Changes in blood glucose level during and after light sedations using propofol-fentanyl and midazolam-fentanyl in diabetic patients who underwent cataract surgery

Abstract

Background:Surgeries may trigger the stress response which leads to changes in blood glucose level, and studies suggest that different sedation and anesthesia methods have different effects on blood glucose level. The aim of this study was to investigate changes of blood glucose levels in diabetic patients and compare them in two sedation methods of propofol + fentanyl and midazolam + fentanyl.Materials and Methods:Totally, 80 diabetic candidates for cataract surgery who had all the inclusion criteria, underwent cataract surgery using two methods of propofol (1 mg/kg/h) + fentanyl (2 μg/kg) (Group P) and midazolam (0.03 mg/kg) + fentanyl (2 μg/kg) (Group M) for light sedation. In the end, 70 patients (Group P n = 35 and Group M n = 35) remained in the study. Patients’ blood glucose levels, vital signs, and hemodynamic data were assessed 30 min prior to the surgery, each 15 min during surgery and at the end of surgery.Results:Hemodynamic parameters did not have a statistically significant difference between the two groups mean blood glucose level in Group M was 149.15 mg/dl and in Group P was 149.2 mg/dl, and based on repeated measures analysis of variance test, significant differences were not observed between the two groups (P = 0.99). T-test showed no significant differences in the blood glucose level at any time of the study between the two groups.Conclusions:Light sedation methods of propofol + fentanyl and midazolam + fentanyl did not have any differences in alteration of blood glucose level.

Preemptive Midazolam Can Reduce the Glycemic Stress Response to Surgery for Type-2 Diabetics Undergoing Simple Eye Surgery

“…The obtained results supported that previously reported non-significant difference between different sedatives used for either pre-medication, induction or as adjuvant during anesthesia as regards the control of glycemic stress response to anesthesia and/or surgery [15,16,17] . Moreover, the obtained results were superior to that obtained by Tilak et al, [18] who reported non-significant differences in the percent of increase in BGC between patients who received midazolam or placebo and concluded that preoperative administration of midazolam did not cause attenuation of the hyperglycemic response compared to the placebo group.…”

“…Also, Tian et al [27,28] experimentally found the GABAA-R positive allosteric modulators work in conjunction with GABA secreted from β -cells to increase β -cell survival and replication [27] and treatment with GABAA-R agonists enhanced β -cell replication and survival in a human islet xenograft model [28] . Interestingly, the controlling effect of midazolam on BGC had extended till the end of surgery and this supported previous works, which reported that midazolam can control surgery induced hyperglycemia during and till end of surgery [16,17] .…”

Impact of Anesthesia Type on Blood Glucose in Intraoperative Diabetic Patients: A Systematic Review and Meta-Analysis Randomized Control Trial

“…Thus, 7 RCT studies met the requirements of the selection criteria and proceeded to the next stage of the study. We reported 519 populations from seven studies included in the meta-analysis [10][11][12][13][14][15][16]. The process of identifying studies in the data base then, screening, eligibility and include can be seen in the PRISMA flow chart (Figure 1).…”

Effects of Intravenous Anesthesia on the Plasma Glucose Level During Cataract Surgery Among Patients With Type II Diabetes

“…Patients with diabetes are known to have worse morbidity and mortality when undergoing surgery, and hyperglycemia is associated with worse patient outcomes (9)(10)(11)(12). Hyperglycemia is an important risk factor for both intraoperative and postoperative complications, including infection such as wound infection, urinary tract infection, or septicemia (13).…”

“…Although there is convincing evidence that shows preoperative glucose control reduces postoperative morbidity and even mortality, the science behind this issue is debatable (4,5). Elevated glucose is thought to contribute to coronary endothelial dysfunction, platelet dysfunction, amplifying ischemic reperfusion injury, and eradicating ischemic preconditioning (6)(7)(8)(9)(10)(11)(12)(13). Every precaution to prevent perioperative hyperglycemia should be taken, including the appropriate choice of intravenous (IV) sedatives and anesthetics for diabetic patients, given our growing understanding of the detrimental effects of hyperglycemia on postoperative infections and neurological, renal, and cardiovascular complications.…”