In this pilot study, we evaluated the incidence and severity of intraoperative hypotension
and its relationship to CAN in patients with CFRD. We compared the CFRD patients to
cystic fibrosis patients without diabetes (CF-noDM) and with type 1 DM patients.
A retrospective chart review of perioperative records was performed on an existing
cohort of CFRD patients in whom diabetic neuropathy status had been previously
characterized (n=25). Testing for CAN included the variation in heart rate response to
deep breathing (HRDB) and to a Valsava maneuver (Valsava ratio,VR). The primary
endpoints were the occurrence and severity of intraoperative hypotension. Intraoperative
data on CFRD patients were compared to data collected from CF-noDM (n=56) and T1DM (n=6).
More than half of CF patient-surgeries experienced hypotension during anesthesia and
the odds of hypotension did not significantly differ between groups (CFRD-52%, CFnoDM-
56%, T1DM-38%). However, the severity of hypotension was worse in those with
diabetes. During hypotension, the mean decrease in SBP was 32% for CFRD and mmHg
33% for T1DM, compared to 24% for CF-noDM (p=0.03, CFRD vs CF-noDM). In
CFRD patients, an abnormal VR was associated with a greater risk of hypotension (88%
vs. 44%, p=0.0046) and greater need for intraoperative vasopressors (p= 0.04) as
compared to normal VR.
CF patients are prone to develop intraoperative hypotension which is more severe in
those with diabetes and it is associated with an abnormal VR. Larger prospective studies
are needed to confirm our findings.
University of Minnesota M.S. thesis. December 2012. Major: Clinical research. Advisor: Antoinette Moran, MD. 1 computer file (pDF); vi, 21 pages.
Risk of introperative hypotension in cystiv fibrosis patients with and without diabetes: a pilot study.
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