Dysautonomia

Abstract

Severe autonomic failure occurs in about 1 in 1000 people. Such patients are remarkable for the striking and sometimes paradoxical responses they manifest to a variety of physiologic and pharmacologic stimuli. Orthostatic hypotension is often the finding most commonly noted by physicians, but a myriad of additional and less well-understood findings also occur. These include supine hypertension, altered drug sensitivity, hyperresponsiveness of blood pressure to hypo/hyperventilation, sleep apnea and other neurological disturbances are also frequently encountered. In this article we will review the clinical pathophysiology that underlies autonomic failure, with a particular emphasis on those aspects most relevant to the care of such patients in the perioperative settings. Strategies used by clinicians to diagnose and treat these patients, and the impact of these interventions on the pre-operative, intra-operative, and post-operative care that these patients undergo is a crucial element in the optimized management of care in these patients.

Role of heart-rate variability in preoperative assessment of physiological reserves in patients undergoing major abdominal surgery

“…Neurological and psychiatric disorders have some degree of AD. 6 – 8 , 12 – 17 In our study, the NCAR group comprised patients with more chronic comorbidities than in the CAR group. We found that AD reflected both the number and severity of illnesses in the NCAR group.…”

“… 8 , 12 – 15 In addition, HRV measurements are influenced by the use of chronic medication. 6 – 8 , 17 The use of some autonomic challenge (ie, the Valsalva maneuver or orthostatic load) can improve HRV measurement and better reflect the real degree of autonomic physiological reserves, in contrast to measurements under static conditions. 10 , 11 In our study, we used orthostatic load which can help us identify patients without autonomic reactivity (NCAR) among elderly patients with comorbidities scheduled for MAS.…”

“… 5 In addition, anesthetics influence cardiovascular homeostasis, and preexisting autonomic dysfunction (AD) can lead to hemodynamic instability during anesthesia. 6 Preserved autonomic regulation represents adequate physiological reserves and better reactivity to various insults during the perioperative course. 7 …”

ANSiscope™: Can it be the crystal ball of cardiac anesthesia?

“…The use of anesthetic drugs decreases the capacity to release residual catecholamines in patients with dysautonomia. [14]…”

Anesthetic experience of frontotemporal dementia patient with severe autonomic dysfunction: a case report

“…That results in further compromises the pressor response during surgery, this is more exacerbated due to their inability to buffer changes in BP [7]. …”