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3 results

  • Chapter 16 - Peripheral Neuropathies

  • Edited by David R. Gambling, University of California, San Diego, M. Joanne Douglas, University of British Columbia, Vancouver, Grace Lim, University of Pittsburgh
  • Book:
    Obstetric Anesthesia and Uncommon Disorders
    Published online:
    26 January 2024
    Print publication:
    01 February 2024, pp 259-272

  • Summary

    Peripheral neuropathy takes many forms and occurs as a primary condition or as a component of diseases with multisystem manifestations. There are manifold etiologies, including genetic, inflammatory, traumatic/compressive, metabolic, vasculitic, neoplastic, dietary, and toxic/drug-induced. They are classified as mononeuropathy, multifocal neuropathy (mononeuropathy multiplex), or polyneuropathy. Peripheral neuropathies affect the cell body and the axon (neuropathy, axonopathy) or the myelin sheath (demyelinating neuropathy/neurapraxia). Neuropathies affect sensory, motor, autonomic nerves, or a combination. Pregnancy exacerbates some neuropathies, while pregnancy or parturition may be a direct or indirect cause of a variety of mononeuropathies and plexopathies. A peripheral neuropathy does not directly impact anesthetic care but associated systemic disease manifestations can complicate peripartum anesthetic care. Some peripheral neuropathies alter drug sensitivity or impair respiration, presenting unique challenges to the anesthesiologist.

  • Dispersion of the P wave as a test for cardiac autonomic function in diabetic children

  • Ebru Y. Imamoglu, Funda Oztunc, Ayse G. Eroglu, Hasan Onal, Alper Guzeltas
  • Journal:
    Cardiology in the Young / Volume 18 / Issue 6 / December 2008
    Published online by Cambridge University Press:
    01 December 2008, pp. 581-585
  • Objective

    We aimed, in this study, to compare dispersion of the p wave in patients with type 1 diabetes to nondiabetic control subjects, and to investigate the relationship between the dispersion of the p wave and cardiac autonomic dysfunction in diabetic children.

    Methods

    We enrolled 49 patients with type 1 diabetes, and 32 age- and sex-matched healthy subjects, measuring the Valsalva ratio, resting heart rate, and orthostatic hypotension in all. The duration of the p wave was measured manually on a high-resolution computer screen. Dispersion, defined as the difference between maximum and minimum durations of the p waves, was also measured in the 12-lead electrocardiogram before and after the Valsalva maneuver.

    Results

    The mean age of the patients and their controls were 14.2 ± 4.8 years, and 12.7 ± 4.5 years, respectively. The mean duration of diabetes had been 6.2 ± 4.6 years. Maximal and minimal values for the duration of the p wave were significantly decreased in the diabetic children, with the dispersion itself significantly increased. Values for the dispersion in the diabetic subjects were similar before and after the Valsalva maneuver, whereas dispersion was found significantly increased after this maneuver in the controls. The differences in the Valsalva ratio, resting heart rate, and orthostatic hypotension between the groups, on the other hand, were not found to be statistically significant.

    Conclusion

    The noted increase in the dispersion of the p wave in diabetic children reveals the onset of cardiac electrophysiological heterogeneity before it is possible to detect parasympathetic and sympathetic dysfunction with other tests.