Authors
Kazanin A. A.
junior researcher, Anesthesiology and Intensive Care Department1
Zagrekov V. I.
Doctor of Medicine, Head, Anesthesiology and Intensive Care Department1
1 - Federal State Institution «Privolzhsky Federal Medical Research Centre», Nizhny Novgorod, Russia
Abstract
Introduction. According to the International Diabetes Federation (Diabetes Federation), the number of patients with diabetes mellitus (DM) is progressively increasing. About 7 million new cases of diabetes are diagnosed every year and annually 3.8 million people die from diabetes related causes. Diabetes is an independent risk factor for cardiovascular diseases and it is also the leading cause of death in patients with type 2 diabetes. Prevention and treatment of late complications of diabetes, including diabetic foot syndrome (DFS), is one of the most important problems of endocrinology. Purpose of the study. Analysis of the main methods of anesthesia in order to choose the one that will have the minimal impact on the cardiovascular, endocrine, respiratory and other body systems. Anesthesiologic support in this complex category of patients should be directed not only to relief of severe pain syndrome during the perioperative period, but also to improvement in trophism of tissues, as the pain supports spasm and microcirculation disorders. The choice of safe anesthetic method for patients in this group will reduce the risk of developing certain complications. Material and methods. Authors performed search and study of information regarding the topic: «Anesthesiologic methods for patients with DFS and critical ischemia of the lower limbs» in the main medical and biological databases. Each method was examined, and the most optimal alternatives were identified. Results. Epidural and conductive anesthesia seem like the most rational alternatives as these two methods not only guarantee a high-quality intraoperative anesthesia, but they also can be used for a long-term pain relief. These types of anesthesia have minimal effect on the cardiovascular system. Also, epidural and conductive anesthesia have an influence on the pathogenetic mechanisms of the disease. Conclusions. All patients with DFS and critical ischemia of the lower extremities of course can be placed under conduction anesthesia. Considering trophic effects, it is preferable to use prolonged blockade of peripheral nerves, by catheterization. Because of the mandatory use of antiaggregant therapy, epidural anesthesia is not recommended for in these patients.
Key words
diabetic foot, conduction anesthesia, epidural anesthesia, spinal anesthesia, critical limb ischemia, transcutaneous oxygen tension, microcirculation
DOI
References
1. Akashev A.V. Klassifikaciya diabeticheskoj stopy «LANOTPAD» [Classification of diabetic foot «LANOTPAD»]. Medicinskij al'manah [Medical Almanac] 2013; (5): 165-168.
2. Anikin A.I. Znachenie ocenki mikrocirkulyatornyh rasstrojstv v hirurgicheskom lechenii gnojno-nekroticheskih porazhenij pri sindrome diabeticheskoj stopy. Avtoref. diss. na soiskanie uchenoj stepeni k.m.n. [The significance of the evaluation of microcirculatory disorders in the surgical treatment of purulent-necrotic lesions in diabetic foot syndrome. Author’s abstract, PhD Thesis] Moscow, 2009.
3. Anisimov O.G. Optimizaciya regionarnoj anestezii v travmatologii i ortopedii. Avtoref. diss. na soiskanie uchenoj stepeni d.m.n. [Optimization of regional anesthesia in traumatology and orthopedics. Author’s abstract, Doctor of Medicine Thesis] St-Petersburg, 2011.
4. Garyaev R.V. Spinal'no-provodnikovaya anesteziya/anal'geziya – novyj podhod k obezbolivaniyu ili nenuzhnaya kombinaciya «staryh» metodov? [Spinal-conductive anesthesia / analgesia – a new approach to analgesia or an unnecessary combination of «old» methods?] Regionarnaya anesteziya i lechenie ostroj boli [Regional anesthesia and treatment of acute pain]. 2011; 5 (4): 20-29.
