Perioperative Management of Pediatric Surgical Patients With Diabetes Mellitus

摘要

Pediatric diabetic patients are managed with increasingly complicated regimens. For optimal management of these patients during the perioperative period, pediatric anesthesiologists must carefully consider the pathophysiology of the disease, patient-specific methods of treatment, the status of glycemic control, and the proposed surgery. Important pediatric considerations, including body size, pubertal development, and the ability to tolerate nil per os status, must be taken into consideration. To keep abreast of the array of options for treating diabetes in children, a plan should be developed in consultation with a pediatric endocrinologist. An algorithm has been developed at Children's Hospital Boston for the management of pediatric patients with either type 1 or 2 diabetes mellitus who present for surgery and general anesthesia. This collaborative effort between the pediatric anesthesia and endocrine services represents an example of a standardized approach to such patients that should facilitate care and improve management. Differences from previously published recommendations are highlighted, as are expected changes caused by the continuing evolution of pediatric diabetes care.