CO 2 Combining Power of the Blood Plasma Before and After Ethylene Anesthesia in Diabetics Protected With Insulin.

Abstract

Formerly diabetics were regarded as very poor surgical risks. Not only was there fear of infection and poor healing but the effect of a general anesthetic was dreaded. Since the advent of insulin it has been shown that diabetics may be operated upon with almost the same degree of safety as normal individuals. Even in normal persons the administration of general anesthetics may produce an acidosis. The metabolism may be profoundly affected. The post-operative period of vomiting and starvation contribute still further to the threat of acidosis. The administration of a general anesthetic to a diabetic, therefore, has been in the past a matter of no small concern. In spite of this there have been apparently recorded in the literature few definite observations as to the alkali reserve of the blood in diabetics under anesthetics and afterwards. The only 2 references I have been able to find in the insulin era have been those of Rabinowitch 1 and McKittrick and Root. 2 The former gives data as to the pH and CO₂ combining power in 2 diabetics under ether. He does not state whether insulin was used. McKittrick and Root state: “We have used the plasma CO₂ combining power as the best index of acidosis and it is true in 15 cases a reduction in this value occurred as a result of operation, with a return to normal within 24 hours due to the use of insulin and carbohydrate food.” Rabinowitch pointed out: “The finding of a low CO₂ combining power in the plasma does not always necessarily denote acidosis. The lowered CO₂ combining power may be due merely to the increased pulmonary ventilation accompanying anesthetics.