5. Glushchenko V.A. Vybor i obosnovanie metodov nejroaksial'nyh anestezij pri operaciyah na organah bryushnoj polosti i nizhnih konechnostyah. Avtoref. diss. na soiskanie uchenoj stepeni d.m.n. [The choice and justification of the methods of neuroaxial anesthesia in operations on the abdominal organs and lower limbs. Author’s abstract, Doctor of Medicine Thesis] St-Petersburg. 2009.
6. Dorofeeva G.B., Dorofeev I.V. Vzaimosvyaz' razvitiya metabolicheskih narushenij i insulinorezistentnosti u pacientov s saharnym diabetom [Interrelation of the development of metabolic disorders and insulin resistance in patients with diabetes mellitus] Consilium medicum 2015; (10): 77-80.
7. Ezhevskaya A.A. Optimizaciya mul'timodal'noj anestezii pri operaciyah hirurgicheskoj korrekcii skolioza [Optimization of multimodal anesthesia in surgical correction of scoliosis]. Byulleten' Vostochno-Sibirskogo nauchnogo centra Sibirskogo otdeleniya Rossijskoj akademii medicinskih nauk [Bulletin of the East Siberian Scientific Center of the Siberian Branch of the Russian Academy of Medical Sciences] 2011; (3-1): 28-33.
8. Eremina N.A. Prolongirovannaya ehpidural'naya blokada kak special'nyj komponent kompleksnogo lecheniya bol'nyh s sindromom diabeticheskoj stopy. Avtoref. diss. na soiskanie uchenoj stepeni k.m.n. Voronezh.[Prolonged epidural blockade as a special component of complex treatment of patients with diabetic foot syndrome. Author’s abstract, PhD Thesis] Voronezh, 2003.
9. Zagrekov V.I. Anesteziologicheskoe obespechenie operacij ehndoprotezirovaniya tazobedrennogo sustava. Avtoref. diss. na soiskanie uchenoj stepeni d.m.n. [Anesthesiologic support of operations of hip joint endoprosthetics. Author’s abstract, Doctor of Medicine Thesis]. Moscow, 2011.
10. Kazakov Y.I., Belov I.V., Hatypov M.G. et al. Predoperacionnaya podgotovka bol'nyh s kriticheskoj nizhnej konechnosti ishemiya i vyrazhennym boleznennym sindromom [Preoperative preparation of patients with critical lower limb ischemia and severe pain syndrome]. Angiologiya i sosudistaya hirurgiya [Angiology and Vascular Surgery] 2004; 10(4): 73-78.
11. Kazanin A.A., Zagrekov V.I., Bobrov M.I., Peretyagin P.V. Vliyanie provodnikovoj anestezii na krovotok i transkutannoe napryazhenie kisloroda u bol'nyh s sindromom «diabeticheskaya stopa» [Effect of conductive anesthesia on blood flow and transcutaneous oxygen tension in patients with the syndrome «diabetic foot»] Sovremennye problemy nauki i obrazovaniya [Modern problems of science and education] 2016; (6). Available at: https://science-education.ru/ru/article/view?id=26039
12. Kvitko I.A. Obosnovanie vybora metoda anesteziologicheskogo posobiya pri rekonstruktivnyh operaciyah u bol'nyh ateroskleroticheskimi okklyuziyami arterij bedrenno-podkolennogo segmenta. Avtoref. diss. na soiskanie uchenoj stepeni k.m.n. [Substantiation of the choice of the method of anesthesia in reconstructive operations in patients with atherosclerotic occlusions of arteries of the femoral-popliteal segment. Author’s abstract, PhD Thesis]. Rostov-na-Donu, 2005.
13. Kohan Z.V. Bruhnov A.V. Pecherskij V.G. Marochkov A.V. Cravnitel'naya ocenka sostoyaniya gemodinamiki u pacientov pri blokadah perifericheskih nervov i spinnomozgovoj anestezii vo vremya operacij na nizhnih konechnostyah [Comparative assessment of hemodynamics in patients with peripheral nerve blockages and spinal anesthesia during operations on the lower extremities.]. Regionarnaya anesteziya i lechenie ostroj boli [Regional anesthesia and treatment of acute pain] 2014; 3(8): 21-25.
