Anesthesiologic management of surgery of the aorta and the major vessels in patients with diabetes mellitus]

In 23 patients with diabetes mellitus, the effectiveness of anesthesiologic support of the operations on the aorta and major vessels, which was based on combined epidural anesthesia performed using the conventional technique, was analysed. Sugar concentration in the blood was maintained at a level of no more than 11 mmol/l. Use of the method permitted to provide an adequate anesthesia, stable concentration of glucose in the blood, constant aqueous-electrolyte balance and acid-base state.     

Brain changes in diabetes mellitus patients with gastrointestinal symptoms

Diabetes mellitus is a common disease and its prevalence is increasing worldwide. In various studies up to 30%-70% of patients present dysfunction and complications related to the gut. To date several clinical studies have demonstrated that autonomic nervous system neuropathy and generalized neuropathy of the central nervous system(CNS) may play a major role. This systematic review provides an overview of the neurodegenerative changes that occur as a consequence of diabetes with a focus on the CNS changes and gastrointestinal(GI) dysfunction. Animal models where diabetes was induced experimentally support that the disease induces changes in CNS. Recent investigations with electroencephalography and functional brain imaging in patients with diabetes confirm these structural and functional brain changes. Encephalographic studies demonstrated that altered insular processing of sensory stimuli seems to be a key player in symptom generation. In fact one study indicated that the more GI symptoms the patients experienced, the deeper the insular electrical source was located. The electroencephalography was often used in combination with quantitative sensory testingmainly showing hyposensitivity to stimulation of GI organs. Imaging studies on patients with diabetes and GI symptoms mainly showed microstructural changes,especially in brain areas involved in visceral sensory processing. As the electrophysiological and imaging changes were associated with GI and autonomic symptoms they may represent a future therapeutic target for treating diabetics either pharmacologically or with neuromodulation.     

Peri-operative management of patients with diabetes mellitus

Patients with diabetes mellitus are routinely encountered in anaesthetic practice. Peri-operative maintenance of good glycaemic control to avoid metabolic decompensation and its sequelae is considered to be the ideal, as they have a worse surgical outcome. In addition to routine anaesthetic assessment, patients with diabetes should be assessed pre-operatively for macrovascular complications (ischaemic heart disease, peripheral vascular disease, cerebrovascular disease) and microvascular complications (nephropathy, neuropathy, retinopathy) of diabetes, along with a review of overall glycaemic control. For elective surgery, patients with poor metabolic control should receive intensive glucose management. For major operations, patients will require an intravenous insulin infusion for which several regimens are currently used in clinical practice. The two most popular methods are: (1) the ‘sliding scale’ and (2) the GIK (glucose–insulin–potassium) infusion. Both methods have advantages and disadvantages, but for more complex surgery the ‘sliding scale’ method is more flexible. Minor surgery should not require the use of intravenous insulin infusions since these patients may be managed by adjustments in their usual dose of insulin or oral hypoglycaemic agents. In specific operative procedures, e.g. cardiothoracic surgery, major hyperglycaemic excursions have been shown to occur highlighting the need for stringent blood glucose monitoring.     

Precision surgery of tuberculoma in patients with diabetes mellitus

Indications and contraindications for precisional excision of tuberculoma in patients with diabetes mellitus were adduced, the original method of its performance was elaborated. Organ-preserving operation was done in 25 patients. The precisional excision of tuberculoma have permitted to preserve healthy pulmonary parenchyma (the part--in 18 patients and the whole lung--in 3). In all the patients the ability to work was restored.