Perioperative Management of Diabetes: A Review.
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Date
2014-07
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Abstract
Diabetes increases the requirements of surgery as well as perioperative morbidity and
mortality. Careful preoperative evaluation and treatment of cardiac and renal diseases,
intensive intraoperative and postoperative management are essential to optimize the
best outcome. Stress hyperglycemia in response to surgery, osmotic diuresis and
hypoinsulinemia can lead to life threatening complications like ketoacidosis or
hyperglycemic hyperosmolar syndrome. Wound healing is impaired by hyperglycemia and
chance of postoperative wound infection is more in diabetics. Therefore aseptic
precautions must be taken. Adequate insulin, glucose, fluid and electrolytes should be
provided for good metabolic control. Though some current study reveals that oral
hypoglycemic agents can be used for the effective management of perioperative diabetes;
the adverse effects of newly introduced agents need more clinical observations.
Subcutaneous administration of insulin as in Sliding Scale may be a less preferable
method, because of unreliable absorption and unpredictable blood glucose. Intravenous
administration of rapid onset soluble (short acting) insulin as in Alberti (GIK) regimen, is
safe and effective method controlling perioperative hyperglycemia. Patient with type 1
diabetes needs frequent monitoring of glucose, electrolytes and acid-base balance as
chance of high hyperglycemia and ketoacidosis is more. In case of emergency surgery
assessment for diabetic ketoacidosis (DKA) and meticulous management is essential.
Postoperative pain and hyperglycemia should be treated carefully to avoid complications.
Description
Keywords
Perioperative management, diabetes, complication, anesthesia
Citation
Kayes Md Nazmul, Prodhan NMN Kabir, Malik Refat Hossain. Perioperative Management of Diabetes: A Review. Delta Medical College Journal. 2014 July; 2(2): 71-76.