14. Kohno V.N. Loktin E.M. Zotov V.A. Flyagin T.S. Provodnikovaya anesteziya pri okazanii pomoshchi bol'nym s narusheniyami uglevodnogo obmena [Conductive anesthesia in the care of patients with impaired carbohydrate metabolism]. Mir nauki, kul'tury, obrazovaniya [World of Science, Culture, Education] 2013; (5): 389-401.
15. Kohno V.N. Loktin E.M. Suhareva S.O. Prolongirovannaya blokada sedalishchnogo nerva u gerontologicheskih pacientov v posleoperacionnom periode pri sindrome diabeticheskoj stopy [Prolonged sciatic nerve blockade in gerontological patients in the postoperative period with diabetic foot syndrome]. Vestnik novyh medicinskih tekhnologij [Bulletin of new medical technologies] 2013; (1): 107-109.
16. Krobot R. Sravnenie odnostoronnego spinal'nogo bloka i blokady sedalishchnogo nerva v podkolennoj yamke dlya provedeniya transmetatarzal'noj amputacii stopy u pozhilyh pacientov [Comparison of a one-sided spinal block and sciatic nerve blockade in the popliteal fossa for performing a transmetatarsal foot amputation in elderly patients]. Regionarnaya anesteziya i lechenie ostroj boli [Regional anesthesia and treatment of acute pain] 2012; 4(6): 16-21.
17. Kuchin Y.L. Nejroaksial'naya anesteziya u pacientov, nuzhdayushchihsya v profilaktike tromboticheskih oslozhnenij s ispol'zovaniem antikoagulyantov [Neuroaxial anesthesia in patients in need of preventing thrombotic complications using anticoagulants]. Medicina neotlozhnyh sostoyanij [Emergency medicine] 2009; (3): 22-23.
18. Kuchin Y.L., Tarasenko S.A Regional'naya anesteziya u pacientov s travmoj: problemy antikoagulyantnoj i dezagregantnoj terapii [Regional anesthesia in patients with trauma: problems of anticoagulant and disaggregant therapy]. Travma [Trauma] 2011; 1(12): 103-110.
19. Levina E.L., Chvikalov E.S., Nalivajko V.E. Invazivnaya ul'trasonografiya pri blokade sedalishchnogo nerva u bol'nogo s kriticheskoj ishemiej nizhnih konechnostej [Invasive ultrasonography with sciatic nerve blockade in a patient with critical ischemia of lower extremities]. Regionarnaya anesteziya i lechenie ostroj boli [Regional anesthesia and treatment of acute pain] 2009; 3(4): 45-48.
20. Lyuboshevskij P.A. Zabusov A.V Timoshenko A.L. Korovkin D.V. Ogranichenie metabolicheskih i vospalitel'nyh izmenenij v posleoperacionnom periode: rol' regionarnoj anestezii i anal'gezii [Limitation of metabolic and inflammatory changes in the postoperative period: the role of regional anesthesia and analgesia]. Rossijskij medicinskij zhurnal [Russian Medical Journal] 2013; (5): 15-19.
21. Meier G., Buettner J. Perifericheskaya regionarnaya anesteziya: atlas. Per. s angl. pod red. P.R. Kamchatnova [Peripheral regional anesthesia: atlas. Russian translation edited by P.R. Kamchatnov 2nd edition]. Moscow: BINOM. Laboratoriya znanij, 2015.
