DIABETES MELLITUS IN THE PRACTICE OF AN ANESTHESIOLOGIST: PERIOPERATIVE MANAGEMENT OF PATIENTS WITH DIABETIC NEUROPATHY

Abstract

Diabetic neuropathy (DNP) is a lesion of the nervous system in patients with diabetes mellitus (diabetes), in which all parts of the central, peripheral and autonomic nervous system can be involved in the pathological process. Due to the almost 100% prevalence of diabetes in patients with diabetes, autonomous (vegetative) diabetic neuropathy is of paramount importance for the anesthesiologist in terms of anesthesia and preparation of a preoperative preparation plan. Thus, cardiovascular autonomic neuropathy occurs in 17–25% of patients with diabetes, correlating with the disease duration and age of patients, and is characterized by three main syndromes: syndrome of heart failure, syndrome of cardiac hypesthesia and syndrome of orthopathy. Chronic hyperglycemia leads to tissue protein glycation and joint stiffness, which can cause severe intubation that complicates anesthesia in 30% of patients with DNP. Autonomic neuropathy of the gastrointestinal tract (gastrointestinal tract) is manifested by the development of gastric atony, decreased gastrointestinal motility and the development of possible regurgitation during tracheal intubation. Thus, patients with diabetic neuropathy have an increased risk of intra- and postoperative complications, which requires careful monitoring of the patient’s condition with constant monitoring of the necessary parameters of homeostasis throughout the perioperative period.