الفهرس 
Acknowledgement Allah,
Classification of Diabetes MellitusOnly 14 pages are availabe for public view
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Abstract
In diabetic patients, neuropathy, microvascular and macrovascular complications are known clinical findings which require attention during anesthesia. Many studies show different changes in the neurophysiological parameters in diabetic patients. In diabetic nerve, conduction velocity of the action potential is decreased, the amplitude of action potentials, both sensory and motor, is smaller, and the latency time is elongated. Therefore, the effects of a neuromuscular blocking agent should be important because of potential complications from incomplete reversal or residual paralysis during anesthesia maintenance. Delayed recovery from the neuromuscular block after vecuronium administration was shown in patients with DM. Currently, rocuronium, with its rapid onset of action, rapid recovery profile and inactive metabolites, is generally known as a safe agent for anesthesia under normal conditions. It is known that the pharmacokinetic properties of rocuronium can be altered in some diseases, such as renal or hepatic failure. However, it has not been investigated whether the effect of rocuronium on neuromuscular function is changed in the presence of neuropathy in DM patients or not. All the clinical studies published until this moment comparing diabetic versus non diabetic ignoring neuropathy which is a very important factor that may affect rocuronium induced neuromuscular block.
Between 2014 and 2017 we conducted this double blind randomized controlled trial at Assiut University Hospital on Sixty adult patients aged from 18 years to 65 years who were scheduled for abdominal surgery under general anesthesia, those patients classified equally into three groups (1)control group (2)T2DM without neuropathy (3)T2DMN with neuropathy. Those patients received rocuronium at 0.6mg/kg intubating dose, and monitoring of neuromuscular block done by TOF Watch SX neurostimulator (acceleromyographic device) till end of surgery. The Pharmacodynamic variables (onset time, clinical time, and recovery time) recorded, also Arterial blood samples (4ml) obtained from the contra lateral arm before administration of rocuronium, 1, 2, 4, 6, 8, 10, 15, 20, 30, 45, 60, 75, 90, and 120 min after administration of rocuronium collected for pharmacokinetic analysis.
Our results showed an increase in the clinical time (duration of action) of rocuronium induced neuromuscular block in diabetic patients with neuropathy under sevoflurane based anesthesia, compared to non diabetic and diabetic patients without neuropathy while Pharmacokinetic analysis of rocuronium showed no significant differences among the three groups.
Conclusion:
Diabetic patients with neuropathy in the absence of other organ affection showed increased clinical time (duration of action) of rocuronium induced neuromuscular block. This difference in the pharmacodynamic properties of rocuronium in diabetic patients with neuropathy is probably due to changes in neuromuscular junction rather than to alterations in the pharmacokinetic properties of the drug.