Comparison of Primary Patency and Maturation Rate of Antecubital Artriovenous Fistula for Dialysis in Diabetic Patient with Two Methods: Regional Block with Ropivacaine 0.5% and Local Anesthesia with Lidocaine 2%

Background: The best arteriovenous access in diabetic patients under dialysis is crucial to attain better therapeutic outcomes and improved prognosis in the patients. The purpose in this study was to compare the primary patency and maturation rate of antecubital artriovenous fistula for dialysis in diabetic patient with two methods: regional block with Ropivacaine 0.5% and local anesthesia with lidocaine 2%. Methods and Materials: In this randomized clinical trial, 40 consecutive diabetic patients under dialysis in 2016 and 2017 in a training center were enrolled and the primary patency and maturation rate of antecubital artriovenous fistula were compared with regional block with Ropivacaine 0.5% versus local anesthesia with lidocaine 2%. Results: The results in this study demonstrated that all factors of final arterial and venous diameter, blood flow, and patency were higher in group under regional block with Ropivacaine 0.5% and all except patency showed significant difference (P < 0.05). The complications rates were alike across the groups (P > 0.05). Conclusion: Totally, according to the obtained results, it may be concluded that regional block with Ropivacaine 0.5% is superior to local anesthesia with lidocaine 2% leading to higher patency rate and shorter maturation time and also higher arteriovenous diameter and blood flow.

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Psychological Study of Anxiety among Diabetic Patients

International Journal of Indian Psychology ◽

10.25215/0501.028 ◽

2017 ◽

Vol 5 (1) ◽

Author(s):

Parth R. Desai

Keyword(s):

Diabetic Patient ◽

Urban Area ◽

Rural Area ◽

T Test ◽

Anxiety Scale ◽

Diabetic Patients ◽

Male And Female ◽

Psychological Study ◽

Significant Difference ◽

The Mean

The main aim of the present study is to find out the level of Anxiety among diabetic patient. It was hypothesized that the level of and Anxiety will differ in diabetic patients with regards to gender and type of area. The sample consists of total 120 (60 patients of urban and 60 patients of rural area) the sample is selected from city and various villages, by using purposive technique. Anxiety scale prepared by A.K.P. Sinha and L.N.K. Sinha devised this test and it is available both test in Hindi and English. Gujarati Adoption by Bhatt D. J. (1999). The data was scored, analyzed as per the manual. ‘t’ test was being calculated. The result showed that (1) There is no significant difference between the mean score of anxiety among male and female diabetic patient. (2) There is significant difference between the mean score of anxiety among type of area i.e. urban and rural. Thereafter could be said that, diabetic patient of rural area show more anxiety than diabetic patient of urban area.

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Effect of insulin treatment on pulsatility ratio and resistance index of the retinal artery in patients with type 2 diabetes

PLoS ONE ◽

10.1371/journal.pone.0254980 ◽

2021 ◽

Vol 16 (7) ◽

pp. e0254980

Author(s):

Tsuneaki Omae ◽

Youngseok Song ◽

Takafumi Yoshioka ◽

Tomofumi Tani ◽

Akitoshi Yoshida

Keyword(s):

Type 2 Diabetes ◽

Blood Flow ◽

Insulin Treatment ◽

Diabetic Patients ◽

Type 2 Diabetic Patients ◽

Significant Difference ◽

Retinal Artery ◽

Type 2 Diabetic

This study aimed to evaluate whether long-term insulin treatment is associated with abnormalities in retinal circulation in type 2 diabetic patients. We evaluated 19 eyes of nondiabetic individuals and 68 eyes of type 2 diabetic patients. The eyes of diabetic patients were classified into two groups according to the presence or absence of long-term insulin therapy. We used a Doppler optical coherence tomography flowmeter to measure diameter, velocity, and blood flow in the major temporal retinal artery. The pulsatility ratio (PR) and resistance index (RI), indices of vascular rigidity, were calculated from the blood velocity profile. PR and RI were significantly elevated in type 2 diabetic patients compared with nondiabetic subjects (P < 0.05). In type 2 diabetes patients, PR and RI were significantly higher in patients receiving long-term insulin treatment than in those without (P < 0.01). There was a significant difference in velocity (P < 0.05), but not diameter and blood flow, between nondiabetic subjects and type 2 diabetes patients. No significant difference in diameter, velocity, or blood flow was observed between the groups with and without long-term insulin treatment. Long-term insulin treatment can affect PR and RI, which might be associated with vascular rigidity of the retinal artery in patients with type 2 diabetes.

