Autonomic dysfuction and its correlation research in patients with Parkinson’s disease combined with orthostatic hypotension / 临床神经病学杂志

To investigate the autonomic dysfunction in patients with Parkinson’s disease ( PD) combined with orthostatic hypotension (OH). Methods Seventy-six PD patients were selected and divided into PD-OH group (n=40) and non-OH group (n=36) after the measurement of blood pressure in the supine to standing position. The scales for outcomes in PD-autonomic test (SCOPA-AUT) was used to evaluate the patients in the two groups. Results There were significant differences in age, duration and Hoehn-Yahr stage between the two groups (all P<0.05). The total value of SCOPA-AUT in the PD-OH group was significantly higher than that in the non-OH group ( P< 0.05 ). The scores of digestive system, urinary system, cardiovascular system, sympathetic/parasympathetic system and sexual function of SCOPA-AUT in the PD-OH group were all significantly higher than those in the non-OH group (all P<0.05). Conclusion The autonomic dysfunction of PD patients with OH is more serious than that of PD patients without OH, and clinical diagnosis and management of PD patients with OH should be strengthened.

Changes in the Autonomic Function after Thoracic Sympathicotomy by Clipping / 대한마취과학회지

BACKGROUND: A thoracic sympathicotomy with cauterization has been reported to decrease cardiac sympathetic activity. The purpose of this study was to investigate immediate changes in autonomic function after thoracic sympathicotomy by clipping. METHODS: Autonomic function test such as heart rate response to deep breathing (HRDB), Valsalva ratio (VR), 30/15 ratio and systolic blood pressure change response to standing (delta SBP) were measured before (baseline) and 2 hr after the T3-4 sympathicotomy by clipping in 12 patients with palmar hyperhidrosis. Baseline data were also compared with data obtained from 18 matched patients who were planned to take minor surgery. Anesthesia was induced with 5 mg/kg thiopental sodium and 0.6 mg/kg rocuronium. The anesthesia was maintained with 2.0-2.5 vol% sevoflurane, 2 L/min nitrous oxide and 2 L/min oxygen. RESULTS: There were no significant differences of the autonomic test results between control and clip group before operation. In the clip group, there were no significant differences of autonomic test results between before and after clipping. CONCLUSIONS: This study showed that the response to sympathetic stimulation was not changed after thoracic sympathicotomy by clipping.

Preoperative Autonomic Tests of Geriatrics: Does it Predict the Effect of Labetalol on Cardiovascular Responses to Tracheal Intubation? / 대한마취과학회지

BACKGROUND: This study was to evaluate the relationship of preoperative autonomic tests to the labetalol effect on cardiovascular responses to intubation of geriatrics(65 years of age or older, n=23). The autonomic tests consisted of heart rate response to deep breathing(HRdb), Valsalva ratio(VR), 30/15 ratio(30/15) to assess parasympathetic function. The systolic blood pressure change response to standing(delta SBP) and mean arterial pressure change response to standing(delta MAP) were to assess sympathetic function. METHODS: These autonomic tests were taken preoperatively. At a separate time, labetalol 1.0 mg/kg was injected as a bolus 3 minutes before induction with thiopental sodium (4 mg/kg), succinylcholine (1 mg/kg). The anesthesia was maintained with enflurane, oxygen, nitrous oxide and vecuronium (0.08 mg/kg). The blood pressure and heart rate(HR) were recorded at one minute intervals for 5 minutes after intubation. The hypotension (SBP<90 mmHg) or bradycardia (HR<60 beats/minute) were recorded for 10 minutes after intubation. After anesthesia, they were divided two groups according to presence(old abnormal group, n=10, who required intraoperative vasopressors) or absence(old normal group, n=13, who did not require intraoperative vasopressors) of hypotension or bradycardia. RESULTS: The VR and delta MAP revealed significant correlation with SBP and HR after intubation and 5 minutes later(p<0.05). The autonomic test results revealed significant autonomic dysfunction(p<0.05) among old abnormal group compared with old normal group. HR and SBP declined to a greater degree(p<0.05) during induction of anesthesia in old abnormal group compared with old nortnal group. There was less(p<0.05) increase in the same parameters following intubation in old abnormal group. The highest sensitive autonomic test was VR and the highest specific autonomic test was delta MAP. CONCLUSIONS: Geriatric patients are at increased risk for cardiovascular instability during intubation. The preoperative evaluation with autonomic tests may be useful in identifying those at high risk for perioperative hypotension or bradycardia when pre-induction intravenous labetalol 1.0 mg/kg is indicated.