Effects of intravenous and inhalation anesthesia on blood glucose and complications in patients with type 2 diabetes mellitus: study protocol for a randomized controlled trial

Abstract

Background: Diabetes mellitus (DM) is a metabolic disorder syndrome caused by relative or absolute lack of insulin and varying degrees of insulin resistance. The type and regimen of anesthesia may affect perioperative hyperglycemia following major surgical stress. The effect of perioperative anesthetics on the blood glucose level of diabetic patients will play an essential role in the postoperative recovery of patients.However, there is no rigorously-designed randomized controlled trial to compare the effects of total intravenous anesthesia (TIVA) and total inhalation anesthesia (TIHA) on blood glucose and complications in type 2 diabetes. Hence, we design this clinical trial to compare the effects of TIVA and TIHA of hyperglycemia and clinical outcomes in type 2 diabetes undergoing surgery.Methods: This is a randomized, double-blind, parallel controlled trial. One hundred twelve patients with type 2 DM who meet the qualification criteria will be randomly divided into two groups: TIVA group and TIHA group. The levels of serum insulin and cortisol will be measured before and after the operation, and the levels of blood glucose at different setting time will be monitored. All patients will be followed up by blinded evaluators at baseline and 1, 3, 7, and 30 days after the intervention. The follow-up included postoperative complications [such as myocardial infarction (MI), stroke, renal failure, anastomotic fistula, stress ulcer, incision infection, lung infection] and adverse events.Discussion: The routinely used clinical anesthesia schemes are TIVA, TIHA and intravenous-inhalation combined anesthesia. We expect that the results of this trial will provide high-quality clinical evidence for the choice of anesthesia options for patients with type 2 DM.

Preemptive Midazolam Can Reduce the Glycemic Stress Response to Surgery for Type-2 Diabetics Undergoing Simple Eye Surgery

“…Secondly, the reported effect could be attributed to an agonizing effect of midazolam on GABA receptors on insulin resistance, which is coincident with type-2 diabetes mellitus [7] , in support of this attribution, Li et al, [23] using type-2 DM animal model found supplementation by GABA-rich yogurt favorably regulated homeostasis model assessment of β -cell function, improved islet cells morphology and lowered total cholesterol in a dosedependent manner. Thereafter, Rezazadeh et al, [24] using animal model of type-2 DM found GABA therapy improved insulin resistance in diabetic animals by increasing the expression of GLUT4, the main glucose transporter to the cell, whereby glucose is metabolized with subsequent decrease of BGC.…”

“…Anesthesia and surgery can aggravate diabetic patient and increase the incidence of complications secondary to poor blood glucose control, so decreasing glucose variability during admission for surgery is essential to reduce re-admission rates and length of stay of T2D patients [7] . The type and regimen of anesthesia may affect perioperative hyperglycemia following major surgical stress [8,9] .…”

“…The type and regimen of anesthesia may affect perioperative hyperglycemia following major surgical stress [8,9] . The effect of perioperative anesthetics on the blood glucose level of diabetic patients will play an essential role in the postoperative recovery of patients [7] .…”

Current trends in management of hyperglycaemia in surgical patients with diabetes mellitus: a review

“…На данный момент проводится два больших проспективных клинических исследования, изучающих влияние различных типов анестезии на уровень гликемии в периоперационном периоде у пациентов с СД. Мы надеемся, что данные исследования помогут «расставить все точки над i» в данной проблеме [79,80]. В нескольких клинических исследованиях предпринимались попытки оценить влияние региональной анестезии на развитие гипергликемии в периоперационном периоде.…”

Voglibose and saxagliptin ameliorate the post-surgical stress and cognitive dysfunction in chronic anaesthesia exposed diabetic MCAo induced ischemic rats

“…It has also been commonly noted that binge drinking and psychiatric illnesses are linked to diabetes ( Munukutla et al, 2016 , Kessler et al, 1997 ). Previous research has demonstrated that the kind and length of anaesthesia have an impact on systemic perioperative hyperglycemia after surgical stress, as well as play a role in post-surgical recovery ( Xiong et al, 2020 ). During surgery, anaesthesia and operation might aggravate diabetic patients' symptoms.…”