Diabetes mellitus on insulin going for surgery
|Discussion in 'All Categories' started by Dr Simran Rastogi - Aug 22nd, 2016 11:22 am.|
Dr Simran Rastogi
Please explain about preoperative preparation for a patient with diabetes mellitus on insulin going for Total Laparoscopic Hysterectomy surgery.
re: Diabetes mellitus on insulin going for surgery by Dr R K Mishra - Aug 23rd, 2016 1:47 am
Dr R K Mishra
|Dear Dr Simran
As all of know that Diabetes is a silent killer so it is very important to rule out the risk factors if someone is performing minimal access surgery on a patient with diabetes.
Following investigation is must to do in every patient with DM.
Blood glucose and HbA1c. Blood glucose control must be optimized before surgery if possible.
•ECG and possible Stress Echo to assess for ischemic and other cardiovascular disease.
•U&Es and estimated glomerular filtration rate (eGFR).
•Urine analysis. Ketones, protein and bacteriology.
•CXR. This may be indicated to screen for pulmonary infection, including tuberculosis.
Following precautions should be taken:
Ensure that the potential effects of diabetes and associated co-morbidities on the outcome of surgery are considered before referral for elective procedures.
•Ensure that the relevant medical information is communicated.
•Ensure that diabetes and comorbidities are optimally managed before the procedure.
•Document the current HbA1c, blood pressure and weight measurements with details of relevant complications and medications.
•Optimise glycaemic control before laparoscopic surgery.
•Consider opinion to the diabetes specialist team for advice if HbA1c is greater than 69 mmol/mol (8.5%). A high HbA1c is an indication for intensive blood glucose control but it may not be realistic to delay surgery until the HbA1c has been repeated. Patients with hypoglycaemic unawareness should be treated perioperative by the diabetes specialist team irrespective of HbA1c.
•Optimise other diabetes related comorbidities before surgery of TLH.
•Take a high risk consent before surgery
re: Diabetes mellitus on insulin going for surgery by Dr Alisha - Sep 10th, 2016 10:59 pm
|In my opinion we must seek advice of a physician expert in diabetes and take no objection from him before starting surgery.|