Surgery for diabetics requires careful pre-operatory planning and a good understanding of the complexity of issues surrounding the disease. For example, diabetes anaesthesia dosages must be carefully selected in accordance to the diabetic complications being faced. One of the hardest factors to contend with, however, is that the American Diabetes Association (ADA) estimates that 12-25% of hospitalized adult patients have diabetes mellitus. The prevalence of these patients undergoing surgery is increasingly high.
When considering diabetes and anaesthesia, a careful assessment about the patient should be made. According to Patient.co.uk, a patient’s diabetic history and the history of their diabetic control should be carefully considered. Also, tests for unknown complications of diabetes should be administered. Finally, safe methods for diabetes anaesthesia and surgery should be established.
Considerations for Diabetes Anaesthesia
Local anaesthesia normally is not a problem for diabetics. It reduces the stress of the response to the treatment, and when a patient is awake, hypoglycemia is detectable. General diabetic anaesthesia can sometimes be a problem and therefore careful consideration should be given to the presence of cardiovascular and renal disease as well as the prevention of intra-operative hypoglycemia. The prevalence of autonomic neuropathy should also be considered, as it can mask instances of hypoglycemia and may exacerbate respiratory depression. It is normally recommended that a patient be admitted to the hospital 2-3 days prior to surgery.
For type-1 patients, proper glucose control should be ensured beforehand. This is normally done by administering certain amounts of insulin and monitoring blood sugar levels throughout the day. Prior to surgery, the patient is no longer given insulin and is not allowed to eat from midnight on.
The operation is usually performed as early as possible in the morning, and glucose and electrolyte levels are checked early on in the day. Insulin should be administered and checked at 1-to 2-hourly intervals. Glucose levels should also be checked every 30 minutes throughout the surgery.
After the surgery, glucose levels will be checked every 2 hours and electrolyte levels will be checked every 6-12 hours. Infusions will be adjusted as necessary, and reduced after the patient begins eating properly again.
Surgery on type-2 diabetics is not usually as complicated, provided the control of the diet is adequate. The administration of drugs and their hypoglycemic effects should be carefully considered. Short-acting drugs are best. If the patient takes metformin, it should be discontinued 48 hours prior to surgery, and in some cases insulin may be administered.
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