Effect of intraabdominal pressure on heart rate variability and hemodynamics in patients with diabetes mellitus diagnosed with laparoscopic cholestectomy

Objectives: We aim to evaluate the hemodynamic changes using the heart rate variability (HRV) measurements in laparoscopic cholecystectomy patients. And we expect these preoperative measurements will guide us for a better preoperative anesthesia management. Materials and Methods: We included 143 patients above 40 years old that will undergo elective laparoscopic surgery with American Society of Anesthesiologists (ASA) risk score of I, II and III, and has no other comorbidities except Diabetes Mellitus Type II. The following patinets were excluded from the study;  Patients that refused to participate in our study,  That were younger than 40 years old,  Patients in which laparoscopic surgery were contraindicated,  Patients with Type I Diabetes, uncontrolled hypertension (HT), or arrythmias,  Patients with alcohol or drug dependency,  Patients with ASA risk score of IV and V,  Patients that were started as laparoscopik but ended up with laparotomic surgery,  Patients with comorbidities that could increase the abdominal pressure or cause pulmonary hypertension,  Patinets with shock, decompensated heart/respiratory failure, renal/hepatic faliure, peripheral neuropathy, chronic neurologic/cardiovascular disease,  Patients with known allergy to anesthesic agents,  Patients with obesity, difficult intubation risk and  Patients that will undergo regional anesthesia. Control group (n=77) were patients with no Diabetes [DM (-)] and DM group (n=66) were patients with Type II Diabetes [DM (+)]. These parameters were vii measured in all patients preoperatiely: Hemoglobin A1C (HbA1c), oxygen saturation (SpO2), hemodynamic parameters such as; systolic, diastolic, mean arterial pressures and heart rate, Heart Rate Variability (HRV) parameters, intra- and postoperative SpO2. The intraabdominal pressure was set as 10-12 mmHg during the laparoscopic cholecystectomy procedure. Findings: Systolic, diastolic and mean arterial pressure and heart rate parameters decreased with induction, increased with insufflation and decreased again in postoperative 24th hour. The blood pressure changes were similar in two groups with one exception; diastolic arterial pressure increased more in DM group during insufflation. The changes in heart rate values were similar in two groups except it was lower in DM group during induction. Preoperative HRV parameters were lower in DM group and post induction SDNN, SDNN index, triangular index, HF and LF parameters tended to decrease. The decrease of SDNN, SDNN index and LF parameters were significantly higher in DM group. While triangular index rised during insufflation; SDNN, SDNN index, HF and LF parameters decreased. Postoperative SDNN, SDNN index, HF and LF parameters increased in both groups but more in control group, triangular index decreased similarly in both groups. When we compare the postoperative and preoperative parameters; SDNN, SDNN index, HF, LF and LF/HF values in the DM group were significantly lower than the control group. Results: We established that diabetic patients are more susceptible to higher intraabdomnial pressures in laparoscopic surgery and that we can identify the cardiac autonomous effects via HRV measurements before the clinically changes appear. Also we found that diabetic patients with preoperative LF and/or HF <100 are at risk for autonomous neuropathy hence more careful anesthesia management is required for these patients. Keywords: Diabetes Mellitus, Laparoscopic Cholecystectomy, Intraabdominal Pressure, Heart Rate Variability