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Perioperative Management of Pediatric Patients With Type 1 Diabetes Mellitus, Updated Recommendations for

Lizabeth D Martin1, Monica A Hoagland2, Erinn T Rhodes3

  • 1From the Department of Anesthesiology, University of Washington, Division of Pediatric Anesthesiology, Seattle Children's Hospital, Seattle, Washington.

Anesthesia and Analgesia
|November 6, 2019
PubMed

Insights

Pediatric patients with type 1 diabetes mellitus (T1D) require careful perioperative management, including fasting, insulin, and glucose monitoring. Guidelines address anesthesia for T1D children, focusing on insulin pumps and continuous glucose monitoring (CGM).

Area of Science:

  • Pediatric Anesthesiology
  • Endocrinology
  • Metabolic Disorders

Background:

  • Type 1 Diabetes Mellitus (T1D) affects approximately 1 in 300 US children, necessitating specialized anesthetic care.
  • Perioperative management for pediatric T1D patients is complex, requiring attention to fasting, insulin, and glucose regulation.
  • Anesthetic decisions are influenced by glycemic control, insulin regimens, procedure type, and recovery expectations.

Framework:

  • A multi-institutional working group from the Society for Pediatric Anesthesia Quality and Safety Committee developed evidence-based recommendations.
  • The framework synthesizes current endocrinology and anesthesia literature for perioperative T1D care.
  • Best practice involves preoperative planning with patient endocrinologists.

Implementation:

  • Recommendations cover preoperative evaluation, intraoperative glucose monitoring, and insulin administration strategies.
  • Guidelines address fluid management and postoperative care for pediatric T1D patients.
  • Specific attention is given to managing insulin pumps and continuous glucose monitoring (CGM) devices.

Implications:

  • Standardized guidelines improve perioperative safety and outcomes for children with T1D.
  • Enhanced understanding of T1D perioperative needs supports anesthesiologists.
  • Integration of modern glucose monitoring technologies (CGM) is crucial for optimal patient management.

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