Insulin resistance (IR) is one of the common complications during the perioperative period, usually accompanied by elevated blood glucose, which seriously affects the prognosis of patients. Its mechanism is mainly related to neuroendocrine and inflammatory factors directly or indirectly interfering with insulin pathway. The choice of anesthetics and anesthesia methods affect the outcome of patients after surgery, but the effect on perioperative IR remains controversial. This article mainly expounds the epidemiology and mechanism of perioperative IR, and introduces the anesthetic methods and the influence of narcotic drugs on it, and summarizes the latest progress of perioperative blood glucose management, in order to provide reference for the prevention of perioperative IR.