Perfusion index change and relationship with intraoperative complications in cardiovascular autonomous neuropathy type-2 diabetes mellitus patients with spinal anesthesia

Aim: It is aimed to test whether the basal perfusion index values and increase trend in perfusion index values after spinal anesthesia can be used as a predictive marker for the presence of cardiovascular autonomic neuropathy in diabetic patients. Materials and Methods: 150 patients in ASA I, II and III risk groups, who were over 18 years of age, who were operated under spinal anesthesia and did not have any additional disease other than Type-2 Diabetes Mellitus (DM) were included in the study. Patients who did not agree to participate in the study, patients under 18 years of age, patients with Type-1 DM, patients for whom spinal anesthesia was contraindicated, patients with peripheral artery disease that could impair peripheral perfusion and similar comorbidities other than DM, and patients who were switched to general anesthesia during the operation were excluded from the study. Group control (n: 50): Patients with DM (-) and Cardiyovascular Autonomic Neuropaty (CAN) (-), Group DM (n: 50): Patients with DM (+) and CAN (-), and Group CAN (n: 50): DM (+) and KON (+) patients. Ewing tests were used in the diagnosis of CAN. After all groups were taken to the operating table, the responsible anesthetist with 12.5 mg of aggravated bupivacaine applied spinal anesthesia to the patients. After spinal anesthesia, both preoperative and intraoperative heart rate, blood pressure, SpO2 were recorded at three-minute intervals until the end of the operation. Results: In our study, the lowest baseline PI values were observed in the CAN group and the highest in the control group (p<0,05). When the changes in PI values after spinal anesthesia were examined, the highest values were found in the control group at all times, while the lowest values were found in the CAN group (P<0,05). When hypotension cases developed after spinal anesthesia were examined, no significant difference was found in the PI values at the 0th and 3rd minutes between the patients who developed and those who did not (p>0,05). However, when the values at the sixth minute and after were examined, PI values were found to be significantly lower in the group with hypotension (p<0,05). Conclusion: In the diagnosis of CAN cases; regardless of the anesthesia method to be used, we determined that the basal PI values and the slow PI increase trend after the procedure in the patient groups selected for the neuraxial anesthesia method can be used as a predictive value. Key Words: Diabetes Mellitus, Hypotension, Cardiovascular Autonomic Neuropathy, Perfusion Index, Spinal Anesthesia