Armendariz-Buil Ignacio, Lobato-Solores Felix, Aguilera-Celorrio Lucianob
Introduction and objectives: International Diabetes Federation (IDF) estimates that worldwide there are 415 million adults aged 20-79 with diabetes mellitus (DM). Although diabetes mellitus (DM) is a highly prevalent disease, only a handful of studies have examined the neuromuscular function in diabetic patients. Even more surprising is this data, if we think that neuromuscular blockade (NMB) is an essential part in the induction and maintenance of general anesthesia. NMB is induced by neuromuscular blocking agents (NMBA). The aim of this review is to update the knowledge of neuromuscular blockade in diabetes mellitus and its implications in clinical practice. Material and Methods: Studies on neuromuscular function in DM were reviewed to establish the pathophysiological bases. Subsequently, all the literature that included clinical studies on neuromuscular block in diabetic patients was revised. Clinical key and PubMed data bases were used. Results: The first pathophysiological studies date back to the 60s: Lawrence noted that nerve conduction in peripheral nerves was slower in diabetic patients, even when they had not yet developed clinical neuropathy. Different works found a significant prolongation in the parameters of recovery of neuromuscular function in diabetic patients after administration of vecuronium or rocuronium (amino-steroid NMBA). We also know that time to train-onfour (TOF) ratio 0.90 (DURTOF90) was delayed in patients with type 2 DM. This variable is related with the risk of residual neuromuscular block (RNMB). Monitoring and reversal of neuromuscular blockade are the main measures to prevent the occurrence of RNMB. Regarding the reversal of NMB, when neostigmine is used, the action time delayed appears in diabetic patients. However, time of reversal with sugammadex show no significant differences between type 2 diabetic patients and non-diabetic patients. Conclusion: Diabetic patients, even though they have not developed clinical neuropathy, have delayed recovery time after administration of NMB. NMB monitoring and reversal are the main measures and do not prevent RNMB. Reversal with sugammadex (selective reversal of amino-steroid agents) seems not to show difference between diabetics and non-diabetics. Furthermore, there are still many unanswered questions in the field of research of NMB in diabetic population.
