ISSN 2398-2942      

Anesthesia: in diabetic patient

icanis

Introduction

  • Potential peri-operative problems facing the diabetic patient are:
    • Induction of the stress-response (increased levels of catabolic hormones such as glucagon, growth hormone, cortisol, catecholamines). Healthy patients undergoing major surgery develop a 5-10x increase in cortisol production. Cortisol induces gluconeogenesis and glycogenolysis, antagonizes peripheral insulin and/or decreases the number of insulin receptors and may result in elevated glucose concentrations.
    • Necessary period of starvation.
    • General anesthesia potentially masking signs of hypoglycemia Hypoglycemia.
    • Circulatory disturbances.
    • Pain and stress resulting in inappetence.
    • Renal and glomerular dysfunction are not uncommon.
  • Together, these factors will very likely result in disturbances in glucose control and hydration status, even in those patients normally well controlled at home. Maintaining a perfect glucose balance is virtually impossible in these patients. Much more essential is avoiding extreme glucose values: hypoglycemia and severe hyperglycemia which may even result in ketoacidosis Diabetic ketoacidosis.
  • Elective procedures in unstable diabetic patients should be postponed until glucose homeostasis is well controlled.

Pre-anesthetic work up

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Anesthetic protocol

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Anesthetic management

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Further Reading

Publications

Refereed papers

  • Recent references from PubMed and VetMedResource.
  • Clark L, Leece E A, Brearley J C (2012) Diabetes mellitus affects the duration of action of vecuronium in dogs. Vet Anaesth Analg 39 (5), 472-479 PubMed.
  • Stojanovic V & Ihle S (2011) Role of beta-hydroxybutyric acid in diabetic ketoacidosis: a review. Can Vet J 52 (4), 426-430 PubMed.
  • Oliver J A, Clark L, Corletto F et al (2010) A comparison of anesthetic complications between diabetic and nondiabetic dogs undergoing phacoemulsification cataract surgery: a retrospective study. Vet Ophthalmol 13 (4), 244-250 PubMed.
  • Zeugswetter F & Pagitz M (2009) Ketone measurements using dipstick methodology in cats with diabetes mellitus. JSAP 50 (1), 4-8 PubMed.
  • Kronen P, Moon-Massat P F, Ludders J W et al (2001) Comparison of two insulin protocols for diabetic dogs undergoing cataract surgery. Vet Anaesth Analg 28 (3), 146-155 PubMed.

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