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Cardiothoracic and Vascular Anesthesia
Anesthesia and Pain Medicine 2006;1(1):29-35.
Published online July 30, 2006.
The Effect of Diabetes Mellitus on Vasoconstrictor Requirement and Hemodynamic Parameters in Patients Undergoing Off Pump Coronary Artery Bypass Graft Surgery
Dae Hee Kim, Young Jun Oh, Jae Kwang Shim, Chang Seok Kim, Hyung Seok Lee, Young Lan Kwak
1Department of Anesthesiology and Pain Medicine, Yonsei University College of Medicine, Seoul, Korea. ylkwak@yumc.yonsei.ac.kr
2Anesthesia and Pain Research Institute, Yonsei University College of Medicine, Seoul, Korea.
Abstract
BACKGROUND
Autonomic neuropathy is frequently developed in patients with diabetets mellitus (DM) and is associated with increased perioperative hemodynamic instability. This study investigated the effect of DM on vasoconstrictor requirement and hemodynamic parameters in patients undergoing off pump coronary artery bypass graft surgery (OPCAB). METHODS: Seventy four patients undergoing OPCAB were divided into two groups; patients without DM (control, n = 51) and patients with DM (n = 23). Hemodynamic parameters were recorded at 10 min after induction of anesthesia (T1), at 10 min after stabilizer application for anastomosis of the left anterior descending coronary artery (T2), the obtuse marginalis branch (T3) and the right coronary artery (T4) and at 10 min after sternum closure (T5). The amount of norepinephrine requirement during the period of induction of anesthesia and grafting was also recorded. RESULTS: Pulmonary capillary wedge pressure (PCWP) and mean pulmonary arterial pressure at T3, PCWP and central venous pressure at T4 were significantly higher in the DH group. Mixed venous oxygen saturation at T2 and T4 and cardiac output at T3 were also significantly lower in the DH group. Significantly greater amount of norepinephrine was infused during the induction of anesthesia in the DH group. CONCLUSIONS: Patients with coronary artery occlusive disease and concomitant DM required significantly greater amount of vasoconstrictor during the induction of anesthesia to maintain stable mean arterial pressure. In addition, more pronounced hemodynamic instability was observed during the period of grafing in these patients undergoing OPCAB.
Key Words: diabetes mellitus, hemodynamic instability, off pump coronary artery bypass graft surgery, vasoconstrictor


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