Texte 3Â : période peropératoire

Perioperative hyperglycemia (> 1.80 g/L or 10 mmol/L) is associated with increased morbidity (particularly infection) and mortality. It is managed by decreasing blood sugar levels with insulin. Control of blood sugar levels between 0.90 and 1.80 g/L (5-10 mmol/L) helps to avoid hypoglycemia, which is more frequent when strict normoglycemia is aimed for. Adequate glycemic control should be the aim in the intraoperative period. We propose insulin therapy administered via an infusion pump in T1D and T2D patients if required or in cases of stress hyperglycemia. Stopping the patient's personal insulin pump requires immediate replacement with a hospital infusion pump. Additional elements of intraoperative management include the recommendation of a dose of 4 mg dexamethasone for the prophylaxis of nausea and vomiting, rather than 8 mg, combined with another antiemetic drug. The use of regional anaesthesia (RA), when possible, allows better control of postoperative pain and should be preferred. The analgesic requirements are greater in patients with poorly controlled blood sugar levels than in those with HbA1c < 6.5%. Prevention of hypothermia, use of RA and multimodal analgesia which allows a more rapid recovery of transit, limitation of blood loss, early ambulation and minimally invasive surgery are the preferred measures to mitigate perioperative insulin resistance. Finally, diabetes does not alter the usual rules for fasting and antibiotic prophylaxis.