1/5. Renal transplantation and diabetic autonomic neuropathy.This report describes six episodes of cardiovascular collapse in the perioperative period of a young diabetic woman undergoing general anaesthesia for renal transplantation and a similar episode after a second anaesthetic. She was subsequently found to have an autonomic neuropathy. Recommendations for the management of similar patients are made.- - - - - - - - - - ranking = 1keywords = anaesthesia (Clic here for more details about this article) |
2/5. Cardiorespiratory arrest and diabetic autonomic neuropathy.Twelve cardiorespiratory arrests in eight neuropathy are reported. Only one patient died at the time, but two others subsequently died suddenly at home. There was no evidence of myocardial infarction, cardiac arrhythmia, or hypoglycaemia at the time of arrest. In most of the episodes there was some interference with respiration, either by anaesthesia, drugs, or bronchopneumonia. Five of the episodes occured during or immediately after anaesthesia. It is suggested that the arrests were caused by defective respiratory rather than cardiovascular reflexes. Cardiorespiratory arrest appears to be a specific feature of diabetic autonomic neuropathy and may contribute to the mortality of this condition.- - - - - - - - - - ranking = 2keywords = anaesthesia (Clic here for more details about this article) |
3/5. Anaesthetic implications of long term diabetic complications.A case history in which a patient suffering from long-term diabetes mellitus underwent vascular surgery of a lower extremity is presented. Anaesthesia was commenced with an epidural anaesthesia, but due to insufficient analgesia combined with a high thoracal block general anaesthesia was added. The course was complicated because of cardiomyopathy, autonomic neuropathy, difficult laryngoscopy, aspiration of gastric content, and acute renal failure. Anaesthetic implications of long-term diabetes mellitus are discussed.- - - - - - - - - - ranking = 2keywords = anaesthesia (Clic here for more details about this article) |
4/5. Sudden cardiorespiratory arrest after renal transplantation in a patient with diabetic autonomic neuropathy and prolonged QT interval.A 31-yr male with insulin dependent diabetes mellitus for 20 years underwent general anaesthesia for renal transplantation. During transfer from operating theatre to ICU he developed bradycardia advancing to ventricular fibrillation and had to be resuscitated. bradycardia did not respond to atropine. Postoperative autonomic nervous function tests showed advanced autonomic neuropathy. He was found to have constantly prolonged QTc interval in his pre- and postoperative ECGs (462-503 ms). Prolongation of QTc interval could be used as a valuable predictor of postoperative cardiac complications in diabetic patients with autonomic neuropathy.- - - - - - - - - - ranking = 1keywords = anaesthesia (Clic here for more details about this article) |
5/5. Neuropathological alterations in diabetic truncal neuropathy: evaluation by skin biopsy.OBJECTIVES: To describe the neuropathological features in skin biopsies from patients with diabetic truncal neuropathy. methods: Three patients with diabetic truncal neuropathy underwent skin biopsies from both symptomatic and asymptomatic regions of the chest and trunk. After local anaesthesia, biopsies were performed using a 3 mm diameter punch device (Acupunch). Intraepidermal nerve fibres (IENFs), the most distal processes of small myelinated and unmyelinated nerve fibres, were identified after staining with PGP 9.5 as previously described. RESULTS: Diabetes was diagnosed at the time of the neurological presentation in two, and one was a known diabetic patient. All three had associated sensory-motor polyneuropathy. In all, skin biopsies showed a marked reduction of both epidermal and dermal nerve fibres in the symptomatic dermatomes, compared with skin from asymptomatic truncal areas. In one patient, a follow up skin biopsy when symptoms had improved showed a return of IENFs. CONCLUSIONS: In diabetic truncal neuropathy, skin biopsies from symptomatic regions show a loss of IENFs. After clinical recovery, there is a return of the IENF population, suggesting that improvement occurs by nerve regeneration. These findings suggest that sensory nerve fibre injury in diabetic truncal neuropathy is distal to or within the sensory ganglia. skin biopsy provides a possible tool for understanding the pathophysiology of the disease.- - - - - - - - - - ranking = 1keywords = anaesthesia (Clic here for more details about this article) |