Diabetes and Adult Surgical Inpatients
Highlights
- Assessment of the airway is particularly important in type 1 diabetic patients as they can develop the stiff joint syndrome with limited mobility of the upper cervical spine resulting in difficult tracheal intubation. Since these patients may also have an autonomic neuropathy with gastroparesis, they are at a particular risk of regurgitation and aspiration. (View Highlight)
- Anaesthetic drugs may influence the glucose response to surgery in diabetic patients by decreasing catabolic hormone secretion (RA and opioids) or inhibiting any residual insulin secretion (volatile anaesthetics). (View Highlight)
- The aims of metabolic management are to avoid hypoglycaemia, excessive hyperglycaemia, and to minimize lipolysis and proteolysis by the provision of exogenous glucose and insulin as necessary. (View Highlight)
- Diabetic patients using the ‘basal-bolus’ regimen may not need a GIK regimen if the overall period of starvation, preoperative and postoperative, is short. The ‘basal’ insulin will provide a continuous release of insulin which is unlikely to result in hypoglycaemia if the perioperative fast is similar in duration to the patient's usual overnight fast. ‘Bolus’ insulin is given when eating restarts. This strategy has been successful in ambulatory surgery. (View Highlight)
- In diabetic patients with normal serum creatinine values, an estimated glomerular filtration rate of >50 ml min−1 or both, metformin may be resumed immediately (View Highlight)
- Red cell concentrates are stored in saline–adenine–glucose–mannitol at a glucose concentration of 0.9% (50 mmol litre−1). The infusion of several packs of red cells is an important additional glucose load. (View Highlight)
- Good postoperative analgesia, particularly RA, decreases catabolic hormone secretion which aids glucose control. (View Highlight)