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Comparison of Renal Segmental Artery Blood Flow on Doppler in Young Obese & Non Obese Individuals

10.53350/pjmhs2115103036 ◽

2021 ◽

Vol 15 (10) ◽

pp. 3036-3038

Keyword(s):

Blood Flow ◽

Sampling Technique ◽

P Value ◽

Diabetic Patients ◽

Artery Blood Flow ◽

Segmental Artery ◽

Significant Difference ◽

History Of ◽

Renal Parenchymal Disease ◽

Parenchymal Disease

Aim: To compare renal segmental artery blood flow on Doppler in young obese & non-obese individuals. Methodology: In University Ultrasound Clinic Green Town, Lahore, Pakistan, a comparative study was conducted. 180 patients of age group 16 to 25 were enrolled in this study with convenient sampling technique. All the obese & non-obese patients having no history of renal disease were included in this study. Hypertensive and diabetic patients were also included. Pregnant females having any renal parenchymal disease were excluded. Results: In 90 non-obese individuals the average mean of PI was .989±.249 while in 90 obese individuals the average mean of PI was .985±.338. No statistical difference between the two averages as p-value 0.928> α=0.05. Conclusion: Study concluded that no statistically significant difference between the average PI in non-obese individuals compared to the average of PI in obese individuals. Keywords: Obese, Renal segmental artery, Pulsatility Index (PI), Ultrasonography

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Arteriovenous access does not perform as well for plasmapheresis

The Journal of Vascular Access ◽

10.5301/jva.5000644 ◽

2017 ◽

Vol 18 (2) ◽

pp. 144-147

Author(s):

Mathew Wooster ◽

Rachel Wilson ◽

Murray Shames ◽

Neil Moudgill

Keyword(s):

International Classification Of Diseases ◽

Primary Patency ◽

Secondary Patency ◽

Patient Demographics ◽

Surgical Access ◽

Classification Of Diseases ◽

Maturation Rate ◽

Arteriovenous Access ◽

Stiff Man Syndrome

Purpose Access surgeons are occasionally asked to create arteriovenous access for non-dialysis functions. Subjectively noting overall poor results, we seek to present our experience with arteriovenous access creation for apheresis. Methods Billing records were reviewed using Current Procedural Terminology (CPT) and International Classification of Diseases (ICD-9) codes to identify patients undergoing arteriovenous access creation for diseases other than renal failure from January 2007 to August 2014. Inpatient and outpatient records were reviewed to identify patient demographics, disease-specific medications/treatments, access-specific characteristics, patency data, and reinterventions required. Results A total of 16 access creation procedures were performed for 8 patients, accounting for just 1.6% of total access creations during the period. Treatment was for myasthenia gravis (n = 6), chronic inflammatory degenerative polyneuropathy (n = 9), and stiff man syndrome (n = 1). Access failure was by thrombosis (n = 7), non-maturation (n = 4), and infection/steal syndrome (n = 1), with four accesses still functional at conclusion of review. There was 50% autogenous access creation and overall maturation rate of 37.5%. Mean primary patency was 236 days (range 10-878), with secondary patency achieved in three patients adding a mean of 174 days (range 2-517). Cumulative 3-month and 1-year patency rates were 36.5% and 25%, respectively. Conclusions Arteriovenous access creation for plasmapheresis represents a minority of access procedures. Though it remains unclear why, patency and maturation rates are significantly lower than expected when compared to access for hemodialysis access. These high failure rates must be taken into account when considering replacement of temporary catheters with surgical access for non-hemodialysis needs.

