Diabetes mellitus and anesthesia

Abstract

The perioperative morbidity of diabetic patient is related to preoperative end-organ damage. In particular, the cardiovascular and renal systems demand careful evaluation. Diabetic patients with hypertension should be evaluated thoroughly for autonomic neuropathy. Hypertensive patients have a significantly greater incidence of autonomic neuropathy than do diabetic patients who are normotensive. These patients often will not experience pain with myocardial ischemia. Pulmonary aspiration secondary to delayed gastric emptying is another risk for these patients. Orthostasis (heart rate increase <15 beats/minute or systolic blood pressure decrease >30 mmHg 3 minutes after changing position from supine to upright) is a common sign of autonomic neuropathy and hallmarks potential hemodynamic instability in the setting of acute volume loss secondary to inadequate sympathetic response. The primary goal of intraoperative blood sugar management is to maintain euglycemia, while avoiding hypoglycemia. The key to any metabolic management regime for diabetic patient is to monitor blood glucose levels frequently.