Felis ISSN 2398-2950

Anesthesia: in diabetic patient

Contributor(s): Jackie Brearley, Marieke de Vries

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   General anesthesia: overview   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 fromVetMed Resource and PubMed.
  • Clark L, Leece E A, Brearley J C (2012)Diabetes mellitus affects the duration of action of vecuronium in dogs. Vet Anaesth Analg39(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 C, 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 Ophthalmol13(4), 244-250 PubMed.
  • Zeugswetter F & Pagitz M (2009)Ketone measurements using dipstick methodology in cats with diabetes mellitus.  JSAP50(1), 4-8 PubMed.
  • Kronen P W M, Moon-Massat P F, Ludders J W et al(2001)Comparison of two insulin protocols for diabetic dogs undergoing cataract surgery. Vet Anaesth Analg28(3), 146-155.


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