{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,27]],"date-time":"2026-08-27T15:21:39Z","timestamp":1787844099724,"version":"build-2784847793"},"reference-count":18,"publisher":"Ovid Technologies (Wolters Kluwer Health)","license":[{"start":{"date-parts":[[2026,5,19]],"date-time":"2026-05-19T00:00:00Z","timestamp":1779148800000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0"}],"content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background and Aims:<\/jats:title>\n                    <jats:p>Hypotension is a common adverse effect of spinal anesthesia and poses increased risks for patients with diabetes mellitus. While various tests exist for diagnosing diabetic autonomic neuropathy, dynamic pupillometry is a simple and cost-effective option. This study aimed to assess whether dynamic pupillometry can predict post-spinal hypotension in diabetic patients.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Material and Methods:<\/jats:title>\n                    <jats:p>In this observational study, 75 patients with diabetes mellitus who were scheduled for surgery under spinal anesthesia underwent a pupillary examination the day prior. Both static and dynamic parameters were recorded. On the day of surgery, 3 ml of 0.5% hyperbaric bupivacaine was administered for spinal anesthesia, and instances of intraoperative hypotension and the use of vasopressors were noted.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>\n                      Post-spinal hypotension occurred in 77% of the 75 patients studied, with 27 experiencing mild hypotension (20\u201330% drop in MAP) and 31 having severe hypotension (&gt;30% drop). The severe hypotension group had a significantly lower baseline pupil radius (3.86 \u00b1 0.52 mm) compared to the no hypotension group (4.37 \u00b1 0.57 mm,\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      = 0.006). The area under the receiver operating characteristic curve for baseline pupil radius was 0.720, with a threshold of less than 4.01 mm showing 70.7% sensitivity and 70.6% specificity for predicting post-spinal hypotension.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions:<\/jats:title>\n                    <jats:p>Baseline pupil radius measured using pupillometry may serve as a simple noninvasive marker to identify diabetic patients at risk of post-spinal hypotension.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.4103\/joacp.joacp_672_25","type":"journal-article","created":{"date-parts":[[2026,5,19]],"date-time":"2026-05-19T09:00:10Z","timestamp":1779181210000},"update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":0,"title":["Dynamic pupillometry to predict hypotension after spinal anesthesia in patients with diabetes mellitus \u2013 A prospective observational study"],"prefix":"10.4103","author":[{"given":"Dristi","family":"Sharma","sequence":"first","affiliation":[{"name":"Department of Anaesthesiology and Critical Care, Jawaharlal Institute of Postgraduate Medical Education and Research, Pondicherry, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stalin","family":"Vinayagam","sequence":"additional","affiliation":[{"name":"Department of Anaesthesiology and Critical Care, Jawaharlal Institute of Postgraduate Medical Education and Research, Pondicherry, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"K Ramesh","family":"Babu","sequence":"additional","affiliation":[{"name":"Department of Ophthalmology, Jawaharlal Institute of Postgraduate Medical Education and Research, Pondicherry, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yaal","family":"Elango","sequence":"additional","affiliation":[{"name":"Department of Anaesthesiology and Critical Care, Jawaharlal Institute of Postgraduate Medical Education and Research, Pondicherry, India"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2026,5,19]]},"reference":[{"key":"R1-20260713","doi-asserted-by":"crossref","first-page":"107843","DOI":"10.1016\/j.diabres.2019.107843","article-title":"Global and regional diabetes prevalence estimates for 2019 and projections for 2030 and 2045:Results from the International Diabetes Federation Diabetes Atlas, 9th