22. Maloletkin A.V. Giperbaricheskaya oksigenaciya v komplekse intensivnoj terapii sindroma diabeticheskoj stopy. Avtoref. diss. na soiskanie uchenoj stepeni k.m.n. [Hyperbaric oxygenation in the intensive care complex of the diabetic foot syndrome. Author’s abstract, PhD Thesis]. Novosibirsk, 2010
23. Matveva A.S. Vliyanie kombinirovannoj spinal'no-ehpidural'noj anestezii na pokazateli serdechno-sosudistoj sistemy i gomeostaza pri rekonstruktivnyh operaciyah na aortopodvzdoshnom segmente. Avtoref. diss. na soiskanie uchenoj stepeni k.m.n. [Influence of combined spinal-epidural anesthesia on cardiovascular system and homeostasis in reconstructive operations on the aorto-iliac segment. Author’s abstract, PhD Thesis]. Saratov, 2005.
24. Nedzveckij S.V. Povyshenie ehffektivnosti i bezopasnosti provodnikovoj anestezii v hirurgii nizhnih konechnostej. Avtoref. diss. na soiskanie uchenoj stepeni k.m.n. [Increase of efficiency and safety of conductive anesthesia in surgery of lower extremities. Author’s abstract, PhD Thesis]. Ekaterinburg, 2009.
25. Novikov A. Y., Golub I.E., Majstrovskij K. V. Mul'timodal'naya terapiya hronicheskogo bolevogo sindroma u bol'nyh s kriticheskoj ishemiej nizhnih konechnostej [Multimodal therapy of chronic pain syndrome in patients with critical ischemia of lower extremities]. Sibirskij medicinskij zhurnal [Siberian Medical Journal] 2008; (2): 47-51.
26. Novikov, A. Y. Prodlennaya ehpidural'naya anal'geziya v predoperacionnom periode u bol'nyh s hronicheskoj kriticheskoj ishemiej nizhnih konechnostej. Avtoref. diss. na soiskanie uchenoj stepeni k.m.n. [Extended epidural analgesia in the preoperative period in patients with chronic critical lower limb ischemia. Author’s abstract, PhD Thesis]. Ekaterinburg, 2009.
27. Ovechkin A.M. Hirurgicheskij stress-otvet, ego patofiziologicheskaya znachimost' i sposoby modulyacii [Surgical stress response, its pathophysiological significance and modulation methods]. Regionarnaya anesteziya i lechenie ostroj boli [Regional anesthesia and treatment of acute pain] 2008; (2): 49-62.
28. Ovechkin A.M., Lyuboshevskij P.A., Artamonova N.I. Narusheniya gemostaza kak komponent hirurgicheskogo stress-otveta i vozmozhnost' ih korrekcii [Hemostasis disorders as a component of surgical stress response and the possibility of their correction]. Anesteziologiya i reanimatologiya [Anaesthesiology and Reanimatology] 2012; (3): 44-48.
29. Ovechkin A.M., Osipov S.A., Oslozhneniya spinal'noj anestezii: faktory riska, profilaktika i lechenie [Complications of spinal anesthesia: risk factors, prevention and treatment]. Medicina neotlozhnyh sostoyanij [Emergency medicine] 2008; (4): 17.
30. Orudzheva S.A. Tekhnologiya anesteziologicheskogo obespecheniya v perioperacionnom periode u bol'nyh s gnojno-nekroticheskimi formami sindroma diabeticheskoj stopy Avtoref. diss. na soiskanie uchenoj stepeni d.m.n. [The technology of anesthetic maintenance in the perioperative period in patients with purulent-necrotic forms of the diabetic foot syndrome. Author’s abstract, Doctor of Medicine Thesis]. Moscow, 2006.
31. Orudzheva S.A., Zvyagin A.A, Kurochkina A.I. Central'naya gemodinamika pri provodnikovoj anestezii u bol'nyh s gnojno-nekroticheskimi formami diabeticheskoj stopy [Central hemodynamics with conductive anesthesia in patients with purulent-necrotic forms of the diabetic foot]. Anesteziologiya i reanimatologiya [Anaesthesiology and Reanimatology] 2005; (3): 15-17.
