Perioperative management of a pregnant diabetic patient

Abstract

Operating a diabetic patient presents a challenge to both the surgeons and the Anaesthetists alike. Perioperative morbidity and mortality are greater in diabetic than non-diabetic patients. The problems of managing diabetics who undergo surgery are associated with its attendant period of starvation and the metabolic effects of surgery. The aim is to minimize the metabolic disturbance by ensuring an adequate intake of glucose, calories and insulin, thus controlling hyperglycaemia and reducing proteolysis, lipolysis and production of lactate and ketones. Gestational diabetes usually develops at 24 to 30 weeks of gestation and is associated with increased perinatal morbidity and mortality. The incidence is 2% to 3% of pregnancies and 30% to 50% of these patients eventually develop Non Insulin Dependent Diabetes Mellitus (NIDDM) within 10years. The aim of this article is to review the current concepts in the perioperative management of the pregnant diabetic. A search involving current textbooks, Medline, Pubmed, World of Anaesthesia amongst others was conducted and the information obtained was reviewed and presented.

Annals of Nigerian Medicine Vol. 1(1) 2005: 9-14