orthostatic hypotension and intolerance (OI) may delay early ambulation. The mechanisms of postoperative OI include impaired vasopressor responses relating to postoperative autonomic dysfunction. Thus, based on a previous study on haemodynamic responses during mobilization before and after elective total hip arthroplasty (THA), we performed secondary analyses of heart rate variability (HRV) and aimed to identify possible abnormal postoperative autonomic responses in relation to postural change.MethodsA standardized mobilization protocol before, 6 and 24 h after surgery was performed in 23 patients scheduled for elective THA. Beat-to-beat arterial blood pressure was measured by photoplethysmography and HRV was derived from pulse wave interbeat intervals and analysed in the time and frequency domain as well as by non-linear analysis using sample entropyResultsBefore surgery, arterial pressures and HR increased upon standing, while HRV low (LF) and high frequency (HF) components remained unchanged. At 6 and 24 h after surgery, resting total HRV power, sample entropy and postural responses in arterial pressures decreased compared to preoperative conditions. During standing HF variation increased by 16.7 (95 % CI 8.0–25.0) normalized units (nu) at 6 h and 10.7 (2.0–19.4) nu at 24 h compared to the preoperative evaluation. At 24 h the LF/HF ratio decreased from 1.8 (1.2–2.6) nu when supine to 1.2 (0.8–1.8) nu when standing.ConclusionsThis study observed postoperative autonomic cardiovascular dysregulation that may contribute to limited HRV responses during early postoperative mobilization.Trial registrationClinicalTrials.gov NCT01089946

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Section: Discussionsupporting

confidence: 93%

Decreased heart rate variability responses during early postoperative mobilization – an observational study

et al. 2015

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“…Age, sex, education, diabetes, and hypertension are known to be associated with cognitive function (age, education, diabetes, and hypertension) (Duron et Hanon, 2008;Grady, 2012;Jefferson et al, 2011;Reijmer et al, 2010), ANS function (age, sex, diabetes, and hypertension) (Moodithaya et Avadhany, 2012;Schroeder et al, 2003;Zhang et al, 2011) and driving (age, diabetes and hypertension) (Lyman et al, 2002;Marshall, 2008;McGwin et al, 2000). In partly adjusted models, we included age, sex and education as covariates and we additionally included diabetes and hypertension in the fully adjusted models in order to control for possible confounding influences.…”

Section: Discussionmentioning

confidence: 99%

Investigating the autonomic nervous system and cognitive functions as potential mediators of an association between cardiovascular disease and driving performance

Gaudet

Bélanger²,

Corriveau

et al. 2013

Can. J. Physiol. Pharmacol.

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Cardiovascular disease (CVD) impacts the autonomic nervous system and cognitive functions related to activities of daily living, including driving an automobile. Although CVD has been linked to unsafe driving, mechanisms underlying this relationship remain elusive. The aim of this study was to examine the role of cognitive functions and the autonomic nervous system as potential mediators of driving performance. Nineteen individuals having recently suffered a cardiac event and sixteen individuals with no history of CVD completed a simulated drive using a STISIM simulator to assess driving performance. Heart rate was recorded throughout testing using a Polar RS800CX heart rate monitor and measures of executive, orienting and alerting functions were obtained through the Attention Network Test. We used the Baron and Kenny analysis method to assess potential mediating effects of the relationship between CVD and driving performance. Executive function was the only potential mediator investigated to be associated with driving (p < 0.01) and CVD (p < 0.05), however, it did not appear to play a mediating role (p = 0.28). These results suggest that individuals with CVD exhibit decrements in complex cognitive tasks such as driving and that further research is needed to better understand the mechanisms underlying this relationship.

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“…Moreover, such patients have diabetes‐related comorbidities including renal disease (RD) and coronary artery disease (CAD), as well as a poor cognitive performance status . They usually have a borderline functional capacity to endure the surgical stress and all postoperative complications . Therefore, it is essential to optimise the decision process with regards to the level of amputation, especially for ambulatory patients.…”

Section: Introductionmentioning

confidence: 99%

The emerging role of microdialysis in diabetic patients undergoing amputation for limb ischemia

Liasis

Malietzis

Galyfos

et al. 2016

Wound Repair Regeneration

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Lower limb ischemia in diabetic patients is a result of macro- and microcirculation dysfunction. Diabetic patients undergoing limb amputation carry high mortality and morbidity rates, and decision making concerning the level of amputation is critical. Aim of this study is to evaluate a novel microdialysis technique to monitor tissue microcirculation preoperatively and predict the success of limb amputation in such patients. Overall, 165 patients with type 2 diabetes mellitus undergoing lower limb amputation were enrolled. A microdialysis catheter was placed preoperatively at the level of the intended flap for the stump reconstruction, and the levels of glucose, glycerol, lactate and pyruvate were measured for 24 consecutive hours. Patients were then amputated and monitored for 30 days regarding the outcome of amputation. Failure of amputation was defined as delayed healing or stump ischemia. Patients were divided into two groups based on the success of amputation. There was no difference between the two groups regarding gender, ASA score, body mass index, comorbidities, diagnostic modality used, level of amputation, as well as glucose, glycerol, and pyruvate levels. However, local concentrations of lactate were significantly different between the two groups and lactate/pyruvate (L/P) ratio was independently associated with failed amputation (threshold defined at 25.35). Elevated preoperative tissue L/P ratio is independently associated with worse outcomes in diabetic patients undergoing limb amputation. Therefore, preoperative tissue L/P ratio could be used as a predicting tool for limb amputation's outcome, although more clinical data are needed to provide safer conclusions.

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Dysfunction of pre- and post-operative cardiac autonomic nervous system in elderly patients with diabetes mellitus

Cited by 6 publications

References 21 publications

Decreased heart rate variability responses during early postoperative mobilization – an observational study

Decreased heart rate variability responses during early postoperative mobilization – an observational study

Investigating the autonomic nervous system and cognitive functions as potential mediators of an association between cardiovascular disease and driving performance

The emerging role of microdialysis in diabetic patients undergoing amputation for limb ischemia

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