Complications of diabetes mellitus

Cardiovascular disorders (coronary artery, cerebrovascular and peripheral vascular) are common in diabetics, and there is an increased risk of perioperative myocardial infarction. Careful preoperative assessment of cardiovascular function, appropriate choice of anaesthetic technique and precise perioperative monitoring are essential.

Renal disease. Microvascular damage produces glomerulosclerosis with proteinuria, oedema and eventually chronic renal failure. Anaesthetic implications of renal disease are discussed on page 442.

Ocular problems. Cataracts, exudative or proliferative retinopathy, vitreous haemorrhage and retinal detachment may occur. In the long term, good blood glucose control has been shown to reduce the frequency of such complications.

Infection. Diabetics are prone to infection and an increased risk of septicaemia and abscess formation. Infection is associated with increased insulin requirements, which return to normal on its eradication, e.g. after surgical drainage of an abscess.

Neuropathy. Chronic sensory peripheral neuropathies are common; mononeuropathies and acute motor neuropathies (amyotrophy) are associated with poor control of blood glucose. Loss of sensation together with peripheral vascular disease can lead to ulceration after trivial trauma; consequently, care in positioning patients in the operating theatre is important. Local anaesthetic nerve or plexus blocks should be avoided in patients with an acute neuropathy, as neurological deficits may be attributed to the local anaesthetic solution.

Autonomic neuropathy may cause postoperative urinary retention or vasomotor instability, e.g. postural hypotension or hypotension during anaesthesia. IPPV or subarachnoid or epidural block may be associated with severe hypotension; adequate preoperative volume resuscitation, precise cardiovascular monitoring and careful anaesthetic management are essential.

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