Diabetic neuropathy is a heterogeneous disorder that encompasses a wide range of abnormalities affecting Sensory, motor and autonomic nervous system. Classification of Autonomic Dysfunction:- Early:- 1 heart rate response (parasympathetic) abnormal or 2 borderline Definite:- 2 or more heart rate abnormal Severe:- 2 or more heart rate and 1 or both blood pressure response (sympathetic) abnormal Note: Autonomic dysfunction is IRREVERSIBLE Anaesthetic Implications of Autonomic Neuropathy Gastroparesis - increases chances of aspirations during induction of anesthesia:- requires Rapid sequence intubation.
Asymptomatic hypoglycemia: More stringent blood sugar monitor during anesthesia Orthostatic Hypotension: Profound hypotension during spinal, positioning & induction Pressor response to laryngoscopy & intubation is exaggerated More susceptible to the depressant effects of…
