Perioperative management of diabetic patients: new controversies

Präoperative Evaluation erwachsener Patienten vor elektiven, nicht Herz-Thorax-chirurgischen Eingriffen

“…Nach individueller NutzenRisiko-Abwägung ist daher auch eine Weiterführung der Medikation bis zum Vorabend der Operation zu rechtfertigen. Die britischen "National Health Services" (NHS) sowie die "Society of Ambulatory Anaesthesia" (SAMBA) empfehlen sogar die Fortführung der Metformintherapie bei Nierengesunden, u. a. wegen Hinweisen auf ein verbessertes Outcome bei diesem Vorgehen [37]. Bei geplanter intravenöser Gabe von Kontrastmittel sollte allerdings die Metformingabe 24-48 h vor dem Eingriff pausiert werden [38] [41].…”

Preoperative evaluation of adult patients before elective, noncardiothoracic surgery

“…Continuation of metformin medication up until the evening before surgery can thus be justified on the basis of an individual risk-benefit assessment. The British National Health Service (NHS) and the Society of Ambulatory Anaesthesia (SAMBA) even recommend continuation of metformin treatment in patients with healthy kidneys, in part because of results indicating a better outcome with this scheme [37]. However, if application of an intravenous contrast agent is planned, metformin treatment should be paused 24-48 h in advance of the procedure [38].…”

Patients With Type 2 Diabetes: Anesthetic Management in the Ambulatory Setting. Part 1: Pathophysiology and Associated Disease States

“…The recommendations state that prior to surgery, anesthesia providers should have knowledge of the patient's current fasting blood glucose level and most recent HbA1c. 25,27,28 This is because patients with acute hyperglycemia have more perioperative and postoperative complications including dehydration, ketoacidosis, hyperosmolar hyperglycemic state, delayed wound healing, and wound infection. 5,27 The decision to cancel or postpone surgery should be made in conjunction with the surgeon and should be based on the urgency of the surgery as well as the risks versus the benefits of proceeding.…”

“…However, it must be understood that the Food and Drug Administration accepts a 20% manufacturer's measurement error for meters reading levels greater than 100 mg/dL (5.6 mmol/L) and a 15% error for levels less than 100 mg/dL (5.6 mmol/L). 27,28 When precise blood glucose levels are desired, laboratory tests should be used if possible.…”