The following anesthetic plan is designed for a well regulated diabetic patient:
Premedication
Opioids and anticholinergics may be administered as warranted. Reversible drugs, or those with a short duration of action, are suggested for prompt recovery and return to a normal feeding schedule. Because of their antiinsulin effect, α2-agonists are generally not recommended. Acepromazine has a long duration of action; therefore, its use must be weighed carefully. Benzodiazepines may be considered as premedicants as long as the user recognizes that excitement (vs tranquilization) may be seen in some patients; the ability to reverse their actions is advantageous.
Anesthesia Induction
Propofol is recommended at 2 to 4 mg/kg IV with or without benzodiazepine at 0.1 to 0.3 mg/kg IV. Propofol has a short duration of action and facilitates a smooth recovery. Benzodiazepine helps reduce the dose. Of note, one study suggested that the propofol dose was not altered by the addition of benzodiazepine midazolam1; however, this was likely a result of study methodology, in which midazolam was given 2 minutes before propofol and resulted in excitement in dogs in this group.
Ketamine has a sympathomimetic effect and may increase blood glucose; thus, it is not generally recommended but may be used if blood glucose is monitored and hyperglycemia can be treated.
Anesthesia Maintenance
An inhaled anesthetic agent is recommended. Adjunct drugs (eg, opioid, lidocaine CRI) may be used to provide analgesia and/or decrease the inhaled anesthetic dose if warranted.
Periprocedural Analgesics
These analgesics are procedure dependent. NSAIDs are ideal if they are not contraindicated (eg, hypotension, renal or GI disease, concurrent steroid use), as they provide analgesia without sedation.
Support & Monitoring
In addition to routine support and monitoring, blood glucose concentrations should be monitored. Fluids may be supplemented with dextrose in hypoglycemic patients, whereas hyperglycemic patients may warrant insulin therapy.