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Assessment of autonomic function after spinal anaesthesia in diabetic and non-diabetic patients undergoing elective
Arun Kumar Patra1, Sachin Shouche2, Bhaskar Das3
1Assistant Professor (Anaesthesia), 7 Air Force Hospital, Kanpur, India.
Background:
Diabetes is known for autonomic neuropathy and related complications even at the time of diagnosis. Objective assessment of autonomic functions is rarely used in clinical settings though there are many conditions when autonomic dysfunction is temporarily induced e.g. spinal anaesthesia.
Methods:
We planned a prospective observational study to assess the alteration of autonomic functions and its recovery after spinal anaesthesia in 50 Diabetic (Gr D) and 50 Non- diabetic patients (Gr ND) using a sudomotor scan.
Results:
The mean age of Gr D was 48yrs and of Gr ND was 30yrs and the difference was statistically significant. The mean weight and BMI of Gr D patients was 68Kg and 25.3 Kg/m2 in comparison to 65 Kg and 23.54 Kg/m2 in Gr ND. The gender distribution, height, surgery type and duration in both the groups were not significantly different. The average electrical skin conductance hand score (ESCH) was 55 in Gr D in comparison to 62 in Gr ND; scores in the foot (ESCF) were 64 and 75, the difference was statistically significant. ESCF at 48h is 56 in diabetic and 70 in Gr ND; this is significantly different from the preoperative scores in both groups. The post-operative scores are significantly less than preoperative, for up to 24h after spinal anaesthesia though they recover thereafter.
Conclusion:
Autonomic neuropathy is one of the common complications of diabetes which can be detected in the perioperative settings. The dysfunction is exaggerated with subarachnoid block and it takes more than 48h to recover.