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A prospective clinical study of Glycemic control in well controlled type ii diabetes mellitus patients subjected to operative procedures under regional versus general Anaesthesia

Author: 
Dhulkhed, V. K., Pavan Dhulkhed, Bilal Mohammad, Indrajit Gupta and Gagandeep Singh
Subject Area: 
Health Sciences
Abstract: 

Background: Surgery and anaesthesia by itself is a stress. Although a normal patient goes through it without adverse effects, in a patient with insulin dependent diabetes it can lead to significant hyperglycaemic reaction. It was observed that a skillfully conducted regional anaesthesia is better as far as glycemic control is concerned and overall outcome of the patient postoperatively, compared to general anaesthesia (GA) technique. Therefore, we though it prudent to test our hypothesis on patients with well controlled diabetes, on insulin therapy, to compare regional versus GA technique. Method: We recruited 120 patients with well controlled DM on subcutaneousinsulin scheduled for surgery in this comparative clinical study into two groups, Group ITGA (Intratracheal General Anaesthesia) and Group NB (Neuraxial Block) of 60 each.The blood sugar levels were recorded before induction, intraoperatively every 20 minutes and post-operatively every hourly till 5 hours. The systolic and diastolic blood pressure, heart rate and SPO2 were recorded every 20 minutes intraoperatively and post-operatively. Result: BSL was significantly higher immediately after induction, intraoperatively and postoperatively at all levels in group ITGA compared to group NB. Insulin requirement was more in ITGA group as compared to NB group intraoperatively and postoperatively. Wound healing was better in group NB as compared to group ITGA. Conclusion: In well controlled diabetic type 2 patients subjected to surgery, glycemic control under ITGA was poor compared to those under NB intra and post operatively and that the patients in former group needed early and more repeated insulin supplementation to control BSL to desired level.

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