edition","volume":"157","author":"Saeedi","year":"2019","journal-title":"Diabetes Res Clin Pract"},{"issue":"(S1)","key":"R2-20260713","doi-asserted-by":"crossref","first-page":"127","DOI":"10.1111\/anae.15258","article-title":"Regional anaesthesia in patients with diabetes","volume":"76","author":"Levy","year":"2021","journal-title":"Anaesthesia"},{"key":"R3-20260713","doi-asserted-by":"crossref","first-page":"336","DOI":"10.1111\/anae.12904","article-title":"The impact of 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dysfunction in type 2 diabetes mellitus to refine the early diagnosis of diabetic autonomic neuropathy","volume":"30","author":"Yang","year":"2006","journal-title":"Neuro-Ophthalmology"},{"key":"R7-20260713","doi-asserted-by":"crossref","first-page":"26","DOI":"10.1186\/1475-925X-9-26","article-title":"Using dynamic pupillometry as a simple screening tool to detect autonomic neuropathy in patients with diabetes:A pilot study","volume":"9","author":"Ferrari","year":"2010","journal-title":"Biomed Eng Online"},{"key":"R8-20260713","doi-asserted-by":"crossref","first-page":"205","DOI":"10.3389\/fendo.2014.00205","article-title":"Autonomic neuropathy in diabetes mellitus","volume":"5","author":"Verrotti","year":"2014","journal-title":"Front Endocrinol (Lausanne)"},{"key":"R9-20260713","doi-asserted-by":"crossref","first-page":"1470","DOI":"10.1111\/dme.12752","article-title":"Type 2 diabetes and cardiac autonomic neuropathy screening using dynamic pupillometry","volume":"32","author":"Lerner","year":"2015","journal-title":"Diabet Med"},{"key":"R10-20260713","doi-asserted-by":"crossref","first-page":"639","DOI":"10.1002\/dmrr.1239","article-title":"Cardiovascular autonomic neuropathy in diabetes:Clinical impact, assessment, diagnosis, and management","volume":"27","author":"Spallone","year":"2011","journal-title":"Diabetes Metab Res Rev"},{"key":"R11-20260713","doi-asserted-by":"crossref","first-page":"75","DOI":"10.1016\/j.jns.2004.04.008","article-title":"Pupillography refines the diagnosis of diabetic autonomic neuropathy","volume":"222","author":"D\u00fctsch","year":"2004","journal-title":"J Neurol Sci"},{"key":"R12-20260713","doi-asserted-by":"crossref","first-page":"659","DOI":"10.1111\/cxo.12659","article-title":"Static and dynamic pupillometry data of healthy individuals","volume":"101","author":"Tekin","year":"2018","journal-title":"Clin Exp Optom"},{"key":"R13-20260713","first-page":"e250406","article-title":"Autonomic neuropathy in diabetes","volume":"70","author":"Tannus","year":"2025","journal-title":"Arch Endocrinol Metab"},{"key":"R15-20260713","doi-asserted-by":"crossref","first-page":"655","DOI":"10.1213\/ane.0b013e31818ec9e5","article-title":"The effect of Trendelenburg Position, Lactated Ringer's solution and 6% hydroxyethyl starch solution on cardiac output after spinal anesthesia","volume":"108","author":"Zorko","year":"2009","journal-title":"Anesth Analg"},{"key":"R16-20260713","doi-asserted-by":"crossref","first-page":"155","DOI":"10.4103\/0259-1162.118943","article-title":"Co-loading or pre-loading for prevention of hypotension after spinal anaesthesia!A therapeutic dilemma","volume":"7","author":"Bajwa","year":"2013","journal-title":"Anesth Essays Res"},{"key":"R17-20260713","doi-asserted-by":"crossref","first-page":"e128","DOI":"10.1213\/ANE.0000000000004160","article-title":"Routine fluid coloading during spinal anesthesia should be abandoned","volume":"128","author":"Muggleton","year":"2019","journal-title":"Anesth Analg"},{"key":"R18-20260713","doi-asserted-by":"crossref","first-page":"1611","DOI":"10.4103\/IJO.IJO_953_23","article-title":"Measurement of dynamic pupillometry parameters in adult Indian population","volume":"72","author":"Rattan","year":"2024","journal-title":"Indian J Ophthalmol"},{"key":"R19-20260713","doi-asserted-by":"crossref","first-page":"566","DOI":"10.1007\/s12630-020-01905-z","article-title":"Pupillometry in perioperative medicine:A narrative review","volume":"68","author":"Packiasabapathy","year":"2021","journal-title":"Can J Anaesth"}],"container-title":["Journal of Anaesthesiology Clinical 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