Anaesthetic problems

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1. Hypotension. Blood pressure is extremely sensitive to changes in extracellular fluid volume, and hypotension may occur on induction of anaesthesia. In a prospective study of 17 diabetic patients having eye surgery, 35% required vasopressors, compared with 5% of nondiabetic controls.They were required more often in those with the poorest autonomic function (Burgos et al 1989).Tracheal intubation produces less of a pressor response than is seen in normal patients and, in fact, the first few minutes after tracheal intubation is the period of highest risk for hypotension and bradycardia.

2. Arrhythmias, bradycardias, and unexpected cardiac arrest have all been described.Atropine-induced heart rate increases were found to be significantly less in diabetics than in nondiabetics (Tsueda et al 1991).

3. Respiratory arrest and diminished sensitivity to hypoxia and hypercarbia have been reported (Page & Watkins 1978).

4. The response to catecholamines is variable

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