Pre-operative evaluation for diabetic cardiac autonomic neuropathy and their behaviour during regional anesthesia

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Pre-operative evaluation for
diabetic cardiac autonomic neuropathy and their
behaviour during regional anesthesia

• Dr.s.sivakumar
• m.d anesthesiology(III year)
• Kilpauk medical college

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• Guide
• Dr.P.S. SHANMUGAM, M.D., D.A
• PROFESSOR H.O.D
• ANESTHESIOLOGY,
• KILPAUK MEDICAL COLLEGE

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Aim of the study

• preoperative evaluation for diabetic cardiac
  autonomic neuropathy using cardiac autonomic
  neuropathy system analyser and evaluating their
  hemodynamic stability during regional anesthesia

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Study design

• Randomized prospective comparative study
• Pre-study assessment done
• consent obtained from all patient

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Patient selection

• inclusion criteria
• case
• age40-60 years
• sex both male female
• DM gt 3 years
• PS I
  Control
• age40-60 years
• sexboth male female
• not a known diabetic
• PS I

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• Exclusion criteria
• 1.age lt 40 gt 60 years
• 2.PS II III

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GROUPS

• Group I 20 diabetic patient with autonomic
  neuropathy
• Group II 10 diabetic patient without autonomic
  neuropathy
• Group III 20 control pt , non- diabetic patient
  without autonomic neuropathy

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EQUIPMENT REQUIRED

• CANS 504 cardiac neuropathy system analyser
• ECG moniter
• Spyghmomanometer
• Pulse oxymeter

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CANS 504

• tool to measure and diagnose autonomic
  dysfunction using ECG R-R interval and automatic
  BP measurement

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Normal and abnormal values in tests of autonomic
function
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METHODOLOGY

• 50 patient were randomized into three groups
• Patients evaluated for cardiac autonomic
  dysfunction using CANS 504 - preoperatively
• Subarachonoid block given at the level of L2- L3
  ,volume 3 ml of 0.5 bupivacine ,level T4 T5.
• Intraoperative recording of B.P, pulse rate ,ECG
  rate and rhythm were done for each 5 min in first
  30 min. and then for each 15 min till the end of
  surgery.

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METHODOLGY.

• i.v Fluids and inj.ephedrine 6mg given if
  systolic B.P falls below 90 mmHg
• Inj. Atropine 0.6 mg given if P.R falls below 60

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RESULTS

• During spinal anesthesia patients in group 1
  experienced hypotensive reactions bradycardia
  significantly more often(72) than patients in
  group II (35) and groupIII (15)
• In order to achieve stability in B.P the patients
  of group I had to be given vasoactive drugs much
  more often (55) than patients of groupII(30)
  and those of groupIII(15)

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conclusion

• We found a significant correlation between degree
  of autonomic dysfunction and largest drop in B.P
  variability in H.R cardiac rhythm
• These results prove the atypical hemodynamic
  behaviour and extreme instability in B.P in
  diabetic autonomic neuropathy under spinal
  anesthesia

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Conclusion.,

• Therefore we consider it to be very helpful to
  check the cardiovascular reflectory status of
  diabetics preoperatively.

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