Anesthesiologist’s Guide to Perioperative Glycemic Management

Abdelmalak, Basem

doi:10.1097/asa.0000000000000008

Cited by 2 publications

(1 citation statement)

References 51 publications

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“…Hyperglycemia is associated with poor outcomes such as postoperative infections, acute renal failure, acute myocardial infarction, increase 30-d mortality and longer intensive care unit (ICU) and hospital stays[ 52 ]. It has been reported that nearly 12%-30% of patients without previous history of diabetes may have hyperglycemia during surgery[ 3 , 51 ].…”

Section: Intraoperative Management Of Diabetes Mellitusmentioning

confidence: 99%

Perioperative challenges in management of diabetic patients undergoing non-cardiac surgery

Galway¹,

Chahar²,

Schmidt³

et al. 2021

WJD

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Prediabetes and diabetes are important disease processes which have several perioperative implications. About one third of the United States population is considered to have prediabetes. The prevalence in surgical patients is even higher. This is due to the associated micro and macrovascular complications of diabetes that result in the need for subsequent surgical procedures. A careful preoperative evaluation of diabetic patients and patients at risk for prediabetes is essential to reduce perioperative mortality and morbidity. This preoperative evaluation involves an optimization of preoperative comorbidities. It also includes optimization of antidiabetic medication regimens, as the avoidance of unintentional hypoglycemic and hyperglycemic episodes during the perioperative period is crucial. The focus of the perioperative management is to ensure euglycemia and thus improve postoperative outcomes. Therefore, prolonged preoperative fasting should be avoided and close monitoring of blood glucose should be initiated and continued throughout surgery. This can be accomplished with either analysis in blood gas samples, venous phlebotomy or point-of-care testing. Although capillary and arterial whole blood glucose do not meet standard guidelines for glucose testing, they can still be used to guide insulin dosing in the operating room. Intraoperative glycemic control goals may vary slightly in different protocols but overall the guidelines suggest a glucose range in the operating room should be between 140 mg/dL to 180 mg/dL. When hyperglycemia is detected in the operating room, blood glucose management may be initiated with subcutaneous rapid-acting insulin, with intravenous infusion or boluses of regular insulin. Fluid and electrolyte management are other perioperative challenges. Notably diabetic ketoacidosis and hyperglycemic hyperosmolar nonketotic state are the two most serious acute metabolic complications of diabetes that must be recognized early and treated.

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Section: Intraoperative Management Of Diabetes Mellitusmentioning

confidence: 99%

Perioperative challenges in management of diabetic patients undergoing non-cardiac surgery

Galway¹,

Chahar²,

Schmidt³

et al. 2021

WJD

View full text Add to dashboard Cite

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The Role Multimodal Pain Management Plays With Successful Total Knee and Hip Arthroplasty

Warren

Froehlich

Feldman

2019

Topics in Geriatric Rehabilitation

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Approaching the best way to treat and manage a patient's surgical pain following total joint arthroplasty is a challenging task. To reduce the use of opioids, we utilize many different methods working together in a synergistic way. This is the true core of multimodal pain control. This task can be accomplished with a driven effort from the interdisciplinary team mostly comprising of but not limited to the surgeon, regional anesthesiologist, nurse, and physical therapist. The team addresses education of the patient, anesthesia type, medications, and nonpharmacological interventions within the development of the pain management plan. Achieving the goal of safe, effective pain management, in this population, will lead to improved outcomes, patient satisfaction, and enhanced functional life of patients.

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Anesthesiologist’s Guide to Perioperative Glycemic Management

Cited by 2 publications

References 51 publications

Perioperative challenges in management of diabetic patients undergoing non-cardiac surgery

Perioperative challenges in management of diabetic patients undergoing non-cardiac surgery

The Role Multimodal Pain Management Plays With Successful Total Knee and Hip Arthroplasty

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