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Cerebral blood flow in the diabetic patient

Perfusion ◽

10.1177/026765919601100502 ◽

1996 ◽

Vol 11 (5) ◽

pp. 363-370 ◽

Cited By ~ 31

Author(s):

Faith Pallas ◽

Douglas F Larson

Keyword(s):

Blood Flow ◽

Smooth Muscle ◽

Cerebral Blood Flow ◽

Vascular Smooth Muscle ◽

Diabetic Patient ◽

Vascular Function ◽

Molecular Mechanisms ◽

Morphological Changes ◽

Diabetic Patients ◽

Functional Changes

Diabetes is a major risk factor for cardiovascular disease. Coronary revascularization utilizing cardiopulmonary bypass (CPB) is frequently required for the diabetic patient. Nondiabetic individuals can autoregulate cerebral blood flow (CBF) through metabolic and perfusion pressure mechanisms during CPB. However, it has been reported that diabetic patients have impaired CBF autoregulation during CPB. It is possible, therefore, that impaired CBF autoregulation may contribute to postoperative neuropsychologic dysfunction. The mechanisms for this defect may reside in impaired endothelial-dependent responses in the diabetic that are related to morphological and functional changes linking the vascular endothelium and the vascular smooth muscle. The morphological changes occurring in the diabetic include microangiopathy and macroangiopathy which are characterized by endothelial cell (EC) hyperplasia and basement membrane thickening. Also, significant functional changes in local control of vascular tone, such as an imbalance in the synthesis and secretion of vasoactive factors by the EC and abnormal reactivity of the vascular smooth muscle, are seen in the diabetic when compared to the nondiabetic. More specifically, vascular responses to both calcium-dependent pathways of vasoconstriction and nitric oxide pathways of vasorelaxation have been shown to significantly differ between the diabetic and nondiabetic. The emphasis of this discussion is to examine the molecular mechanisms by which diabetes alters vascular function, with emphasis placed on regulation of cerebral artery blood flow during CPB.

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389 Microvascular dysfunction in patients with Type II diabetes mellitus: invasive assessment of absolute coronary blood flow and microvascular resistance reserve

European Heart Journal Supplements ◽

10.1093/eurheartj/suab136.005 ◽

2021 ◽

Vol 23 (Supplement_G) ◽

Author(s):

Pasquale Paolisso ◽

Emanuele Gallinoro ◽

Alessandro Candreva ◽

Konstantinos Bermpeis ◽

Davide Fabbricatore ◽

...

Keyword(s):

Blood Flow ◽

Diastolic Dysfunction ◽

Coronary Blood Flow ◽

Coronary Flow ◽

Microvascular Dysfunction ◽

Microvascular Function ◽

Diabetic Patients ◽

Flow Reserve ◽

Significant Difference ◽

Microvascular Resistance

Abstract Aims Coronary microvascular dysfunction (CMD) is an early feature of diabetic cardiomyopathy, which usually precedes the onset of diastolic and systolic dysfunction. Continuous intracoronary thermodilution allows an accurate and reproducible assessment of absolute coronary blood flow and microvascular resistance thus allowing the evaluation of coronary flow reserve (CFR) and Microvascular Resistance Reserve (MRR), a novel index specific for microvascular function, which is independent from the myocardial mass. In the present study we compared absolute coronary flow and resistance, CFR and MRR assessed by continuous intracoronary thermodilution in diabetic vs. non-diabetic patients. Left atrial reservoir strain (LASr), an early marker of diastolic dysfunction was compared between the two groups. Methods In this observational retrospective study, 108 patients with suspected angina and non-obstructive coronary artery disease (NOCAD) consecutively undergoing elective coronary angiography (CAG) from September 2018 to June 2021 were enrolled. The invasive functional assessment of microvascular function was performed in the left anterior descending artery (LAD) with intracoronary continuous thermodilution. Patients were classified according to the presence of DM. Absolute resting and hyperaemic coronary blood flow (in mL/min) and resistance (in WU) were compared between the two cohorts. FFR was measured to assess coronary epicardial lesions, while CFR and MRR were calculated to assess microvascular function. LAS, assessed by speckle tracking echocardiography, was used to detect early myocardial structural changes potentially associated with microvascular dysfunction. Results The median FFR value was 0.83 (0.79–0.87) without any significant difference between the two groups. Absolute resting and hyperaemic flow in the left anterior descending coronary were similar between diabetic and non-diabetic patients. Similarly, resting and hyperaemic resistances did not change significantly between the two groups. In the DM cohort the CFR and MRR were significantly lower compared to the control group [CFR = 2.38 ± 0.61 and 2.88 ± 0.82; MRR = 2.79 ± 0.87 and 3.48 ± 1.02 for diabetic and non-diabetic patients respectively, (P < 0.05 for both)]. Likewise, diabetic patients had a significantly lower reservoir, contractile and conductive LAS (all P < 0.05). Conclusions Compared with non-diabetic patients, CFR and MRR were lower in patients with DM and non-obstructive epicardial coronary arteries, while both resting and hyperaemic coronary flow and resistance were similar. LASr was lower in diabetic patients, confirming the presence of a subclinical diastolic dysfunction associated to the microcirculatory impairment. Continuous intracoronary thermodilution-derived indexes provide a reliable and operator-independent assessment of coronary macro- and microvasculature and might potentially facilitate widespread clinical adoption of invasive physiologic assessment of suspected microvascular disease.

