The pathophysiological aspects of anesthetic management in patients with type 2 diabetes mellitus in the ambulatory practice

O.V. Ivaniushko

Abstract


Diabetes mellitus is an epidemic disease, its incidence in the world is increasing rapidly among all age groups and races. Each third person has pre-diabetes, therefore, in case of detection of hyperglycemia (often due to surgical stress), one should remember about the pre-diabetes. Accor­ding to national surveys, only 14 % of patients with diabetes do not have concomitant disease. Therefore, surgeons should take into account the fact that every tenth patient can potentially have diabetes. Obesity is an additional problem in anesthesia, including difficulties with breathing, ventilation, oxyge­nation; obstructive sleep apnea, gastroesophageal reflux disease, problem with dosage and delayed effect of the drug. The main causes of death of patients with type 2 diabetes mellitus are cardiovascular and atherosclerotic diseases, including acute cerebrovascular accident and coronary artery disease. Correct blood pressure control has a direct and significant impact on morbidity and mortality and is more important than blood glucose or lipid level control. Portable glucometer is a common way to determine the level of glucose in the blood. Liver diseases are the major cause of death in patients with type 2 diabetes mellitus. Compared with the general population, patients with type 2 diabetes mellitus have a higher level of liver diseases. Chronic kidney disease affect the pharmacokinetics of insulin, due to this fact, insulin-dependent patients have an increased risk of hypoglycemia. In diabetics with cardiovascular autonomic neuropathy confirmed by heart rate variability, the level of silent myocardial ischemia and mortality is two times higher. Thus, the anesthesiologist must understand the pathophysiology of diabetes mellitus and its common comorbidities. It is necessary to pay close attention to the choice of effective and safe anesthesia for patients with diabetes mellitus during surgical interventions in outpatient settings.

Keywords


type 2 diabetes mellitus; pre-diabetes; hyperglycemia; hemoglobin A1c

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DOI: https://doi.org/10.22141/2224-0586.3.90.2018.129491

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