Hemodynamic effects of etomidate anesthesia induction in diabetic and non-diabetic patients: Importance of heart rate variability in early detection of cardiac autonomic dysfunction

Aims: Cardiovascular diseases represent the primary cause of perioperative morbidity among diabetic patients. Etomidate, an anesthetic agent with minimal cardiovascular effects, is commonly used in these patients. Diabetic patients often experience cardiovascular autonomic neuropathy, a severe complication of diabetes. In recent years, measuring heart rate variability has become increasingly important for early detection of cardiac autonomic dysfunction. The aim of this study was to compare the hemodynamic effects of etomidate anesthesia induction between diabetic and non-diabetic patients. Methods: This was a prospective randomized study that enrolled consecutive ASA I-III patients scheduled for various elective surgeries under general anesthesia. The patients were divided into two groups: Group D (diabetic, n = 21) and Group ND (non-diabetic, n = 21). Heart rate variability analyses were performed using a Norav-800 Holter on the day before surgery. On the day of the operation, after premedication and monitoring, general anesthesia was induced with etomidate. Hemodynamic parameters were measured before induction (T1), after induction (T2), and 2 min (T3), 5 min (T4), and 10 min (T5) after endotracheal intubation. Hemodynamic changes and heart rate variability were compared between the two groups. Results: Group D showed a statistically significant decrease in systolic arterial pressure values at T2, T4, and T5 compared to baseline values (p < 0.001), while Group ND showed no significant differences in any period. Diastolic blood pressure decreased significantly in Group D compared to baseline values in the preintubation period (p < 0.001), but there was no significant change in Group ND. Heart rate did not significantly differ between the two groups during any measurement period, and there was no correlation between heart rate variability and hemodynamic changes. Conclusion: The results suggest that etomidate anesthesia induction provides hemodynamic stability in patients with type 2 diabetes mellitus. Despite its potential utility, heart rate variability measured during resting conditions may not provide sufficient diagnostic accuracy for predicting the presence of autonomic neuropathy, particularly in individuals with diabetes mellitus.Therefore, additional measures may be needed for early detection of cardiac autonomic dysfunction in these patients.