32. Paskhalova Y.S. Strategiya hirurgicheskogo lecheniya nejro-ishemicheskoj formy sindroma diabeticheskoj stopy. Avtoref. diss. na soiskanie uchenoj stepeni k.m.n. [The strategy of surgical treatment of the neuro-ischemic form of the diabetic foot syndrome. Author’s abstract, PhD Thesis]. Moscow, 2011.
33. Pokrovskij A.V. Klinicheskaya angiologiya: Rukovodstvo. Pod red. A. V. Pokrovskogo [Clinical Angiology: A Guide. Edited by A.V. Pokrovsky. Vol.1]. Moscow: JSC «Izdatel'stvo »Medicina«, 2004.
34. Pokrovskij A.V. Nacional'nye rekomendacii po vedeniyu pacientov s zabolevaniyami arterij nizhnih konechnostej [National guidelines for management of patients with lower limb arteries]. Angiologiya i sosudistaya hirurgiya [Angiology and Vascular Surgery] 2013; 19. Supplement.
35. Prusov E. V., Shevkunov N. G., Tyun I. I. Osobennosti provedeniya anesteziologicheskogo posobiya u bol'nyh s sindromom diabeticheskoj stopy [Features of anesthesia in patients with diabetic foot syndrome]. Al'manah klinicheskoj mediciny [Almanac of Clinical Medicine] 2006; (11): 129-132.
36. Rundo A.I. Sovremennye aspekty ehtiologii i patogeneza sindroma diabeticheskoj stopy [Modern aspects of the etiology and pathogenesis of diabetic foot syndrome]. Novosti hirurgii [Surgery news] 2015; (1): 97-104.
37. Sitkin S.I. Regionarnaya anesteziya v sosudistoj hirurgii [Regional anesthesia in vascular surgery]. Regionarnaya anesteziya i lechenie ostroj boli [Regional anesthesia and treatment of acute pain] 2009; (2): 61-69.
38. Federyakin D.V., Kazakov Y.I., Kozlov S.E. et al. Znachenie metoda anestezii pri vypolnenii rekonstruktivnyh operacij na vnutrennih sonnyh arteriyah [The significance of the anesthesia method in performing reconstructive surgeries on the internal carotid arteries]. Verhnevolzhskij medicinskij zhurnal [Upper Volga medical journal] 2011; (9): 9-14.
39. Fedin A.B. Optimizaciya anesteziologicheskogo obespecheniya hirurgicheskih operacij pri diabeticheskoj angiopatii nizhnih konechnostej. Avtoref. diss. na soiskanie uchenoj stepeni k.m.n. [Optimization of anesthetic support for surgical operations for diabetic angiopathy of the lower extremities. Author’s abstract, PhD Thesis] Moscow, 2010.
40. Fedorov M. E., Yashkina L. V. Vedenie bol'nyh v predoperacionnom periode s sindromom diabeticheskoj stopy [Management of diabetic foot syndrome patients in the preoperative period]. Vestnik sovremennoj klinicheskoj mediciny [Herald of modern clinical medicine] 2012; (1): 30-31.
41. Filichkin A. S., Reshetnikov V. A., Fedin A. B., Cygipalo A. I. Sochetannaya blokada bedrennogo i sedalishchnogo nervov pri operaciyah po povodu gnojno-nekroticheskih porazhenij stopy i goleni [Combined blockade of the femoral and sciatic nerves during surgery for purulent necrotic lesions of the foot and lower leg]. Regionarnaya anesteziya i lechenie ostroj boli [Regional anesthesia and treatment of acute pain] 2010; (2): 32-36.
42. Flyagin T.S. Prolongirovannaya blokada sedalishchnogo nerva u pacientov s sindromom diabeticheskoj stopy. Avtoref. diss. na soiskanie uchenoj stepeni k.m.n. [Prolonged sciatic nerve blockade in patients with diabetic foot syndrome. Author’s abstract, PhD Thesis] Novosibirsk, 2015.
