DIABETES MELLITUS IN ANAESTHESIA

SHARANIA MANIVANNAN
11 2014 182

ABSTRACT

Anaesthesiologists frequently encounter patients

with diseases of the endocrine system, in particular
diabetes mellitus. The major risk factors for people
with diabetes undergoing surgery are the associated
end-organ

diseases:

cardiovascular

autonomic

neuropathy, joint collagen tissue, and immune

deficiency.

INTRODUCTION

Patients

increased

with
risk

diabetes
of

have

premature

significantly

mortality

and

an

increased risk of microvascular and cardiovascular

complications and are often sicker than most nondiabetic

patients

and

therefore

place

proportionally larger burden on anaesthetic services.

INTRODUCTION
Cardiovascular
dysfunction

Neuropathies

Major
risk
factor

Joint stiffness

Renal
insufficiency

ANAESTHETIC AGENTS AND DIABETES

MELLITUS
Affect glucose homeostasis peri-operatively by decreasing
catabolic hormone secretion
Use of succinylcholine should be avoided if patients have elevated baseline
serum potassium concentrations

Infusions of midazolam shown to decrease ACTH and cortisol

secretion
Benzodiazepines reduce SS but increase growth hormone secretion,
resulting in decrease in the hyperglycaemic response to surgery.

Morphine needs to be reduced to 75% of the standard dose in patients

with a GFR of 1050 ml/min, and 50% in patients with a GFR < 10 ml/min

ANAESTHETIC AGENTS AND

DIABETES MELLITUS
Fentanyl is primarily metabolised in the liver by
CYP3A4, making it an attractive choice for
patients with renal dysfunction.

Premedication with clonidine in DM 2 90 minutes

before surgery improved blood glucose control
hence decreasing insulin requirement.

Halothane and sevoflurane, produce greater

negative inotropic effects in diabetic patients than
in non-diabetic patients.

ANAESTHETIC TECHNIQUES

Spinal, epidural or other regional blockade

modulate the secretion of catabolic hormones and
insulin secretion.

No evidence suggests that one anaesthetic

technique

or

another

affects

morbidity in diabetic patients.

mortality

or

SPINAL ANAESTHESIA

REGIONAL ANAESTHESIA

Advantages

Disadvantages

Allow patient to remain

conscious and decrease
surgical stress response

Cardiovascular instability

Decreases blood loss and

leads to a decreased risk of
thromboembolism.

Exacerbation of peripheral
neuropathy since diabetic
patients more susceptible to
anaesthetic toxidity

BLOCK OF THE
DEEP PERONEAL
NERVE
Along the imaginary
line - between the
medial and lateral
malleolus, feel for
tendons of the anterior
tibialis and extensor
hallucis longus muscle.
The muscle tendon can
be easily palpated if
the patient is asks to
dorsiflex his/her foot.
Insert the needle
between the two
tendons with the point
of the needle towards
the tibia. A loss of
resistance should be
detected as the needle
pierces the flexor
retinaculum, inject 5
ml of 0.5-1% lidoocaine
with adrenaline

PERIOPERATIVE MANAGEMENT

It

is

generally

recommended

to

aim

for

normoglycaemia in hospitalised patients.

The main concern of the anaesthesiologist in the

peri-operative management of diabetic patients
has always been the avoidance of harmful
hypoglycaemia;

made more difficult by the

reduced level of consciousness masking its signs

and symptoms.

PERIOPERATIVE MANAGEMENT

Glucose levels > 200 mg/dL are considered

detrimental and require treatment.

It is important to exclude diabetic ketoacidosis

and non-ketotic hyperglycaemic hyperosmolar
states in patients presenting with very high
glucose levels; surgery in the presence of such
conditions carries a high mortality.

SUMMARY

Endocrine disorders should be identified and

evaluated before surgery. Diabetes affects
multiple

organ

operative

systems,

effects

of

and

diabetes

the

peri-

can

be

profound. Peri-operative management should

be based on the type of diabetes, end organ
dysfunction

and

the

desired

degree

of

glucose control in the peri-operative periods.