Published Online
on September 4, 2003

A more recent version of this article appeared on October 1, 2003

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Submitted on March 31, 2003
Accepted on May 9, 2003

Diabetic Patients Have an Impaired Cerebral Vasodilatory Response to Hypercapnia Under Propofol Anesthesia

Yuji Kadoi MD^*; Hiroshi Hinohara MD; Fumio Kunimoto MD; Shigeru Saito MD; Masanobu Ide MD; Haruhiko Hiraoka MD; Fuminori Kawahara MD; and Fumio Goto MD

From Intensive Care Medicine (Y.K., H. Hinohara, K. Kunimoto) and the Department of Anesthesiology and Reanimatology(S.S., M.I., H. Hiraoka, F. Kawahara, F.G.), Gunma University School of Medicine, Gunma, Japan.

^* To whom correspondence should be addressed. E-mail: kadoi{at}med.gunma-u.ac.jp.

Background and Purpose--The purpose of this study was to examine the effects of diabetes mellitus and its severity on the cerebral vasodilatory response to hypercapnia.

Methods--Thirty diabetic patients consecutively scheduled for elective major surgery were studied. After induction of anesthesia, a 2.5-MHz pulsed transcranial Doppler probe was attached to the patient's head at the right temporal window, and mean blood flow velocity of the middle cerebral artery (Vmca) was measured continuously. After the baseline Vmca, arterial blood gases, and cardiovascular hemodynamic values were measured, end-tidal CO₂ was increased by reducing ventilatory frequency by 2 to 5 breaths per minute. Measurements were repeated when end-tidal CO₂ increased and remained stable for 5 to 10 minutes.

Results--Significant differences were observed in absolute and relative CO₂ reactivity between the diabetes and control groups (absolute CO₂ reactivity: control, 2.8±0.7; diabetes mellitus, 2.1±1.3; P<0.01; relative CO₂ reactivity: control, 6.3±1.4; diabetes mellitus, 4.5±2.7; P<0.01, Mann-Whitney U test). Significant differences were also found between diabetic patients with retinopathy and those without retinopathy in absolute (P=0.002) and relative (P=0.002) CO₂ reactivity, glycosylated hemoglobin (P=0.0034), and fasting blood sugar (P=0.01) (Scheffé's test, Mann-Whitney U test). There was an inverse correlation between absolute CO₂ reactivity and glycosylated hemoglobin (r=0.69, P<0.001).

Conclusions--Insulin-dependent diabetic patients have an impaired vasodilatory response to hypercapnia compared with that of the control group, and the present findings suggest that their degree of impairment is related to the severity of diabetes mellitus.

Key words: carbon dioxide • diabetes mellitus • vasodilation

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