Changes in blood glucose in diabetic patients during cataract surgery which manner is better?

Resumen

Background: Surgery is a kind of trauma which Hemodynamic, metabolic and hormonal responses. Anesthesia and Analgesia can cause extra stress for body.   blood glucose levels can be measured as an indicator of stress factors, Blood glucose rising in Diabetic patient is unpleasant. Method: 60 diabetic patients aged between 40 and 70 treated with oral glycemic agents that underwent elective Blood glucose level was scaled by BioNime GM 100 half an hour prior to anesthesia or sedation, exactly after anesthesia or sedation and after surgery. After OR admission, patients underwent standard monitoring like ECG, NIBP and pulse-oximetry. First group was anesthetize by Topical Anesthesia with Tetracaine and second group was anesthetized by Retrobulbar Block. Prior to anesthesia, in both groups, sedation was performed with 2mg Midazolam and 1 µgr/kg Fentanyl. For the third group, candidate for General Anesthesia, 1.5 mg/kg Propofol was administered for induction and 0.5 mg/kg Atracorium was used for preparing appropriate muscle relaxation before intubation. After successful tracheal intubation, patients were ventilated with Isoflurane on its maintenance dosage 1.5% V/V. Patients of 3^rd group were extubated after surgery and the reverse of muscle relaxants. As mentioned, blood glucose level was assessed and recorded exactly after anesthesia, exactly after surgery and every 30 minutes after entering the recovery room. Result: In the group underwent General Anesthesia changes during surgery and after it are statistically significant (P<0.05). In groups underwent Retrobulbar block and Topical anesthesia no significant change in BS after anesthesia, during surgery or after it .no significant difference between blood glucose levels after anesthesia among three groups. changes in BS at the time of entering recovery room and 30 minutes after it are statistically significant in all patients The last measured BS, 30 minutes after recovery, was higher in patients under went general anesthesia than in other patients with topical anesthesia or Retrobulbar block . It means that in patients underwent general anesthesia, the rise of blood glucose level is not only higher but also more persistent. Conclusion: General Anesthesia impose more stress to patients than two other methods. the rise of blood glucose level is not only higher but also more persistent.