Management of diabetes during surgery: 30 yr of the Alberti regimen.

satisfaction for carotid endarterectomy performed under local anaesthesia. properties of local anesthetics and their present and potential clinical implications. Anesthetic technique for radical prostatectomy surgery affects cancer recurrence: a retrospective analysis. regional analgesia reduce the risk of recurrence after breast cancer? Methodology of a multicenter randomized trial. In 1979, the British Journal of Anaesthesia published an article by Alberti and Thomas 1 in which they introduced the i.v. infusion of a premixed bag of glucose – insulin – potassium for the metabolic management of diabetic patients in the perioperative period. The Alberti regimen has been superceded in many centres by the use of separate infusions of insulin (usually 1 U ml 21) and glucose with or without potassium. 2 Although the separate infusions offer greater flexibility, they lack the inherent safety of the combined regimen. The article reviewed the management of diabetic surgical patients in detail, in addition to the description of the Alberti regimen, and it is apposite to reexamine this seminal paper when there is great interest currently in glucose control in surgical patients, both diabetic and non-diabetic. 3 In their introductory remarks, Alberti and Thomas noted the need for a logical and straightforward set of guidelines for treating diabetic patients during and after surgery and that many of the regimens recommended in 1979 were irrational if not dangerous. It is to be hoped that 30 yr later, the current guidelines are both logical and safe, but there is little evidence to support the regimens described in standard anaesthetic textbooks. 4 – 6 The authors discussed first the normal endocrine and metabolic response to starvation and surgery and then how this may be modified in the diabetic patient. They commented that starvation was generally the fate of the surgical patient, despite the best intentions of the clini-cians. Although there have been undoubted improvements in decreasing the duration of preoperative starvation, postoperative starvation has not received the same attention in many centres. The detailed description of the metabolic changes occurring in starvation is striking even 30 yr later and it is regrettable that this key knowledge is still lacking in some clinicians managing surgical patients. Alberti and Thomas emphasized that during starvation in type 1 diabetics, the restraining effects of basal insulin on catabolism are lost and that catabolism 'runs riot' when catabolic hormone secretion increased during surgery. The provision of insulin with sufficient carbohydrate, 180 g day 21 …