Diabetes and Anaesthesia Flashcards
What is type 1 diabetes?
-inability to produce insulin because of the destroyed beta cells in the pancreas
What is type 2 diabetes?
-produces insulin but there is insulin resistance
There’s more glucose released from the liver than is being uptakes by the tissues
What is gestational diabetes?
-develops during pregnancy because of rather metabolic load
What tests do we do ton diagnose diabetes?
- Random: >11,1 mmol/l
- Fasting: >7 mmol/l
- HbA1C>6,5%
What is the differential diagnosis for hyperglycaemia?
- Pancreatic disease
- Metabolic syndrome
- Endocrinopathies
- Drugs-glucosteroids
- Genetic disorders
What should we worry about a couple of days post-operatively?
-sudden death because of a silent myocardial infarction or myocardial ischaemia which can cause hypotension, dysarrthmias, ECG changes peri-operatively
What reduces the risk of peri-operative myocardial infarction?
-beta adrenergic blockers
Which drugs do we usually use to control the hypertension in diabetic patients peri-operatively?
ACE inhibitors
What is stiff joint syndrome?
- happens to longstanding type 1 diabetic patients
- they have stiff joints particularly of the airway and this causes difficult intubation
Which drugs should be avoided if the patient has renal impairment?
Metformin
What aspiration prophylaxis can we give to patients?
Metoclopramide
List 5 signs and symptoms of autonomic neuropathy in diabetic patient?
- Decreased heart rate variability with vasalva, respiration or change in position
- Orthostatic hypertension
- Resting tachycardia
- impotence
- Gastro-intestinal dysmotility
What is orthostatic hypertension?
-increase of systolic blood pressure of about 20mmHg and diastolic blood pressure of 10mmHg when moving from supine to upright
What are the main things to focus on pre-operatively?
- History and examination
- ask about the type of diabetes, medication, duration of the disease, how well controlled,
Why must you focus special attention on the airway and neck structures?
- to figure out whether intubation will be easy or not
- test the hoarseness, voice changes and prayer sign
How do we test the autonomic neuropathy?
Ask the patient to do the vasalva makeover and check the heart rate
What other organs can we test for pre-operatively that we could be worried about?
- Renal system-do urinalysis, blood urea and creatinine to test for renal disease
- ECG-check for poor RR variability
What is the normal value of HBA1C in non diabetics?
-5-7% is normal
Before surgery what glucose value should we aim for?
4-8mmol/l
Which class of drugs can give rise to lactate accumulation and acidosis?
Biguanides
What should we prevent happening intra-op in a patient?
-hyperglycaemia caused by pain and the release of cortisol and adrenaline
What is one disadvantage of general anaesthesia use in a diabetic patient?
The symptoms of hypoglycemia are diminished
How often should we check the blood glucose in these patients intra-operativelky?
-every 30 minutes and should be controlled to 6-8mmol/l
If the patients blood glucose drops to less than 6mmol/l what can we do?
Give dextrose containing fluids as boluses or maintenance
Why do diabetic patients experience wound infections more easily?
-the postulation that high levels of glucose causes white blood cell Che oat is and function
What should we ensure happens post-operatively?
- Analgesia
- Early enteral feeding
- Strict fluid management
- Make sure patient starts oral medication once oral feeding happens
