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Aspekte der perioperativen Behandlung von Diabetespatienten

Aspects of perioperative care in patients with diabetes

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Zusammenfassung

Diabetes mellitus ist in Deutschland eine Volkskrankheit. Aufgrund der diabetischen Folgeerkrankungen (Makroangiopathie, Mikroangiopathie und Neuropathie) bedürfen Diabetespatienten einer intensiveren anästhesiologischen Betreuung in der perioperativen Phase im Vergleich zu Nichtdiabetespatienten. Eine sorgfältige, ausführliche Anamnese mit Erfassung des diabetesbedingten perioperativen Gefährdungspotenzials (Herz-Kreislauf-Erkrankungen, Gastroparese, Neuropathie, „Stiff-joint“-Syndrom) hat nach derzeitigem Wissensstand wahrscheinlich größere Bedeutung als eine spezifische Medikamenten- oder Verfahrenswahl. Das intraoperative anästhesiologische Management diabeteskranker Patienten fokussiert sich in besonderem Maß auf die Erhaltung der hämodynamischen Stabilität, perioperative Infektionsprophylaxe und Kontrolle der Glucosehomöostase. Wurde noch vor einigen Jahren das Erzwingen einer strikten Normoglykämie mithilfe forcierter Insulintherapie propagiert, erkennen neuere Studien hierin ein Risikopotenzial. Die optimierte perioperative Behandlung von Diabetespatienten sollte daher den gewünschten Blutzuckerspiegel klar benennen, bewährte Therapiealgorithmen vorhalten und eine engmaschige Überwachung mit ggf. umgehender Modifikation der Behandlung ermöglichen.

Abstract

Diabetes is a common disease in Germany. Due to diabetes-associated end-organ disease, such as large and small vessel disease and neuropathy, diabetic patients require more intense anesthesia care during the perioperative phase. An in-depth and comprehensive medical history focusing on hemodynamic alterations, gastroparesis, neuropathy and stiff joint syndrome is a cornerstone of perioperative care and may affect outcome of diabetes patients more than specific anesthetic medications or the anesthetic procedure. Intraoperative anesthetic care needs to focus on preservation of hemodynamic stability, perioperative infection control and maintenance of glucose homeostasis. Whereas some years ago strict glucose control by aggressive insulin therapy was adamantly advocated, the results of recent studies have put the risk of such therapeutic algorithms into perspective. Therefore, optimized perioperative care of diabetic patients consists of setting a predefined targeted blood glucose level, evidence-based therapeutic approaches to reach that goal and finally adequate and continuous monitoring and amendment of the therapeutic approach if required.

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  1. Klinik für Anästhesiologie, Universitätsmedizin der Johannes-Gutenberg Universität, Langenbeckstr. 1, 55131, Mainz, Deutschland

    G. Pestel, D. Closhen & C. Werner

  2. 1. Medizinische Klinik und Poliklinik, Schwerpunkt Endokrinologie und Stoffwechselerkrankungen, Universitätsmedizin Mainz, Mainz, Deutschland

    A. Zimmermann & M.M. Weber

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  1. G. Pestel
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Herrn Professor Dr. med. A. Rothhammer zum 65. Geburtstag gewidmet.

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Pestel, G., Closhen, D., Zimmermann, A. et al. Aspekte der perioperativen Behandlung von Diabetespatienten. Anaesthesist 62, 9–19 (2013). https://doi.org/10.1007/s00101-012-2089-y

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