Anaesthetic Management of Patient with Diabetes Mellitus
There is an increasing prevalence of diabetic patients undergoing surgery with the high number of complications associated with comorbidities. And even shorter surgical procedures without prior adequate diabetes compensation can pose a significant risk to them.
This algorithm aims to emphasize the importance of preoperative preparation of the patient with DM, choice of anaesthesia and perioperative monitoring.
Review
The glycemic control was one of the most discussed topics of intensive medicine a few years ago and at major international conferences, the whole sections were focused on it. Unfortunately, nowadays this topic began to be avoided for no reason – the high blood sugar level is still toxic to cells. It causes mitochondrial damage due to increased peroxide production. Still, hyperglycemia has negative impacts on the myocardium and renal functions, has a thrombogenic effect, damages the endothelium, activates systemic inflammation and leads to infection-related complications. So, why don't we pay due attention to it? Because we cannot manage it reliably, efficiently, and safely. Because it is too technically, organizationally demanding and time-consuming. Just because it is doesn't mean hyperglycemia should be accepted. It is not necessary to approach precise glycemic control at all costs. On the other hand, there is convincing evidence that glycemia greater than 8.3 mmol / l (150 mg / dl) is harmful and has a provable negative effect on both morbidity and mortality in diabetic and non-diabetic patients.
It is therefore of great advantage the algorithm gives cause for reflection about perioperative glycemic control. It points out that the goal of preoperative and perioperative control is primarily to stabilize blood glucose levels, avoiding large and rapid fluctuations in both directions. After all, too fast changes in blood glucose level are responsible for increased production of mitochondrial peroxides and cellular damage.
Sources
BARKER, P., P. E. CREASEY, K. DHATARIYA, et al. Peri-operative management of the surgical patient with diabetes 2015. Anaesthesia [online]. 2015, 70(12), 1427-1440 [viewed 2018-04-12]. DOI: 10.1111/anae.13233. ISSN 00032409. Available from: http://doi.wiley.com/10.1111/anae.13233
KELLY, J. L. Continuous Insulin Infusion: When, Where, and How? Diabetes Spectrum [online]. 2014, 27(3), 218-223 [viewed. 2017-12-15]. DOI: 10.2337/diaspect.27.3.218. ISSN 1040-9165. Available from: http://spectrum.diabetesjournals.org/cgi/doi/10.2337/diaspect.27.3.218
KREJČÍ, Hana. Předoperační vyšetření a perioperační péče o diabetické pacienty. Interní medicína pro praxi [online]. Solen, 2005, 2005(12), 543-546 [viewed 2018-04-12]. Available from: https://www.internimedicina.cz/pdfs/int/2005/12/05.pdf
