title: Bradycardia and hypotension refractory to ephedrine and atropine treatment: severe autonomic dysfunction with abnormal heart rate variability.
abstract: Diabetic patients with autonomic dysfunction are potentially poor risks for anesthesia and particular care is needed during and after surgery. We here report a 48-year-old male patient with diabetes mellitus who suffered from intraoperative hypotension and bradycardia which did not respond to ephedrine and atropine treatment and eventuated in cardiac arrest. A heart rate variability study confirmed the diagnosis of autonomic dysfunction after the event. Possible predisposing mechanisms and anesthetic considerations are discussed.
authors.affiliation: Taichung Armed Forces General Hospital, Taiwan, ROC.
authors.forename: Huei-Chi
authors.initials: HC
authors.lastname: Horng
authors.forename: Fa-Chang
authors.initials: FC
authors.lastname: Chen
authors.forename: Ching-Chih
authors.initials: CC
authors.lastname: Ho
authors.forename: Chang-Po
authors.initials: CP
authors.lastname: Kuo
authors.forename: Ching-Tang
authors.initials: CT
authors.lastname: Wu
authors.forename: Chih-Shung
authors.initials: CS
authors.lastname: Wong
mesh_terms: D001285:Atropine / Q000627:therapeutic use*; D001342:Autonomic Nervous System Diseases / Q000150:complications*; D001919:Bradycardia / Q000188:drug therapy*; D048909:Diabetes Complications / Q000150:complications; D004809:Ephedrine / Q000627:therapeutic use*; D006323:Heart Arrest / Q000209:etiology; D006339:Heart Rate; D006801:Humans; D007022:Hypotension / Q000188:drug therapy*; D007431:Intraoperative Complications / Q000188:drug therapy*; D008297:Male; D008875:Middle Aged
chemical_list: D001285:Atropine; D004809:Ephedrine