Perioperative management of adult diabetic patients. Specific situations.

Gaëlle Cheisson, Sophie Jacqueminet, Emmanuel Cosson, Carole Ichai, Anne-Marie Leguerrier, Bogdan Nicolescu-Catargi, Alexandre Ouattara, Igor Tauveron, Paul Valensi, Dan Benhamou

Journal: Anaesthesia, critical care & pain medicine 2019;37 Suppl 1():S31-S35

PMID: 29555546

Free Full Text on Elsevier Science View on PubMed

Abstract

Ambulatory surgery can be carried out in diabetic patients. By using a strict organisational and technical approach, the risk of glycaemic imbalance is minimised, allowing the patients to return to their previous way of life more quickly. Taking into account the context of ambulatory surgery, with a same day discharge, the aims are to minimise the changes to antidiabetic treatment, to maintain adequate blood sugar control and to resume oral feeding as quickly as possible. The preoperative evaluation is the same as for a hospitalised patient and recent glycaemic control (HbA1c) is necessary. Perioperative management and the administration of treatment depend on the number of meals missed. The patient can return home after taking up usual feeding and treatment again. Hospitalisation is necessary if significant glycaemic imbalance occurs. In pregnancy, it is necessary to distinguish between known pre-existing diabetes (T1D or T2D) and gestational diabetes, defined as glucose intolerance discovered during pregnancy. During labour, blood sugar levels should be maintained between 0.8 and 1.4g/L (4.4-8.25mmol/L). Control of blood sugar levels is obtained by using a continuous administration of insulin using an electronic syringe (IVES) together with a glucose infusion. Post-partum, management depends on the type of diabetes: in T1D and T2D patients a basal-bolus scheme is restarted with decreased doses while in gestational diabetes insulin therapy is stopped after delivery. Antidiabetic treatment is again necessary if blood sugar levels remain>1.26g/L (7mmol/L).

Address: Department of surgical anaesthesia and intensive care, South Paris university hospital, hôpital de Bicêtre, AP-HP, 78, rue du Général-Leclerc, 94275 Le Kremlin-Bicêtre, France.; Institute of cardiometabolism and nutrition, Department of diabetes ad metabolic diseases, hôpital de la Pitié-Salpêtrière, AP-HP, 75013 Paris, France.; Department of endocrinology, diabetology and nutrition, hôpital Jean-Verdier, AP-HP, Paris 13 university, Sorbonne Paris Cité, CRNH-IdF, CINFO, 93140 Bondy, France; UMR U1153 Inserm, U1125 Inra, CNAM, Sorbonne Paris Cité, Paris 13 university, 93000 Bobigny, France.; Department of versatile intensive care, hôpital Pasteur 2, CHU de Nice, 30, voie Romaine, 06001 Nice cedex 1, France; Inserm U1081, CNRS UMR 7284 (IRCAN), University Hospital of Nice, 06001 Nice, France.; Department of diabetology and endocrinology, CHU de Rennes, hôpital Sud university hospital, 16, boulevard de Bulgarie, 35056 Rennes, France.; Department of endocrinology ad metabolic diseases, hôpital Saint-André, Bordeaux university hospital, 1, rue Jean-Burguet, 33000 Bordeaux, France.; Bordeaux university hospital, Department of Anaesthesia and Critical Care II, Magellan Medico-Surgical Centre, 33000 Bordeaux, France; Inserm, UMR 1034, Biology of Cardiovascular Diseases, université de Bordeaux, 33600 Pessac, France.; Department of endocrinology and diabetology, Clermont-Ferrand university hospital, 58, rue Montalembert, 63000 Clermont-Ferrand, France; UFR médecine, Clermont-Auvergne university, 28, place Henri-Dunant, 63000 Clermont-Ferrand, France; UMR CNRS 6293, Inserm U1103, Genetic Reproduction and development, Clermont-Auvergne university, 63170 Aubière, France; Endocrinology-Diabetology, CHU G.-Montpied, BP 69, 63003 Clermont-Ferrand, France.; Department of endocrinology, diabetology and nutrition, hôpital Jean-Verdier, AP-HP, Paris 13 university, Sorbonne Paris Cité, CRNH-IdF, CINFO, 93140 Bondy, France.; Department of surgical anaesthesia and intensive care, South Paris university hospital, hôpital de Bicêtre, AP-HP, 78, rue du Général-Leclerc, 94275 Le Kremlin-Bicêtre, France. Electronic address: [email protected].

DOI: 10.1016/j.accpm.2018.02.022