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Effect of Local Anesthesia with 1:100,000 Epinephrine on Glycemic Level of Type II Diabetic Patients Undergoing Oral Surgery

Journal of Saidu Medical College, Swat ◽

10.52206/jsmc.2021.11.4.674 ◽

1969 ◽

Vol 11 (4) ◽

pp. 181-184

Author(s):

Muhammad Tariq Khan ◽

Muhammad Ilyas ◽

Salman Khan ◽

Jawad Ahmad Kundi ◽

Fariha Kifayat

Keyword(s):

Diabetes Mellitus ◽

Blood Glucose ◽

Blood Glucose Level ◽

Local Anesthesia ◽

Glucose Level ◽

Oral Surgery ◽

Diabetic Patients ◽

Type Ii ◽

Glycemic Level ◽

Significant Difference

Background: The rate of type II diabetic patients is increasing and results in oral manifestations. The oral surgery needsextraordinary measures in these patients.Objective: To assess the effect of anesthetic agent with 1:100,000 epinephrine and without epinephrine in the blood glucose levelof diabetic patients.Material and Methods: This was a randomized study of 60 patients having type 2 diabetes mellitus who were undergoing toothextraction. The study was double blind. 30-70years aged patients were selected. Blood glucose level was monitored 15 minutesbefore giving local anesthesia and after 20 minutes of the injection. ANOVA was used for comparison between groups.Results: No significant difference was seen in glycemic level using local anesthesia with 1:100,000 epinephrine (p=0.345). Therewas slight decrease noted in the blood glucose level of both groups.Conclusion: The use of 2% local anesthesia with 1:100,000epinephrine didn't cause hyperglycemia in diabetic patients.Keywords: Diabetes Mellitus, Local Anesthesia, Epinephrine, Tooth Extraction, Lidocaine.

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Regional versus local anesthesia for arteriovenous fistula creation in end-stage renal disease: a systematic review and meta-analysis

The Journal of Vascular Access ◽

10.5301/jva.5000683 ◽

2017 ◽

Vol 18 (3) ◽

pp. 177-184 ◽

Cited By ~ 19

Author(s):

Ammar Ismail ◽

Abdelrahman Ibrahim Abushouk ◽

Amira H. Bekhet ◽

Osama Abunar ◽

Omar Hassan ◽

...

Keyword(s):

Blood Flow ◽

Postoperative Complications ◽

Arteriovenous Fistula ◽

Local Anesthesia ◽

Randomized Trials ◽

Meta Analysis ◽

Primary Patency ◽

Failure Rates ◽

Hemodynamic Parameters ◽

Brachial Artery Diameter

There is a consensus in the literature that regional anesthesia (RA) improves local hemodynamic parameters in comparison to local anesthesia (LA) during arteriovenous fistula (AVF) surgical construction. However, the effects of both techniques on fistula patency and failure rates are still controversial. The aim of this meta-analysis is to synthesize evidence from published randomized trials and observational studies regarding the safety and efficacy of RA versus LA in AVF surgical construction. A computer literature search of PubMed, Scopus, Web of Science, and Cochrane Central retrieved six randomized trials (462 patients) and one retrospective study (408 patients). Pooling data using RevMan software (version 5.3) showed that RA was superior to LA in terms of primary fistula patency rate (RR = 1.22, 95% CI [1.08, 1.37], p = 0.0010); however, both types were comparable in terms of primary fistula failure rate (RR = 0.81, 95% CI [0.47, 1.40], p = 0.46). In comparison to LA, RA was associated with improved hemodynamic parameters including fistula blood flow (MD = 25.08, 95% CI [19.40, 30.76], p<0.00001), brachial artery diameter (SMD = 2.63, 95% CI [2.17, 3.08], p<0.00001), and outflow venous diameter (SMD = 0.93, 95% CI [0.30, 1.75], p = 0.004). Postoperative complications were comparable between both groups (OR = 0.23, 95% CI [0.05, 0.97], p = 0.05). In conclusion, RA was associated with higher primary patency rates of AVF and improved local blood flow in comparison to LA; however, both procedures were comparable in terms of primary failure rates and postoperative complications. Larger well-designed trials with longer follow-up periods should compare both techniques in terms of long-term patency rates and safety outcomes.

