Acarbose


  Issues for Surgery


Increased risk of post-operative infection and delayed wound healing due to poor glycaemic control when omitted.

Hypoglycaemia if continued during nil by mouth (NBM) period.


  Advice in the Perioperative period


Elective Surgery

Acarbose should be taken as normal the day prior to surgery1.

Morning Surgery
Omit morning dose if nil by mouth1, 2.

Afternoon Surgery
Take morning dose if eating1, 2.

Emergency Surgery

In the event of emergency surgery and the patient has already taken their acarbose dose(s) monitor capillary blood glucose (CBG) levels closely and treat any hypoglycaemia accordingly.

Perioperative Considerations 

Commence variable rate intravenous insulin infusion (VRIII) perioperatively where indicated (see Further Information) and omit acarbose during VRIII treatment1.

Ensure emergency treatment of hypoglycaemia is prescribed i.e. Glucogel® and 20% dextrose. Rapid acting insulin should also be prescribed1, 2.

Post-operative Advice

Restart once eating and drinking normally and VRIII (where applicable) has been stopped1.


  Interaction(s) with Common Anaesthetic Agents


None2, 3.

  Interaction(s) with other Common Medicines used in the Perioperative Period


None2, 3.

  Further Information


VRIII

Patients with a planned short starvation period (no more than one missed meal in total) should be managed by modification of their usual diabetes medication, avoiding VRIII wherever possible (although VRIII may be necessary if emergency surgery or in people with poorly controlled diabetes (HbA1c >69mmol/mol))1. Patients with type 2 diabetes who are expected to miss more than one meal should have VRIII if they develop hyperglycaemia (CBG >12mmol/L)1.


  References


  1. Centre for Perioperative Care. Guideline for Perioperative Care for People with Diabetes Mellitus Undergoing Elective and Emergency Surgery (March 2021). Available at: https://cpoc.org.uk/guidelines-resources/guidelines [Accessed on 8th March 2021]
  2. Joint Formulary Committee. British National Formulary (online) London: BMJ Group and Pharmaceutical Press. http://www.medicinescomplete.com [Accessed on 27th February 2021]
  3. Summary of Product Characteristics – Acarbose 100mg Tablets. Glenmark Pharmaceuticals Europe Ltd. Accessed via www.medicines.org.uk 27/02/2021 [date of revision of the text December 2018]