Patients with Diabetic Neuropathy Are at Risk of a Greater Intraoperative Reduction in Core Temperature

Kitamura, Akira; Hoshino, Takeshi; Kon, Tadashi; Ogawa, Ryō

doi:10.1097/00000542-200005000-00019

Cited by 117 publications

(51 citation statements)

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“…15 The normal autonomic response of vasoconstriction and tachycardia does not completely compensate for the vasodilating effects of anesthesia. There is an association between CAN and more severe intraoperative hypothermia 16 that results in decreased drug metabolism and impaired wound healing. Reduced hypoxic-induced ventilatory drive 17 requires preoperative CAN screening for loss of HRV.…”

Section: Intraoperative and Perioperative Cardiovascular Instabilitymentioning

confidence: 99%

“…Patients with severe autonomic dysfunction have a high risk of BP instability, 92,93 and intraoperative BP support is needed more often in those with greater impairment. 15 Intraoperative hypothermia 16 (which may decrease drug metabolism and affect wound healing) and impaired hypoxic induced ventilatory drive 17 have also been shown to be associated with the presence of CAN. Noninvasive diagnostic methods assessing autonomic function allow identification of at-risk patients preoperatively and may better prepare the anesthesiologist for potential hemodynamic changes.…”

Section: Perioperative Managementmentioning

confidence: 99%

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Diabetic Cardiovascular Autonomic Neuropathy

2007

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Section: Intraoperative and Perioperative Cardiovascular Instabilitymentioning

confidence: 99%

Section: Perioperative Managementmentioning

confidence: 99%

Diabetic Cardiovascular Autonomic Neuropathy

2007

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“…Moreover, patients with diabetes and CAN experience more severe intraoperative hypothermia than those without CAN and may therefore fail to develop a normal core temperature plateau [17]. Because of the increased risk for intraoperative cardiovascular lability, preoperative screening of cardiac autonomic function may be useful in identifying those patients who are at risk.…”

Section: Clinical Featuresmentioning

confidence: 99%

Diagnosis and treatment of diabetic autonomic neuropathy

Ziegler

2001

Curr Diab Rep

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Diabetic autonomic neuropathy (DAN) is associated with a markedly reduced quality of life and poor prognosis. The manifestations of DAN cause multiple symptoms and involve the 1) cardiovascular system: resting tachycardia, reduced heart rate variability and circadian rhythm of heart rate and blood pressure, painless myocardial ischemia/infarction, orthostatic hypotension, exercise intolerance, perioperative instability, sudden death; 2) respiratory system: reduced ventilatory drive to hypercapnia/hypoxemia, sleep apnea; 3) gastrointestinal tract: esophageal motor dysfunction, diabetic gastroparesis, gallbladder atony, diabetic enteropathy, colonic hypomotility, anorectal dysfunction; and 4) genitourinary tract: diabetic cystopathy, erectile dysfunction. Treatment is based on four cornerstones: 1) causal treatment aimed at near-normoglycemia; 2) treatment based on pathogenetic mechanisms; 3) symptomatic treatment; and 4) avoidance of risk factors and complications. Pharmacologic treatment of symptomatic DAN may be difficult, due to limited efficacy and frequent adverse reactions. First-line treatments include midodrine for orthostatic hypotension, prokinetic drugs for gastroparesis, broad-spectrum antibiotics for diabetic diarrhea, and sildenafil for erectile dysfunction. Prior to an adequate symptomatic treatment a thorough risk-benefit estimate, aimed at maintaining the patient's quality of life, is required.

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“…Also patients' medical problems such as diabetes and hypertension are considered to be related to IOM via hypothermia and hypotension. It has been reported diabetic neuropathy or diabetes itself influence to intraoperative core temperature [29,30].…”

Section: Effect Of Intraoperative Hypotension and Hypothermia On Iommentioning

confidence: 99%

Feasibility and Predictability of Intraoperative Monitoring in Patients with Intradural Extramedullary and Epidural Metastatic Spinal Tumors

Kang¹,

Gwak²,

Shin³

et al. 2016

J Spine

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Objectives: To evaluate the feasibility, sensitivity and specificity of IOM for IDEM and ED metastatic spinal tumours, and to assess usefulness of SSEP for patients in whom MEP was not measurable. Methods and materials:One hundred and one consecutive patients with IDEM and ED metastatic spinal tumours at the cord level (C1 to L1) received surgery under SSEP and/or MEP was included. Feasibility of IOM was defined to be negative in case of no measurable MEP or SSEP under general anaesthesia after confirmation of reversal of neuromuscular block. More than 50% change of MEP or SSEP amplitude and more than 10% delay of SSEP latency were evaluated as positive signs of IOM change.Results: MEP was measurable in 74 out of 101 trials, thus feasibility is 73%. Patient with normal motor power showed higher feasibility than those with motor power 3 or less. (93% vs. 39%) Among 74 patients with measurable MEP, 19 patients showed positive MEP change and 14 patients got worse of their motor power postoperatively.

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Patients with Diabetic Neuropathy Are at Risk of a Greater Intraoperative Reduction in Core Temperature

Cited by 117 publications

References 0 publications

Diabetic Cardiovascular Autonomic Neuropathy

Diabetic Cardiovascular Autonomic Neuropathy

Diagnosis and treatment of diabetic autonomic neuropathy

Feasibility and Predictability of Intraoperative Monitoring in Patients with Intradural Extramedullary and Epidural Metastatic Spinal Tumors

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