43. Flyagin T. S., Kohno V. N., Loktin E. M Vazoaktivnyj ehffekt ropivokaina pri blokade sedalishchnogo nerva u bol'nyh s diabeticheskoj stopoj [The vasoactive effect of ropovocaine in sciatic nerve blockade in patients with diabetic foot]. Medicina i obrazovanie v Sibiri [Medicine and Education in Siberia] 2015; (3). Available at: https://elibrary.ru/item.asp?id=26027230
44. Scheck T, et al. Postoperative pain and subcutaneous oxygen tension. Lancet 1999; 354(9172): 41-2.
45. Amin N., Doupis J. Diabetic foot disease: From the evaluation of the »foot at risk« to the novel diabetic ulcer treatment modalities. World J Diabetes. 2016; 7(7): 153-64.
46. Auroy Y., Narchi P., Messiah A. et al Serious complications related to regional anesthesia: results of a prospective survey in France. Anesthesiology 1997; 87(3): 479-86.
47. Beattie W. Meta-analysis demonstrates statistically significant reduction in postoperative myocardial infarction with the use of thoracic epidural analgesia. Anesth. Analg. 2003; 97(3): 919–920.
48. Beattie W.S., Badner N.H., Choi P. Epidural analgesia reduces postoperative myocardial infarction: a meta-analysis. Anesthesia & Analgesia 2001; 93(4): 853-858.
49. Berendes E. Reversible cardiac sympathectomy by high thoracic epidural anesthesia improves regional left ventricular function in patients undergoing coronary artery bypass grafting. A randomized trial. Arch. Surg. 2003; 138(12): 1283-1290.
50. Beverly C. Smith Relief of pain by peripheral nerve block in arterial diseases of the lower extremities. New York Surgical society. 1936. P.934-944.
51. Block B.M., Liu S.S., Rowlingson A.J., et al. Efficacy of postoperative epidural analgesia: a meta-analysis. JAMA 2003; 290(18): 2455-63.
52. Borghi B., D'Addabbo M., Borghi R. Can neural blocks prevent phantom limb pain Pain Manag 2014; 4: 261-6.
53. Chelly J.E., Clark K.L., Consensus of the Orthopedic Anesthesia, Pain, and Rehabilitation Society on the use of peripheral nerve blocks in patients receiving thromboprophylaxis. Clin Anesth 2014; 1: 69-74.
54. Cuvillon P., Reubrecht V., Zoric L., et al Comparison of subgluteal sciatic nerve block duration in type 2 diabetic and non-diabetic patients. Br J Anaesth. 2013; 110(5): 823-30.
55. Dahlgren N., Tornebrandt K. Neurological complications after anaesthesia. A follow-up of 18.000 spinal and epidural anaesthetics performed over three years. Acta Anaesth. Scand. 1995; 39: 872-880.
56. Di Minno M.N., Milone M., Russolillo A., et al. Ropivacaine infusion in diabetics subject with peripheral arterial disease. A prospective study. Diabetes 2013; 121(2): 91-93.
57. Ghanami R.J., Hurie J., Andrews J.S. et al. Anesthesia-based evaluation of outcomes of lower-extremity vascular bypass procedures. Ann Vasc Surg. 2013; 27(2): 199-207.
58. Glenn E., Mehl J., Rosinia F.A., and Henry Liu Safe removal of an epidural catheter 72 hours after clopidogrel and aspirin administrations guided by platelet function analysis and thromboelastography. Anaesthesiol Clin Pharmacol. 2013: 29(1): 99-101.
59. Gomon M.L. Optimization of the sciatic nerve blockade as a methods of anesthesia/analgesia. Klin Khir. 2014; 10: 60-2.
60. Greisen J., Nielsen D.V., Sloth E., Jakobsen C.J. High thoracic epidural analgesia decreases stress hyperglycemia and insulin need in cardiac surgery patients. Acta Anaesthesiol Scand. 2013; 57(2): 171-7.
