Risk of introperative hypotension in cystiv fibrosis patients with and without diabetes: a pilot study

Abstract

Objective: 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. Methods: 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). Results: 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. Conclusion: 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.