Perioperative management of adult patients with concomitant diabetes mellitus: guidelines of the All-Russian public organization “Federation of Anesthesiologists and Reanimatologists” (second revision)

Abstract

Diabetes mellitus is a proven predictor of postoperative complications, especially infectious and cardiac, and also significantly increases the risk of mortality. The article presents a revision of the national guidelines of the Federation of Anesthesiologists and Reanimatologists (FAR) on the perioperative management of adult patients with diabetes mellitus, which summarizes and evaluates all available data at the time of revision on this topic. The literature search was focused on meta-analyses and randomized controlled trials, but also included registries, non-randomized comparative and descriptive studies, case series, cohort studies, systematic reviews, and expert opinions. Before publication, the guidelines were approved by the Presidium of the FAR Board. In the revised version of 2022, changes were made in comparison with the previous one: the preoperative diagnosis of cardiac autonomic neuropathy using a deep breathing test and an orthostatic test was justified, the principles of elective surgery canceling depending on the level of glycated hemoglobin and the tactics of preoperative oral hypoglycemic drugs prescribing were presented. The choice between general and regional anesthesia based on the detection of cardiac autonomic neuropathy and polyneuropathy was also justified, the choice of drugs for anesthesia and the principles of their dosing were reasoned, antiemetic therapy was determined. For each recommendation, the level of evidence is presented. The guidelines were developed by experts in the field of perioperative management of patients for anesthesiologists and intensive care specialists to help in decision-making, the final decisions concerning an individual patient must be made by the by the attending physician after consultation with an endocrinologist and/or based on the decision of the council of specialists.