61. Gritsenko K., Marcello D., Liguori G.A., et al Meningitis or epidural abscesses after neuraxial block for removal of infected hip or knee prostheses. Br J Anaesth. 2012; 108(3): 485-90.
62. Hashimoto A., Ito H., Sato Y., Fujiwara Y. Automated intermittent bolus infusion for continuous sciatic nerve block: a case report. Masui 2011; 60(7): 873-5.
63. Hirsh J., Chair P., Guyatt G. Antithrombotic ànd Thrombolytic Therapy, 7th Ed.: ACCP Guidelines. Chest. 2004; 126: 172-173.
64. Horlocker T.T. Regional anaesthesia in the patient receiving antithrombotic and antiplatelet therapy. Br J Anaesth. 2011; 107: 96-106.
65. Horlocker T.T., Wedel D.J., Offord K.P. Does preoperative antiplatelet therapy increase the risk of hemorrhagic complications associated with regional anesthesia? Anesth Analg. 1990; 70(6): 631-4.
66. Jin J.W., Wang G., Gong M.W. et al. Retrospective comparison of the effects of epidural anesthesia versus peripheral nerve block on postoperative outcomes in elderly Chinese patients with femoral neck fractures. Clin Aging. 2015; 10: 1223-31.
67. Jordan J., Tank J. Complexity of impaired parasympathetic heart rate regulation in diabetes. Diabetes 2014; 63: 1847-9.
68. Keyl C., Held T., Albiez G., Increased electrical nerve stimulation threshold of the sciatic nerve in patients with diabetic foot gangrene: a prospective parallel cohort study. Eur J Anaesthesiol. 2013; 30(7): 435-40.
69. Kinlay S. Management of Critical Limb Ischemia Circ Cardiovasc Interv. 2016; 9(2). URL: http://circinterventions.ahajournals.org/content/9/2/e001946
70. Kotzé A., Hinton W., Crabbe D.C. et al Audit of epidural analgesia in children undergoing thoracotomy for decortication of empyema. Br J Anaesth. 2007; 98(5): 662-6.
71. Lecoq P.H, Brichant F., M. L. Lamy and J. L. Joris Norepinephrine and ephedrine do not counteract the increase in cutaneous microcirculation induced by spinal anaesthesia Br J Anaesth 2010; 105(2): 214-19.
72. Lee S.H., Dong Hoon Lee, Dong Hoon Ha et al. Dynamics of heart rate variability in patients with type 2 diabetes mellitus during spinal anaesthesia: prospective observational study. BMC Anesthesiol. 2015;15: 141.
73. Lee Y.N., Kim H.S., Kang J.A., Han S.K. Can macrocirculation changes predict nonhealing diabetic foot ulcers? J Wound Ostomy Continence Nurs. 2014; 41(5): 430-5.
74. Li J., Halaszynski T. Neuraxial and peripheral nerve blocks in patients taking anticoagulant or thromboprophylactic drugs: challenges and solutions. Local Reg Anesth. 2015; 8: 21-32.
75. Li Y., Zhu S., Yan M. Combined general/epidural anesthesia (ropivacaine 0.375%) versus general anesthesia for upper abdominal surgery. Anesth Analg. 2008; 106(5): 1562.
76. Lirk P., Rutten M.V., Haller I., et al Management of the patient with diabetic peripheral neuropathy presenting for peripheral regional anesthesia: a European survey and review of literature. Minerva Anestesiol. 2013; 79(9): 1039-48.
77. Liu J., Ma C., Elkassabany N., Fleisher L.A., et al Neuraxial anesthesia decreases postoperative systemic infection risk compared with general anesthesia in knee arthroplasty. Anesth Analg. 2013; 117(4): 1010-6.
78. Marcus A.J., Lotzof K., Kamath B.S., et al A new approach: regional nerve blockade for angioplasty of the lower limb. Cardiovasc Intervent Radiol. 2006; 29(2): 235-40.
