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

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

3. 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

4. Study design Randomized prospective comparative study
Pre-study assessment done
consent obtained from all patient

5. Patient selection inclusion criteria case: age:40-60 years
sex :both male& female
DM > 3 years
PS I Control:
sex:both male &female
not a known diabetic
PS I

6. Exclusion criteria
1.age < 40& > 60 years
2.PS II & III

7. 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

8. EQUIPMENT REQUIRED CANS 504 – cardiac neuropathy system analyser
ECG moniter
Spyghmomanometer
Pulse oxymeter

9. CANS 504
tool to measure and diagnose autonomic dysfunction using ECG R-R interval and automatic BP measurement

11. Normal and abnormal values in tests of autonomic function

14. METHODOLOGY 50 patient were randomized into three groups
Patients evaluated for cardiac autonomic dysfunction using CANS 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.

15. 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

16. INJ. EPHEDRINE * Group Crosstabulation
Group 1 2 3
Total
INJ. EPHEDRINE
0 dose
Count 4 12 18
% within Group
20.0%
60.0%
36.0%
1 dose 8 15
15.0%
40.0%
30.0%
2 dose 5 9
25.0%
.0%
18.0%
3 dose 6
12.0%
4 dose
10.0%
4.0% 20 10 50
100.0%

18. INJ. ATROP * Group Crosstabulation
Group 1 2 3
Total
INJ. ATROP
0 dose
Count 5 19 27
% within Group
15.0%
50.0%
95.0%
54.0%
0dose
.0%
30.0%
6.0%
1 dose 9 12
45.0%
20.0%
5.0%
24.0%
2 dose
2.0%
nil 7
35.0%
14.0% 20 10 50
100.0%

20. 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%)

21. 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

22. Conclusion….,
Therefore we consider it to be very helpful to check the cardiovascular reflectory status of diabetics preoperatively.