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Korean Journal of Anesthesiology 2007;53(2):180-187.
DOI: https://doi.org/10.4097/kjae.2007.53.2.180   
Heart Rate Variability during Propofol-Remifentanil TCI Induction in Diabetic Patients.
Eun Bin Yim, Hee Jung Baik, Jong Hak Kim, Yoon Jin Kim
Department of Anesthesiology and Pain Medicine, School of Medicine, Ewha Womans University, Seoul, Korea. baikhj@ewha.ac.kr
The aim of this study was to compare heart rate variability (HRV) changes between diabetics and non-diabetics throughout induction with maintaining BIS 40-60 by propofol-remifentanil target controlled infusion.
Non-diabetic patients (n = 12) and non-insulin dependent diabetes mellitus (NIDDM) patients (n=12) were recruited. Anesthesia was induced by target controlled infusion of propofol and remifentanil. Target effect-site concentration of propofol was adjusted to maintain bispectral index (BIS) 40-60, and target effect-site concentration of remifentanil was adjusted to maintain blood pressure (BP) within 20% of baseline value. The HRV was recorded at resting, after glycopyrrolate injection, during BIS 40-60, and after intubation. Log-transformed power spectrum (ms2) of TP (total power, < or = 0.4 Hz), LF (low frequency, 0.04-0.15 Hz), HF (high frequency, 0.15-0.4 Hz), LFnorm (normalized LF, LF/[LF + HF]), HFnorm (normalized HF, HF/[LF + HF]), and LF/HF ratio were compared.
Initial LnTP, LnLF, and LnHF was significantly lower in diabetics (P < 0.05). During BIS 40-60, LnTP, LnLF, and LnHF in non-diabetics decreased significantly (P < 0.05). Immediately after intubation, LnLF, LnHF in non-diabetics, and LnHF in diabetics decreased significantly (P < 0.05). LF/HF ratio showed no significant change throughout induction. Systolic, diastolic BP, mean arterial pressure, and heart rate have no significant differences between the groups.
This study suggests that hemodynamic variables and balance of autonomic nervous system measured by HRV can not be altered during induction, by adjusting effect site concentration of propofol and remifentanil in accordance with BIS and BP in diabetic patients.
Key Words: diabetic autonomic neuropathy; effect site controlled infusion; heart rate variability; power spectral analysis; propofol; remifentanil


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