Severe bradycardia and hypotension induced by autonomic neuropathy in a diabetic patient during general anesthesia – A case report

Cardiovascular autonomic neuropathy (CAN) is characterized by dysregulation of sympathetic and parasympathetic nervous systems that causes cardiovascular and respiratory disorders. The number of diabetic patients undergoing surgery is increasing in line with the prevalence of DM. Anesthesiologists should pay attention to diabetic patients with CAN because it is related to serious cardiovascular morbidity and mortality. We report an 80-year-old male who underwent cervical laminoplasty. He had severe bradycardia and hypotension from induction to the suspension of surgery. His blood pressure dropped to 70/40 mmHg and his heart rate to 20 bpm. Ephedrine, phenylephedrine, and atropine administration had minimal effect, but after epinephrine administrations, his heart rate and blood pressure increased to 70 bpm and 170/90 mmHg. The operation was discontinued because of the patient's unstable, fluctuating vital signs. The results of autonomic nervous system function examination indicated postganglionic cholinergic sympathetic dysfunction, sympathetic adrenergic dysfunction, and parasympathetic cholinergic dysfunction.