Page 94 - GALENIKA MEDICAL JOURNAL

Zaključak

Glavni ciljevi perioperativnog liječenja djece sa DM su izbjegavanje velikih varijacija glikemije i
ketoacidoze. Primjenom provjerenih protokola i vodiča svjetskih udruženja za dijabetes kod djece
i adolescenata (ISPAD i ACDC) koji predviđaju svaku situaciju u perioperativnom periodu moguće
je ostvariti ove ciljeve, smanjiti komplikacije i imati dobar ishod hirurškog liječenja. Zbog toga je
preporuka da se pacijenti sa DM operišu u specijalizovanim dječjim zdravstvenim ustanovama, uvijek

kada je to moguće, naročito kada su u pitanju visokorizične, kompleksne hirurške intervencije.

Abstract

Diabetes mellitus is a chronic and insidious disease that can occur at all ages, including childhood. The disease, its
diagnosis, treatment, and complications have certain specificities in children compared to adults with the same condition.
Less frequently than in adults, diabetes mellitus can be a comorbidity in pediatric surgical patients. Less frequently than
in adults, diabetes mellitus can be a comorbidity in pediatric surgical patients. Perioperative metabolic stress occurs as
a result of changes in routine diabetes management, emotional stress and anxiety, the surgical condition, and the type
of surgical procedure. The perioperative management of children with diabetes depends on preoperative therapeutic
regimens (insulin vs oral hypoglycemics), the complexity of the surgical intervention, and the duration of preoperative and
postoperative fasting. A thorough understanding of the disease from all aspects (type of diabetes, type of therapy, degree
of metabolic control, chronic complications) is crucial for preoperative preparation or making decisions about postponing
elective surgery or urgent treatment to prepare for emergency surgery. It has been proven that the use of evidence-
based protocols for the perioperative management of children with diabetes in various medical situations results in better
treatment outcomes. However, acute perioperative complications such as ketoacidosis, hyperglycemic hyperosmolar states,
and hypo/hyperglycemia can still occur. Therefore, increased caution is necessary when dealing with pediatric surgical
patients with diabetes mellitus.

Keywords: diabetes mellitus, child, anesthesia, surgical procedures, insulin, complications of diabetes

Literatura 8. Black AE, McEwan A. Management of diabetes in pediatric surgery.
In: Hall GM, Hunter JM, Cooper MS,eds. Core Topics in Endocrinology
in Anaesthesia and Critical Care.Cambridge University Press, 2010;
1. Stevanović V, Kalezić N, Vranić A, Mandraš A, Zdravković V. Specifičnosti 11:109-16.
perioepartivnog liječenja djece sa dijabetesom melitusom, u:Kalezić N. 9. Cengiz E, Danne T, Ahmad T, Ayyavoo A, Beran D, Ehtisham S et al.
Perioperativna medicina 2, 2021; 23:543-62.
ISPAD Clinical Practice Consensus Guidelines 2022: Insulin treatment in
2. Kalezić N, Stevanović K, Antonijević V, Ivošević T, Cvetković A, Lakićević children and adolescents with diabetes. Pediatr Diabetes 2022;23:1277-
M at al. Značaj i načini adekvatne perioperativne glikoregulacije. Četvrti 96.
Beogradski anestezija forum, Zbornik radova 2019:p-26-34. 10. Cote CJ, Lerman J, Anderson B. Essentials of Endocrinology. A Practice of
3. Vojislav C, Natasa R, Milica P, Slobodan A, Radivoj K, Danijela R, et al. Anesthesia for Infants and Children. Philadelphia:Elsevier,2019:2813-39.
Incidence trend of type 1 diabetes mellitus in Serbia. BMC Endocr 11. Stevanović K, Sabljak V, Kalezić N. Anaesthesia and the patient with
Disord. 2020 Mar 9;20(1):34. diabetes. Diabetes Metab Syndr2015;9(3):177-9.
4. Shah AS, Zeitler PS, Wong J , Pena AS, Wicklow B, Arslanian S et al. 12. Kalezić N, Velickovi J, Janković R, Sabljak V, Zivaljević V, Vucetić C.
ISPAD Clinical Practice Consensus Guidelines 2022: Type 2 diabetes in Preoperative preparation of patient with diabetes mellitus. Acta Chir
children and adolescents. Pediatr Diabetes 2022;23:872-902. Iugosl. 2011;58(2):97-102.
5. Pinhas-Hamiel O, Zeitler P. Type 2 Diabetes in Children and Adolescents- 13. Kapellen T, Chizo Agwu J, Martin L, Kumar S, Rachmiel M, Cody D, et
A Focus on Diagnosis and Treatment. [Updated 2023 Nov 7]. In: al. ISPAD clinical practice consensus guidelines 2022: Management
Feingold KR, Anawalt B, Blackman MR, et al., editors. Endotext of children and adolescents with diabetes requiring surgery .Pediatr
[Internet]. South Dartmouth (MA): MDText.com, Inc.; 2000-. Available Diabetes 2022;23:1468–77.
online: https://www.ncbi.nlm.nih.gov/books/NBK597439/
14. Kershaw M, Short J, Chizo Agwu J, Ng SM, Edge JA, Drew JH, et al. Care
6. American Diabetes Association; 2. Classification and Diagnosis of of children under 18 years with Diabetes Mellitus undergoing Surgery
Diabetes: Standards of Medical Care in Diabetes—2020. Diabetes Care 1 or MRI under GA. Association of Children’s Diabetes Clinicians 2021:1-
January 2020; 43 (Supplement_1): S14–S31. Available online: https://doi. 13.
org/10.2337/dc20-S002
15. De Bock M, Codner E, Craig ME, Huynh T, Maahs DM, Mahmud FH.
7. Libman I, Haynes A, Lyons S, Pradeep P, Rwagasor E, Yuet-ling ISPAD Clinical Practice Consensus Guidelines 2022: Glycemic targets
Tung J et al. ISPAD Clinical Practice Consensus Guidelines 2022: and glucose monitoring for children, adolescents, and young people
Definition, epidemiology, and classification of diabetes in children and with diabetes. Pediatr Diabetes. 2022;23:1270-6.
adolescents. Pediatr Diabetes 2022;23:1160-74.

92 DOI: 10.5937/Galmed2411078S