79. Mauermann W.J., Shilling A.M., Zuo Z. A comparison of neuraxial block versus general anesthesia for elective total hip replacement: a meta-analysis. Anesthesia & Analgesia 2006; 103(4): 1018-25.
80. Monahan A.M., Madison S.J., Loland V.J., Continuous Popliteal Sciatic Blocks: Does Varying Perineural Catheter Location Relative to the Sciatic Bifurcation Influence Block Effects? A Dual-Center, Randomized, Subject-Masked, Controlled Clinical Trial. Anesth. Analg. 2016; 122(5). 1689-95.
81. Monk T.G. Saiani V. Weldon B.C., et al Ansthetic management and one-year mortality after noncardiac surgery. Anesth Analg. 2005; 100: 4-10.
82. Osaka Y, Shimada N, Saito R, et al. Clinical Comparison of Continuous Sciatic Nerve Block and Epidural Anesthesia for Postoperative Pain Control in Patients with Fracture of the Foot. Masui 2015; 64(4): 388-91.
83. Pardo M., Alcaraz M., Bernal F.L., et al Transcutaneous oxygen tension measurements following peripheral transluminal angioplasty procedure has more specificity and sensitivity than ankle brachial index. Br J Radiol. 2015; 88(1046) URL http://onlinelibrary.wiley.com/doi/10.1111/j.1464-5491.2005.01446.x/full
84. Patel N., Solovyova O., Matthews G., et al. Safety and efficacy of continuous femoral nerve catheter with single shot sciatic nerve block vs epidural catheter anesthesia for same-day bilateral total knee arthroplasty. Arthroplasty 2015; 30(2): 330-4.
85. Popping D.M., Elia N., Marret E., et al. Protective effects of epidural analgesia on pulmonary complications after abdominal and thoracic surgery. A meta-analysis. Archives of Surgery. 2008; 143(10): 990-99.
86. Preis S.R., Pencina M.J., Hwang S.J, et al Trends in cardiovascular disease risk factors in individuals with and without diabetes mellitus in the Framingham Heart Study. Circulation. 2009; 120(3): 212-20.
87. Rasouli M.R., Cavanaugh P.K., Restrepo C. et al. Is neuraxial anesthesia safe in patients undergoing surgery for treatment of periprosthetic joint infection? Clin Orthop Relat Res. 2015: 473(4): 1472-7.
88. Shapoval S.D., Savon I.L., Sofilkanych M.M. Prolonged blockade of nervus ischiadicus in a system of complex treatment of patients, suffering complicated diabetic foot syndrome. Klin Khir 2015; 3: 52-4.
89. Thomas P.S., Hakim T.S., Trang L.Q., The synergistic effect of sympathectomy and hyperbaric oxygen exposure on transcutaneous PO2 in healthy volunteers. Anesth Analg. 1999; 88(1): 67-71.
90. Treschan, Tanja A. MD; Taguchi, et al. The Effects of Epidural and General Anesthesia on Tissue Oxygenation. Anesthesia & Analgesia 2003; 96 (6): 1553-1557.
91. Tryba M. Epidural regional anesthesia and low molecular heparine // Anasthesiol Intensivmed Notfallmed Schmerzther. 1993; 28: 179-81.
92. Van den Brom C.E., Bulte C.S., Loer S.A., et al Diabetes, perioperative ischaemia and volatile anaesthetics: consequences of derangements in myocardial substrate metabolism. Cardiovasc Diabetol. 2013; 12: 42.
93. Williams B.A., Murinson B.B., Grable B.R., Orebaugh S.L. Future considerations for pharmacologic adjuvants in single-injection peripheral nerve blocks for patients with diabetes mellitus. Reg Anesth Pain Med. 2009: 34(5): 445-57.
94. Zheng J., Hasting M.K., Zhang X., et al. A pilot study of regional perfusion and oxygenation in calf muscles of individuals with diabetes with a noninvasive measure. Surg. 2014; 59(2): 419-26.
