Anesthesia & Clinical Research
Open Access

Abstract

Perioperative Management of Diabetes Mellitus: A Review

Mariana Raquel Moreira Azevedo and Humberto S Machado

Introduction: Diabetes Mellitus (DM) is frequently observed in surgical patients and relates to an increase in perioperative morbidity and mortality. Disease, anesthesia and surgery result in dysglycemia (hypo and/or hyperglycemia), which is one of the worse prognostic factors. The objective of this study is to review the specific needs of the diabetic surgical patient in the perioperative period, regarding its optimization.

Methods: Scientific studies (n=89) were obtained through PubMed, Google Scholar and Google, between 2008 and 2018.

Results: Actions proposed in order to reduce perioperative complications in the diabetic patient. Preoperative period: an anesthetic evaluation, discontinuation of OADs and fast-acting insulin, prioritization of diabetics in the surgery list, cancellation of non-urgent procedures when there are metabolic abnormalities and poor glycemic control and promotion of gastric emptying due to gastrointestinal autonomic dysfunction. Intraoperative period: the use of IV perfusion of insulin for glycemic control in major surgeries, the use of glycoside sera in cases of prolonged fasting and/or IV insulin perfusion, hourly glycemic monitoring, a glycemic goal between 80-180 mg/dl with correction of hyperglycemias with insulin, and the use of a rapid-sequence intubation when there is risk of aspiration. Postoperative period: the early return to oral nutrition and the restitution of OADs and insulin with the onset of food intake, multimodal analgesia and antiemetic prophylaxis, the correct transition from IV perfusion to subcutaneous insulin and pre-discharge therapeutic optimization.

Discussion: Several studies have shown a correlation between dysglycemia and postoperative morbidity and mortality. Nevertheless, the ideal glycemic range and the best glycemic management strategy remain indeterminate.

Conclusion: Studies that establish specific measures and universal cut-offs are scarce. There is a need for clearer and guidelines to minimize perioperative complications. It is also important that diabetic patients have the capacity to manage their own disease, to facilitate their optimization in the surgical context.