Table 2: Summary of DM effects and practice suggestions for perioperative management of patients with DM.

Organ systemEffectPlan

Central Nervous System(i) Temperature regulation
(ii) Increased risk of corneal abrasions from proptosis
(i) Keep patient warm
(ii) Increase temperature in operating room
(iii) Careful taping of eyes, ophthalmic ointment

Behavioral issues(i) Cognitive dysfunction
(ii) Behavioral issues
(a) Anxiety
(b) Bipolar disorder
(c) Obsessive- compulsive disorder
(i) Check for mood altering medications
(ii) Use small 0.5 mg to 1 mg boluses of benzodiazepines to assess patient’s sensitivity

Endocrine(i) Diabetes
(ii) Hyperthyroid
(iii) Hyperparathyroid
(i) Check AM blood sugar
(ii) Preop thyroid function testing
(iii) Check calcium level preoperatively

Cardiac(i) Arrhythmias:
(a) Atrial flutter
(b) Atrial fibrillation
(i) Have defibrillator available and pads on patient
(ii) Interrogate AICD if present

Pulmonary(i) Impairment of ventilation and sensitivity to respiratory depressants
(ii) Ineffective coughing
(a) Aspiration pneumonia
(i) Minimize use respiratory depressants
(ii) Aggressive postoperative pulmonary hygiene

Musculoskeletal(i) Involuntary muscle contraction, progressive weakness(i) Avoid triggering agents:
(a) Succinylcholine
(b) Neostigmine

Gastrointestinal(i) Prolonged gastric emptying(i) Consider rapid sequence induction and intubation