New Diabetes Medications Raise New Perioperative Concerns for the Anesthesiologist

DeCou, Jennifer A.

doi:10.1213/ane.0000000000002740

Cited by 4 publications

(5 citation statements)

References 12 publications

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“…The following recommendations are based on our synthesis of the very limited, but best available, evidence. We note that these recommendations are slightly different to others in recent editorials and case reports 6,22,[25][26][27] . We recommend slightly earlier preoperative cessation, and emphasise that there should be no rush to recommence therapy postoperatively.…”

contrasting

confidence: 71%

The Good, the Bad, and the Ugly: Sodium–Glucose Cotransporter-2 Inhibitors (Gliflozins) and Perioperative Diabetes

Kerridge

Whyte

Prior

et al. 2018

Anaesth Intensive Care

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contrasting

confidence: 71%

The Good, the Bad, and the Ugly: Sodium–Glucose Cotransporter-2 Inhibitors (Gliflozins) and Perioperative Diabetes

Kerridge

Whyte

Prior

et al. 2018

Anaesth Intensive Care

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“…SGLT-2-Inhibitoren haben eine Halbwertszeit von 8 bis 16 h, weshalb ein präoperatives Pausieren von 3 bis 5 Tagen rational begründbar ist [123,[129][130][131]. Internationale Empfehlungen einschlägiger Fachgesellschaften sind aufgrund der mangelnden Datenlage uneinheitlich [7,[132][133][134].…”

Section: Sodium Glukose Co-transporter-2 (Sglt-2)-inhibitorenunclassified

Position statement: surgery and diabetes mellitus (Update 2023)

Kietaibl

Huber²,

Clodi

et al. 2023

Wien Klin Wochenschr

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ZusammenfassungDas vorliegende Positionspapier beschreibt die Sicht der Österreichischen Diabetes Gesellschaft hinsichtlich des perioperativen Managements von Menschen mit Diabetes mellitus auf Basis der verfügbaren wissenschaftlichen Evidenz. Dabei wird Bezug genommen auf die präoperative Begutachtung und Vorbereitung sowie auf die perioperative Stoffwechselkontrolle mittels oraler Antidiabetika und/oder injektabler Therapie (Insulin‑/GLP-1-RA-therapie).

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“…Пациенты пожилого возраста, получавшие препараты SGLT2, могут быть предрасположены к развитию периоперационной гиповолемии и гипотензии из-за потери натрия с мочой и повышенного диуреза [89]. Лечение препаратами SGLT2 может также увеличить риск гипогликемии, когда данные препараты используются в комбинации с инсулинотерапией [90,91]. Необходимо помнить, что препараты SGLT2 могут значительно влиять на баланс электролитов у пациентов с почечной недостаточностью, вызывая гипонатриемию и гиперкалиемию [90,91].…”

Section: практические рекомендации по оптимизации лечения гипергликемииunclassified

“…Лечение препаратами SGLT2 может также увеличить риск гипогликемии, когда данные препараты используются в комбинации с инсулинотерапией [90,91]. Необходимо помнить, что препараты SGLT2 могут значительно влиять на баланс электролитов у пациентов с почечной недостаточностью, вызывая гипонатриемию и гиперкалиемию [90,91].…”

Section: практические рекомендации по оптимизации лечения гипергликемииunclassified

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

Kuklin

Matri

Barlow

et al. 2022

Annals of Critical Care

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A large amount of clinical evidences demonstrates a clear association between long-term and/or stress-related hyperglycaemia, and development of complications after surgery. The incidences of perioperative hyperglycaemia are demonstrated in 20-80 % of all cases depending on the type of elective surgery, with the h ighest rate registered in cardiac surgery. The most studied pathophysiological complications of long-term hyperglycaemia in Diabetes Mellitus (DM) patients are; activation of the polyol pathway, diacylglycerol/protein kinase C and hexosamine pathways, advanced glycation product formation, and oxidative stress. The uncontrolled stress-related hyperglycaemia during and after surgery instigates: osmotic diuresis with further fluid and electrolyte imbalance, increased gluconeogenesis and glucogenolysis, breakdown of fats into free fatty acid and glycerol, proteins into amino acids, and increases generation of pro-inflammatory cytokines. All these changes may lead to development of diabetic ketoacidosis, immune deregulation and insulin resistance. Some clinical investigations seems to indicate that anaesthesia with propofol may have some advantages in keeping of stable blood sugar over inhalational agents. Two clinical trials comparing the influence of different anaesthetic agents on perioperative glycaemic status in diabetic patients are currently underway. For better management of perioperative hyperglycaemia in diabetic patients under surgery we have proposed several important practical principles.

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New Diabetes Medications Raise New Perioperative Concerns for the Anesthesiologist

Cited by 4 publications

References 12 publications

The Good, the Bad, and the Ugly: Sodium–Glucose Cotransporter-2 Inhibitors (Gliflozins) and Perioperative Diabetes

The Good, the Bad, and the Ugly: Sodium–Glucose Cotransporter-2 Inhibitors (Gliflozins) and Perioperative Diabetes

Position statement: surgery and diabetes mellitus (Update 2023)

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

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