Title: A Comparative Study of the Effect of Spinal And General Anaesthesia on Blood Glucose Levels in Diabetic Patients
Authors: K.Sarda Devi, Ibemhal Heisnam, Surmila Khoirom, Seni Potsangbam, Rakesh Nongthombam
DOI: https://dx.doi.org/10.18535/jmscr/v5i7.76
Abstract
Aim of Study: Surgical stress produces metabolic as well as hormonal changes and these effects are even more pronounced in diabetics. Glycemic control is a very challenging task during surgical stress especially in diabetics. The aim of our study is to compare the effects of spinal and general anaesthesia on blood glucose level in diabetic patients.
Material and Methods: Forty diabetic patients controlled on oral hypoglycemic agent or insulin posted for elective surgical procedures were randomly divided into two groups I & II. Group I patients were given general anaesthesia and group II received spinal anaesthesia. In both the groups, blood glucose were recorded at pre-operative period, 30 minutes intra-operative, and 60 minutes intra-operative and at 20 minutes post-operative. The results were compared and studied statistically.
Results: The mean glucose level of group I (GA) and group II (SA) were comparable at pre-operative period. The values at 30 minutes, 60 minute intra-operative and 20 minute post-operative of group I (GA) are 127.45 + 13.69, 141.50 + 12.57 and 150.30 + 13.18 respectively. In group II the values are 120.50 + 9.82 at 30 minute and 124.05 + 10.56 at 60 minute intra-operative. At 20 minute post-operative it was 125.00 + 11.11. When these values are compared, group I (GA) patients showed a significant increase in blood glucose level than group II (SA) patients at all the time intervals, p (30 min) = 0.073, p (60 min) = 0.000, p (20 min post-operative) = 0.000.
Conclusion: The increase in blood glucose level during surgical stress in diabetics is less under spinal anaesthesia than under general anaesthesia.
Key Words: Blood glucose, diabetes, spinal anaesthesia, general anaesthesia.References
1. Smiley DD, Umpierrez GE. Peri operative glucose control in the diabetic or non-diabetic patient. South Med J. 2006; 99(6): 580 – 589.
2. Ramos M, Khalpey Z, Lipsitz S, Steinberg J. Relationship of peri operative hyperglycemia and post-operative infection in patients who undergo general and vascular surgery. Ann Surg. 2008; 248(4); 585 – 591.
3. Gandhi GY, NuttalGA, Abel MD, Mullany CJ. et al. Intra-operative hyperglycemia and perioperative outcome in cardiac surgery. Myo Clinic Proc. 2005; 80(7): 862 – 6.
4. J.P. Desborough. The stress response to trauma and surgery. Br J Anaesth 2000; 85: 109 – 17.
5. Furnary AP. Gao G, Greenkemeier GL, Wu Y, Zerr KJ, Bookin SO, Floten HS, Starr A. Continuous insulin infusion reduces mortality in patients with diabetes undergoing coronary artery bypass grafting. J Thorac Cardiovasc Surg. 2003; 125(5): 1007 –1021.
6. Smetana B, Milosavljevic, Aleksandar P, Pavlovic et al. Influence of spinal and general anaesthesia on the metabolic, hormonal and haemodynamic response in elective surgical patients. Med Sci Monit 2014; 20: 1833 – 40.
7. Pan H, Yang GR. The influence of haemodynamic and glucose in elder diabetics with combined spinal and epidural analgesia.Clin Edu Gen Pract 2010; 08:524-7.
8. Liu XM. Practical Endocrinology, 1997; Beijing P: Peoples Med Press, 269.
9. Quattara A, Lecomte P, Le Manach Y, Landi M et al. Poor intra-operative blood glucose control is associated with a worsened hospital outcome after cardiac surgery in diabetic patients. Anaesthesiology 2005; 104(4) : 813 – 20.
10. Duncan AE, Abd – Elsayed A, Maheshwari A, Xu M, Soltesy E, Koch CG. Role of intra operative and post-operative blood glucose concentration in predicting outcomes after cardiac surgery. Anaesthesiology. 2010; 112(4) : 860 – 71.
11. Andre Gottschalk, Birgit Rink, Smektala et al. Spinal anaesthesia protects against perioperative hyperglycemia in patients undergoing hip arthroplasty. J Clin Anesth 2014 Sep; 26(6): 455-60.
12. Moller IW. Hjortso E, Krantz T, Wandall E, Kehlet H. The modifying effect of spinal anaesthesia on intra and post-operative adrenocortical and hyperglycemic response to surgery. Acta Anaesthesiol Scand. 1984; 28(3): 266 – 9.
13. Fereshtch Amiri, Ali G Homeishi, Syed Mohammad Mehdi Aslani et al. Comparison of surgical stress responses during spinal and general anaesthesia in curettage surgery. Anesth Pain Med. 2014 August; 4(3): e 20554.
14. A. Ramakrishna Rao, P Indira. A comparative study of blood glucose levels under general anaesthesia in non-diabetic and controlled diabetic patients. 10SR Journal of Dental and Medical Sciences. Volume 14, Issue 10 ver 11 (Oct. 2015), PP51 – 56.
15. Li Xueqiong, Wang, Jinjing, Chen Kang et al. Effects of different types of anaesthesia on intra operative blood glucose of diabetic patients : A PRISMA – complaint systemic review and meta-analysis. Medicine. Issue: Volume 96(13), March 2017, P E 6451.