Anesthetic Management of Patient with Diabetes Mellitus

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You are an anaesthesiologist at the district hospital and have an appointment with patient Mr. Prochazka from the Department of Long-Term Care and Aftercare (80 years old, DM, COPD) for a preanaesthetic assessment before undergoing femoral amputation of the right lower limb for ischemia. He has already done an outpatient preoperative evaluation including the physical examination and some routine laboratory tests (coagulation tests, the complete blood count, fasting blood glucose, electrolytes and kidney function tests).
What further examinations are required?

Chest X-ray, spirometry, ECG.

Wrong answer

These aren’t any specific tests to determine the level of diabetes compensation.


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Chest X-ray, spirometry, ECG, glycated haemoglobin (HbA1c), urinalysis, blood urea nitrogen and creatinine in the blood.

Correct answer

Chest X-ray is indicated for all patients 60 years and older, ECG for patients over 40 years of age. Spirometry test results are required due to COPD in anamnesis, urea and creatinine tests - these are referred to as renal function studies. Glycated haemoglobin and urinalysis tests are stated for prediction of diabetes compensation.


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Chest X-ray, Lung scintigraphy, ECG, glycated haemoglobin (HbA1c), urinalysis.

Wrong answer

The lung ventilation scintigraphy is used to study the regional distribution of lung ventilation for diagnosing COPD. So it is unnecessary exposure to radiation.


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COPD = Chronic obstructive pulmonary disease×
 
RR

18 bpm

HR

85 bpm

SpO2

94 %

BP

138/90 mmHg

ECG

not available

Examination:
Anamnesis & Examination:
Past Medical History: Diabetes Mellitus type 2 (approximately 40 years), COPD (Moderate GOLD 2 severity), Mild class I obesity (BMI 31, 100 kg), arterial hypertension
Past surgeries: one year ago distal phalanx of the hallux and second finger amputation
Medications: Metformin 500 mg 3 times a day after meals.
Losartan - 50 mg once a day, Serevent® (salmeterol) - inhaler, 2 times a day 50 mg
Substance abuse/Habits: Ex-smoker - stopped 15 years ago (since 18 years old roughly 20 cigarettes per day) Other laboratory results: INR 0,9; aPPT 28 s

Gly

results

ABG

not available

CBC

results

biochemistry

results