Perioperative maternal and neonatal acid-base status and glucose metabolism in patients with insulin-dependent diabetes mellitus.
Maternal and neonatal acid-base status and glucose metabolism were studied in 20 patients with insulin-dependent diabetes mellitus (group 1) undergoing elective cesarean section under lumbar epidural anesthesia. All patients were given glucose/insulin infusion before delivery. Fifteen healthy patients with iatrogenic hyperglycemia (group 2) and 15 healthy euglycemic patients (group 3) served as controls. Results were expressed as mean +/- 1 SE and were analyzed using analysis of variance and chi 2 analysis at P less than 0.05. No significant differences were seen at delivery either in maternal arterial and neonatal umbilical venous and arterial blood acid-base status or in neonatal Apgar scores among the three groups. Patients in groups 1 and 2 had larger blood glucose concentrations than those in group 3 (P = 0.01). Diabetic mothers and their neonates had a 25%-50% reduction in pyruvate concentration in maternal venous, and neonatal umbilical venous and arterial blood compared with that in the other two groups (P = 0.001). Postpartum neonatal hypoglycemia (less than 30 mg/dL) developed in seven of the group 1 neonates (P = 0.05). Thus, epidural anesthesia in diabetic women is associated with normal acid-base status in the mother and in the neonate. The data also show an increased incidence of neonatal hypoglycemia and altered maternal and neonatal glycolysis in patients with diabetes mellitus.
Ramanathan
S
S
Department of Anesthesiology, New York University Medical Center, New York 10016.
Khoo
P
P
Arismendy
J
J
D000328:Adult; D000767:Anesthesia, Epidural; D000773:Anesthesia, Obstetrical; D001786:Blood Glucose; D002045:Bupivacaine; D002585:Cesarean Section; D003922:Diabetes Mellitus, Type 1 / Q000378:metabolism*; D005260:Female; D005947:Glucose / Q000008:administration & dosage / Q000378:metabolism*; D006801:Humans; D007231:Infant, Newborn; D007332:Insulin Infusion Systems; D007432:Intraoperative Period; D007773:Lactates / Q000097:blood; D011247:Pregnancy; D011254:Pregnancy in Diabetics / Q000378:metabolism*; D011773:Pyruvates / Q000097:blood
D001786:Blood Glucose; D007773:Lactates; D011773:Pyruvates; D005947:Glucose; D002045:Bupivacaine