Impact Of General Anesthesia Depth On Intraoperative Of CGRP And SP In Diabetic Patients

Objective:This study was designed to investigate the effects of different general anesthesia depth on intraoperative alterations of calcitonin gene-related peptide(CGRP)and substance P(SP)in diabetic patients.At the same time,the incidence of cardiovascular adverse events in the patients was evaluated,and their correlation with the preoperative serum CGRP and SP concentrations was analyzed.Methods:Seventy-eight patients scheduled for selective laparoscopic surgery under general anesthesia were enrolled.The patients were 42-70 years old and classified as American Society of Anesthesiologists physical statusⅠorⅡ,regardless of gender.According to whether the patients complicated type 2 diabetics mellitus,the patients were assigned to non-diabetic group(NDM,n = 40)and diabetic group(DM,n = 38).The two groups were further randomly divided into light anesthesia groups,as light anesthesia non-diabetes mellitus(LNDM)and light anesthesia diabetes group(LDM),and deep anesthesia groups,as deep anesthesia non-diabetes mellitus group(DNDM)and deep anesthesia diabetes mellitus group(DDM).The light anesthesia groups were maintained at the targeting BIS values of 50-59,while the deep anesthesia groups were maintained at the targeting BIS values of 40-49.The duration of anesthesia and operation,eye opening time after drug withdrawal,the length of recovery room stay,propofol dosage,sufentanil dosage,remifentanil dosage,rocuronium dosage,intraoperative adverse cardiovascular events occurrence and vasoactive drug use during surgery were recorded and analyzed.Blood samples were taken at 30 minutes before anesthesia induction and at the end of surgery for determination of serum CGRP and SP concentrations,using enzyme-linked immunosorbent assay.Results:Compared with group LNDM,the serum CGRP and SP concentrations were significantly decreased and the incidence of intraoperative adverse cardiovascular events was increased in the patients of LDM group(all P<0.05),to which similar changes in the values were observed between DNDM and DDM groups.While the postoperative serum CGRP and SP concentrations were significantly decreased in DDM group and the incidence of intraoperative adverse cardiovascular events was increased(all P < 0.05),Compared with group LDM.The postoperative serum CGRP and SP concentrations in LNDM group,DNDM group and LDM group were all higher than those before operation(P<0.05),while postoperative serum CGRP and SP concentrations in DDM group were lower than before operation(P<0.05).Logistic regression analysis showed that the serum CGRP(OR=0.78,95%CI: 0.65-0.94,P=0.01)and SP(OR=0.98,95%CI: 0.97-0.10,P=0.02)concentrations were associated with the increased of adverse cardiovascular events.The value of subtract preoperative serum CGRP(OR=0.80,95%CI: 0.65-0.99,P=0.04)and SP(OR=0.97,95%CI: 0.96-0.99,P=0.01)concentrations from postoperative were also associated with the increased of adverse cardiovascular events.Conclusion:The findings of this study indicate deep anesthesia is a risk factor for the reduction of CGRP and SP.The serum CGRP and SP concentrations decreased in diabetic patients,and the serum CGRP and SP concentrations decreased greatly in diabetic patients under deep anesthesia.The increased incidence of intraoperative adverse cardiovascular events in diabetic patients was associated with decreased serum CGRP and SP concentrations.