Diabetes in the operating room: Metabolic challenges for the anesthesiologist

Abstract

IABETES MELLITUS is the most commonly occurring metabolic disorder in humans today. The term encompasses a heterogeneous group of diseases that have common characteristics of chronic hyperglycemia and other disturbances of carbohydrate and lipid metabolism. All are associated with medical complications such as microvascular complications of the eye and kidney, peripheral vascular disease, and coronary artery disease. The majority of diabetics are in age categories where the incidence of surgery is high, and many disorders associated with diabetes, such as cholelithiasis, cataracts, vascular disease, and infections require surgical care. It is estimated that more than 50% of diabetics will have one or more surgeries in their lifetime. 1,2 Classically, the attention of the anesthesiologist in managing the care of diabetic patients has centered around prevention of acute complications of abnormal blood glucose levels and ketosis during the surgery itself, but intraoperative glucose level management may influence perioperative events as diverse as wound healing, infection response, and neurological function. To understand perioperative problems of patients with diabetes, it is useful to consider differences between two major diabetic groups: type I diabetics, also called juvenile-onset diabetics or insulin-dependent diabetics, and type II diabetics, also known as maturity-onset or noninsulin-dependent diabetics. Although these two classifications are not always strictly distinct from one another and do not include all diabetic disorders, they contrast some important epidemiological and metabolic differences among diabetic patients.