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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. Guide: Dr.P.S. SHANMUGAM, M.D., D.A PROFESSOR & H.O.D

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Presentation Transcript
slide1

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

slide2
Guide:
  • Dr.P.S. SHANMUGAM, M.D., D.A
  • PROFESSOR & H.O.D
  • ANESTHESIOLOGY,
  • KILPAUK MEDICAL COLLEGE
aim of the study
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
study design
Study design
  • Randomized prospective comparative study
  • Pre-study assessment done
  • consent obtained from all patient
patient selection
Patient selection

inclusion criteria

case:

  • age:40-60 years
  • sex :both male& female
  • DM > 3 years
  • PS IControl:
  • age:40-60 years
  • sex:both male &female
  • not a known diabetic
  • PS I
slide6
Exclusion criteria
  • 1.age < 40& > 60 years
  • 2.PS II & III
groups
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
equipment required
EQUIPMENT REQUIRED
  • CANS 504 – cardiac neuropathy system analyser
  • ECG moniter
  • Spyghmomanometer
  • Pulse oxymeter
cans 504
CANS 504
  • tool to measure and diagnose autonomic dysfunction using ECG R-R interval and automatic BP measurement
methodology
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.
methodolgy
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

slide16

INJ. EPHEDRINE * Group Crosstabulation

Group

1

2

3

Total

INJ. EPHEDRINE

0 dose

Count

4

2

12

18

% within Group

20.0%

20.0%

60.0%

36.0%

1 dose

Count

3

4

8

15

% within Group

15.0%

40.0%

40.0%

30.0%

2 dose

Count

5

4

0

9

% within Group

25.0%

40.0%

.0%

18.0%

3 dose

Count

6

0

0

6

% within Group

30.0%

.0%

.0%

12.0%

4 dose

Count

2

0

0

2

% within Group

10.0%

.0%

.0%

4.0%

Total

Count

20

10

20

50

% within Group

100.0%

100.0%

100.0%

100.0%

slide18

INJ. ATROP * Group Crosstabulation

Group

1

2

3

Total

INJ. ATROP

0 dose

Count

3

5

19

27

% within Group

15.0%

50.0%

95.0%

54.0%

0dose

Count

0

3

0

3

% within Group

.0%

30.0%

.0%

6.0%

1 dose

Count

9

2

1

12

% within Group

45.0%

20.0%

5.0%

24.0%

2 dose

Count

1

0

0

1

% within Group

5.0%

.0%

.0%

2.0%

nil

Count

7

0

0

7

% within Group

35.0%

.0%

.0%

14.0%

Total

Count

20

10

20

50

% within Group

100.0%

100.0%

100.0%

100.0%

results
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%)
conclusion
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
conclusion1
Conclusion….,
  • Therefore we consider it to be very helpful to check the cardiovascular reflectory status of diabetics preoperatively.
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