Diabetes Mellitus in Anaesthesia
Diabetes Mellitus in Anaesthesia
Anaesthesiologists frequently encounter patients with diseases of the endocrine system, in particular diabetes mellitus. The major risk factors for people with diabetes undergoing surgery are the associated end-organ diseases: cardiovascular autonomic neuropathy, joint collagen tissue, and immune deficiency. Due to the fact that endocrine diseases can be associated with significant peri-operative morbidity and mortality, it is critical that anaesthesiologists understand these disorders and when indicated request the appropriate investigations.
Diabetes mellitus affects patients of all ages and due to its increasing prevalence, virtually all physicians will inevitably be confronted with diabetic patients requiring anaesthesia and surgery. Patients with diabetes have a significantly increased risk of premature mortality and an increased risk of microvascular and cardiovascular complications and are often sicker than most non-diabetic patients and therefore place a proportionally larger burden on anaesthetic services.
Some reports have suggested that diabetic patients undergoing elective surgery are at a greater risk of morbidity from myocardial ischaemia, wound infection, renal ischaemia and cerebrovascular infarction. A 50% increase in early mortality following coronary artery bypass grafting has been described in diabetic patients. This increased mortality is consequent to impaired myocardial function, a higher incidence of sternal wound infections and an increased likelihood of delayed stroke, all of which result in a longer hospital stay.
End-organ damage from diabetes may be a more important indicator of peri-operative outcome than the presence of diabetes itself. The major risk factors affecting diabetic patients undergoing surgery include cardiovascular dysfunction, renal insufficiency, joint collagen tissue abnormalities (e.g. cervical joint stiffness) and neuropathies (cardiovascular and GI effects), all of which may influence the effects of anaesthetics. Therefore, a major focus for anaesthesiologists should be the pre-operative and pre-procedural evaluation and treatment of the potentially complicating factors of diabetes.
Abstract and Introduction
Abstract
Anaesthesiologists frequently encounter patients with diseases of the endocrine system, in particular diabetes mellitus. The major risk factors for people with diabetes undergoing surgery are the associated end-organ diseases: cardiovascular autonomic neuropathy, joint collagen tissue, and immune deficiency. Due to the fact that endocrine diseases can be associated with significant peri-operative morbidity and mortality, it is critical that anaesthesiologists understand these disorders and when indicated request the appropriate investigations.
Introduction
Diabetes mellitus affects patients of all ages and due to its increasing prevalence, virtually all physicians will inevitably be confronted with diabetic patients requiring anaesthesia and surgery. Patients with diabetes have a significantly increased risk of premature mortality and an increased risk of microvascular and cardiovascular complications and are often sicker than most non-diabetic patients and therefore place a proportionally larger burden on anaesthetic services.
Some reports have suggested that diabetic patients undergoing elective surgery are at a greater risk of morbidity from myocardial ischaemia, wound infection, renal ischaemia and cerebrovascular infarction. A 50% increase in early mortality following coronary artery bypass grafting has been described in diabetic patients. This increased mortality is consequent to impaired myocardial function, a higher incidence of sternal wound infections and an increased likelihood of delayed stroke, all of which result in a longer hospital stay.
End-organ damage from diabetes may be a more important indicator of peri-operative outcome than the presence of diabetes itself. The major risk factors affecting diabetic patients undergoing surgery include cardiovascular dysfunction, renal insufficiency, joint collagen tissue abnormalities (e.g. cervical joint stiffness) and neuropathies (cardiovascular and GI effects), all of which may influence the effects of anaesthetics. Therefore, a major focus for anaesthesiologists should be the pre-operative and pre-procedural evaluation and treatment of the potentially complicating factors of diabetes.
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