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Obstetric Anesthesia for Co-morbid Conditions pp 31–51Cite as

Anesthesia for the Pregnant Diabetic Patient

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Abstract

Diabetes mellitus (DM) is a group of metabolic disorders characterized by hyperglycemia. Especially Type 2 DM has a steadily increasing prevalence because of obesity, and this has led the anesthesiologists to meet more women at childbearing age diagnosed with DM. Additionally, parturients, who are unable to produce enough insulin to compensate insulin resistance in the second or third trimester of pregnancy, are diagnosed with gestational DM. The leading risk factors are advanced maternal age, obesity, family history of Type 2 DM, and previous diagnosis of gestational DM.

Diabetes mellitus can be associated with acute and chronic complications affecting both the mother and the fetus during pregnancy. Therefore, optimal glycemic control, appropriate obstetric management of existing and probable complications (hypoglycemia, diabetic ketoacidosis, nonketotic hyperosmolar state, microvascular and macrovascular complications, etc.), detailed preanesthetic evaluation (autonomic neuropathy, stiff joint, etc.), appropriate analgesic, and anesthetic management are of utmost importance in parturients with DM.

Epidural analgesia is the most commonly used technique for vaginal delivery to provide excellent labor pain management. In terms of anesthesia, epidural technique is again of choice when a parturient with DM has a chronic uteroplacental insufficiency. If urgent Cesarean delivery is required, spinal anesthesia is usually preferred over general anesthesia because of its safety profile. In the anesthetic management of parturients with DM, particular attention should be paid to the increased risk of hypotension and aspiration.

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  1. Istanbul University, Istanbul Faculty of Medicine, Department of Anesthesiology and Intensive Care, Istanbul, Turkey

    Emine Aysu Salviz

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  1. Department of Anesthesiology, Gazi University School of Medicine, Ankara, Turkey

    Berrin Gunaydin

  2. Department of Anaesthesiology, Aga Khan University, Karachi, Pakistan

    Samina Ismail

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Salviz, E.A. (2018). Anesthesia for the Pregnant Diabetic Patient. In: Gunaydin, B., Ismail, S. (eds) Obstetric Anesthesia for Co-morbid Conditions. Springer, Cham. https://doi.org/10.1007/978-3-319-93163-0_3

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