Changes of Hemodynamics and Blood Glucose during Tracheal Intubation in the Geriatrics with Different Glycosylated Hemoglobin Levels

Background: The severe cardiovascular response following tracheal intubation has threatened geriatrics' safety. HbA1c may be an independent risk predictor for the outcome of cardiovascular disease and/or DM. We investigated the relationship between preoperative HbA1c levels and changes of hemodynamic and blood glucose (Glu) during tracheal intubation in geriatrics. Methods: 112 geriatric non-cardiac surgery patients undergoing general anesthesia were divided into 4 groups according to HbA1c levels (Group A, B, C and D). Mean arterial pressure (MAP) and heart rate (HR) were recorded before anesthesia induction (T0), just before intubation (T1), at intubation (T2), 1, 2, 3, 5, 8 and 10 minutes after intubation (T3-8). Glu Levels were measured at T0, T1, T6 and T8. Results: Compared with group A or B, MAP decreased markedly at T1-8 in group C or D (P < 0.05). Compared with T0, HR decreased markedly at T1, T6-8 in group C and at T1-3, T5-8 in group D (P < 0.05). The TΔ (the difference value of MAP between T0 and T8 points) and the HΔ (the difference value of HR between T0 and T8 points) of all patients were highly correlated with preoperative HbA1c levels [TΔ (mmHg) = -9.436 HbA1c 25.94, R2 = 0. 368; HΔ (bpm) = -6.172 HbA1c 26.842, R2 = 0.208]. Conclusion: Preoperative high HbA1c level may contribute to significant hemodynamic changes and significant increased blood Glucose levels after tracheal intubation, especially for elder patients with HbA1c > 7 %.