# Impact of diabetic mellitus and cardiac autonomic neuropathy cooccurrence on postinduction hypotension incidence in old patients who underwent general anesthesia

## TL;DR

This study examines how diabetes and cardiac autonomic neuropathy together affect low blood pressure after anesthesia in older patients.

## Contribution

The study investigates the combined impact of diabetes and cardiac autonomic neuropathy on post-induction hypotension in elderly patients.

## Key findings

- Patients with diabetes and cardiac autonomic neuropathy had a higher trend of post-induction hypotension, though not statistically significant.
- No significant differences were found in vasopressor use or complications between groups.
- Blood pressure was more unstable during surgery in patients with cardiac autonomic neuropathy.

## Abstract

Post-induction hypotension (PIH) is defined as mean arterial pressure less than 30% from baseline. It significantly affects patients’ quality of life and can cause morbidity; however, its prognosis remains unclear, and its treatments need improvement. This study aimed to investigate the impact of diabetes mellitus (DM) and cardiac autonomic neuropathy (CAN) co-occurrence on PIH incidence in old patients and evaluate the effects of vasopressor/inotropic drugs on intraoperative complications during post-induction.

This prospective observational study included 92 old patients with DM who planned for elective noncardiac/neuro surgery under general anesthesia. The patients were evaluated with Composite Autonomic Symptom Score 31 (COMPASS31) for CAN preoperatively. During the operation, vital signs were recorded for PIH evaluation.

CAN incidence was 8.70%. PIH incidence in old patients with DM with CAN was 87.5% (vs. DM without CAN 67.9%) (p = 0.427). The percentages of patients with DM and CAN and those without CAN were 50% and 38.1% (p = 0.707), respectively, in needing a vasopressor drug, and were 87.5% and 75% (p = 0.675), respectively, with intraoperative complications.

PIH incidence tended to be higher in old patients with DM and CAN than in those without CAN; however, the difference was not statistically significant. Furthermore, no significant differences were observed between these two groups of patients in using a vasopressor/inotropic drug or having intraoperative complications. However, the blood pressure trend showed more lability during induction and intubation in those with CAN. These findings could help develop new strategies to treat DM, CAN, and PIH.