Perioperative Anesthetic Management of Diabetic Children in Emergency Conditions

Abstract

Pediatric patients with diabetes are managed with increasingly complex regimens that have direct implications for their perioperative care. In addition to recognizing the relevant differences among diabetes treatment regimens, pediatric anesthesiologists must also consider a child’s metabolic control, age, size, pubertal development, the intended surgical procedure, and its length when devising a perioperative plan. (Betts et al, 2009) As diabetes treatment options for children continue to change, such algorithms will need to be updated. Formal assessment of the impact of such algorithms on clinical outcomes, satisfaction with care, and cost of care would provide additional insight into their revision. (The global challenge of diabetes, 2008) Emergencies in pediatric diabetic patients could be; medical, that include hypoglycemia or hyperglycemia and DKA or surgical, that include victims of polytrauma and supracondylar fractures, airway foreign bodies, post tonsillectomy bleeding or pyloric stenosis. (Chadwick and Wilkinson, 2004) New guidelines has been postulated for the management of diabetic patients throughout surgical interference as tight glycemic control in diabetic patients undergoing major surgery wether elective or emergency has been shown to improve perioperative morbidity and mortality rates. (Rhodes et al, 2005) However, this aggressive strategy requires frequent monitoring of blood glucose concentrations as surgery induces a considerable stress response mediated by the neuroendocrine system through the release of