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British Journal of Anaesthesia, 1995, Vol. 74, No. 5 500-505
© 1995 The Board of Management and Trustees of the British Journal of Anaesthesia

research-article

Metabolic control of non-insulin-dependent diabetic patients undergoing cataract surgery: comparison of local and general anaesthesia

J. P. BARKER, MB, BS, FRCA, P. N. ROBINSON, MB, BS, FRCA, G. C. VAFIDIS, MB, BS, FRCA, J. M. BURRIN, BSC, PHD, MRCPATH, S. SAPSED-BYRNE and G. M. HALL, MB, BS, PHD, FIBIOL, FRCA

Department of Anaesthesia, Edgware General Hospital Edgware, Middlesex HA8 0AD
Department of Ophthalmology, Edgware General Hospital Edgware, Middlesex HA8 0AD
London Hospital Medical School Turner Street, London E1 2AD
Hammersmith Hospital, Royal Postgraduate Medical School London W12 0HS
St George's Hospital Medical School London SW17 0RE

We studied 40 elderly patients undergoing cataract surgery. Ten non-insulin-dependent diabetes mellitus (NIDDM) patients received standardized general anaesthesia, 10 NIDDM patients received local anaesthesia using retrobulbar block, 10 nondiabetic control patients received general anaesthesia and 10 non-diabetic controls received retrobulbar block. We measured sequential changes in blood glucose, lactate and ß-hydroxybutyrate, serum cortisol and insulin, and plasma non-esterified fatty acid concentrations until 4 h after operation. The results showed that in both general anaesthesia groups, NIDDM and control, blood glucose and serum cortisol concentrations increased significantly during surgery, before returning to normal by 4 h after operation; in both local anaesthesia groups, glucose and cortisol concentrations changed little during surgery. Serum insulin concentrations increased 30 mm after operation to coincide with the peak of the glucose increase in the non-diabetic patients who received general anaesthesia, but no insulin response was seen in the diabetic general anaesthesia patients. Blood glucose and insulin concentrations increased in patients who received local anaesthesia (NIDDM and controls) when they ate after operation. The results show that cataract surgery under local anaesthesia provides improved metabolic control for the diabetic patient. Its use maintains glucose homeostasis, prevents the increases in cortisol and glucose which are seen under general anaesthesia and obviates the need for postoperative starvation. (Br. J. Anaesth. 1995; 74: 500–505)


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