Open AccessPerioperative Management of Pediatric Patients With Type 1 Diabetes Mellitus, Updated Recommendations for Anesthesiologists
Author(s) -
Lizabeth D. Martin,
Monica Hoagland,
Erinn T. Rhodes,
Joseph I. Wolfsdorf,
Jennifer L. Hamrick,
James J. Fehr,
Ellen Kim,
Kalie L. Tommerdahl,
Stephen J. Gleich,
Vikas N O’Reilly-Shah,
Steve Tosone,
Kathrine Keech,
Genevieve M D’Souza,
Anita Honkanen
Publication year - 2020
Publication title -
anesthesia and analgesia/anesthesia and analgesia
Language(s) - English
Resource type - Journals
eISSN - 1526-7598
pISSN - 0003-2999
DOI - 10.1213/ane.0000000000004491
Subject(s) - medicine , perioperative , glycemic , type 1 diabetes , insulin , diabetes mellitus , intensive care medicine , pediatric endocrinology , regimen , type 2 diabetes mellitus , diabetes management , anesthesia , surgery , type 2 diabetes , pediatrics , endocrinology
Approximately 1 of every 300 children in the United States has type 1 diabetes mellitus (T1D), and these patients may require anesthetics for a variety of procedures. Perioperative coordination is complex, and attention to perioperative fasting, appropriate insulin administration, and management of hypo- and hyperglycemia, as well as other metabolic abnormalities, is required. Management decisions may be impacted by the patient's baseline glycemic control and home insulin regimen, the type of procedure being performed, and expected postoperative recovery. If possible, preoperative planning with input from the patient's endocrinologist is considered best practice. A multi-institutional working group was formed by the Society for Pediatric Anesthesia Quality and Safety Committee to review current guidelines in the endocrinology and anesthesia literature and provide recommendations to anesthesiologists caring for pediatric patients with T1D in the perioperative setting. Recommendations for preoperative evaluation, glucose monitoring, insulin administration, fluid management, and postoperative management are discussed, with particular attention to increasingly prevalent insulin pumps and continuous glucose monitoring (CGM).