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Evaluation of blood glucose in type II diabetic patients submitted to local anesthesia with different vasoconstrictors

RGO - Revista Gaúcha de Odontologia ◽

10.1590/1981-863720160003000093176 ◽

2016 ◽

Vol 64 (4) ◽

pp. 425-429

Author(s):

Renan Pollettini de MELLO ◽

Juliana Cama RAMACCIATO ◽

Daiane Cristine PERUZZO ◽

Carllini Barroso VICENTINI ◽

Cristiane de Cássia BERGAMASCHI ◽

...

Keyword(s):

Heart Rate ◽

Blood Glucose ◽

Pulse Oximetry ◽

Local Anesthesia ◽

Diabetic Patients ◽

Type 2 Diabetic Patients ◽

Significant Difference ◽

Type 2 Diabetic ◽

Glucose Pulse

ABSTRACT Objective: In the dental clinic, the use of local anesthetics containing vasoconstrictors in diabetic patients are still controversial raising some doubts. Thus, the objective of this randomized crossover clinical trial was to evaluate blood glucose, pulse oximetry and heart rate of type 2 diabetic patients when submitted to local anesthesia using prilocaine 3% associated to felypressin 0,03UI / ml (G1) and 2% lidocaine associated to epinephrine 1: 100,000 (G2). Methods: The sample consisted of 20 compensated type 2 diabetic patients (both genders) who were taking oral hypoglycemic drugs. The volunteers underwent two periodontal sessions (scaling) and one of the solutions tested was used in each visit. The cited parameters were evaluated at three different times: before the procedure (T1), 10 minutes after anesthesia (T2) and after 20 minutes (T3). Results: Regarding the blood glucose levels, no statistically significant difference was found in different times between G1 and G2 (p> 0.05). Similarly, regarding pulse oximetry and heart rate, no statistically significant differences were observed in intervals assessed between groups (p> 0.05), presenting values within normal limits. Conclusion: Considering the vasoconstrictors and the volume of anesthetic solution used, the results suggest that the evaluated vasoconstrictors do not alter significantly blood glucose, pulse oximetry and heart rate in compensated type 2 diabetic patients.

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Left Ventricular Dysfunction and Blood Glycohemoglobin Levels in Young Diabetics

Nuklearmedizin ◽

10.1055/s-0038-1629573 ◽

1991 ◽

Vol 30 (05) ◽

pp. 183-188

Author(s):

A. Aydrner ◽

A. Oto ◽

E. Oram ◽

O. Gedik ◽

C. F. Bekdik ◽

...

Keyword(s):

Ejection Fraction ◽

Left Ventricular Function ◽

Ventricular Function ◽

Left Ventricular ◽

Diabetic Patients ◽

Filling Fraction ◽

Time To Peak ◽

Significant Difference ◽

The Mean ◽

Hba1c Levels

Left ventricular function including regional wall motion (RWM) was evaluated by 99mTc first-pass and equilibrium gated blood pool ventriculography and glycohemoglobin (HbA1c) blood levels determined by a quantitative column technique in 25 young patients with insulin-dependent diabetes mellitus without clinical evidence of heart disease, and in healthy controls matched for age and sex. Phase analysis revealed abnormal RWM in 19 of 21 diabetic patients. The mean left ventricular global ejection fraction, the mean regional ejection fraction and the mean 1/3 filling fraction were lower and the time to peak ejection, the time to peak filling and the time to peak ejection /cardiac cycle were longer in diabetics than in controls. We found high HbA1c levels in all diabetics. There was no significant difference between patients with and without retinopathy and with and without peripheral neuropathy in terms of left ventricular function and HbA1c levels.

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