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Diabetes: Autonomic neuropathy

Diabetic autonomic neuropathy can be defined as dysfunction of the sympathetic and parasympathetic nervous systems due to poor glycemic control. All autonomically innervated organs are affected but those most commonly implicated include the eye, bladder, intestine, reproductive organs, sweat glands, and cardiovascular system. One of the earliest findings in these patients is resting tachycardia and decreased heart rate variability. Additionally, they can have orthostatic bradycardia and tachycardia, postural hypotension(POTTS). These patients are particularly prone to labile hemodynamics under general anesthesia. The presence of gastroparesis can increase risk of aspiration and they are also prone to urinary retention under general anesthesia. These patients are also susceptible to thermodysregulation as damage to the autonomic nervous system results in anhidrosis and inability to cool one’s self. However, under general anesthesia, their peripheral neuropathy can predispose them to poor or delayed vasoconstriction and subsequent hypothermia.


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