Intraoperative glucose control in diabetic and nondiabetic patients during cardiac surgery

Smith, Charles E.; Styn, Nicholas R.; Kalhan, Satish C.; Pinchak, Alfred C.; Gill, Inderjit S.; Kramer, Richard P.; Sidhu, Tejbir S.

doi:10.1053/j.jvca.2005.01.032

Cited by 30 publications

(16 citation statements)

References 31 publications

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“…Smith et al . [15] found that hyperglycemia (blood glucose > 144 mg/dL) occurs in 73% nondiabetic patients following renal transplant. Prasad et al .…”

Section: Discussionmentioning

confidence: 99%

Intraoperative blood glucose levels in nondiabetic patients undergoing elective major surgery under general anaesthesia receiving different crystalloid solutions for maintenance fluid

et al. 2013

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Context:The study was undertaken to observe the effect of different maintenance-fluid regimen on intraoperative blood glucose levels in non-diabetic patients undergoing elective major non-cardiac surgery under general anesthesia.Aims:To know the intraoperative blood glucose levels.Settings and Design:Prospective randomized parallel group study.Subjects and Methods:Two hundred non-diabetic patients (100 in each group) aged between 18 years and 60 years were enrolled for this prospective randomized parallel group study. Group A patients received Ringer's lactate solution and Group B patients received 0.45% sodium chloride with 5% dextrose and 20 mmol/L potassium chloride as maintenance fluid. Capillary blood glucose (CBG) level was measured immediately before initiation of intravenous fluid therapy and thereafter hourly till the end of surgery. If at any time intraoperative CBG was found to be more than or equal to 150 mg/dL calculated dose of human soluble insulin was given as intravenous bolus equal to the amount of CBG/100 units.Statistical Analysis Used:For comparison of normally distributed variables independent sample t test was done. For rest of the data, i.e., CBG_0, CBG_4 and insulin consumption Mann-Whitney U test was employed.Results:63% patients in group B developed at least one episode of hyperglycemia CBG ≥ 150 mg/dL) but only 29% in the Group A did so. Insulin consumption was significantly higher in Group B than in Group A to maintain normoglycemia. The relative risk of becoming hyperglycemic in Group B patients is 2.172 (95% CI 1.544 to 3.057). Number needed to harm, i.e., hyperglycemia, in Group B is 2.941 (95% CI 2 to 5).Conclusions:We conclude that stress induced-hyperglycemic response in patients undergoing major non-cardiac surgery is common in non-diabetic population. Maintenance-fluid therapy by dextrose containing solution as opposed to Ringer's lactate solution increases the incidence of hyperglycemia. To achieve normoglycemia by intravenous bolus dose of human regular insulin, significantly higher doses are required in patients receiving dextrose containing saline as maintenance fluid.

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“…Smith et al . [15] found that hyperglycemia (blood glucose > 144 mg/dL) occurs in 73% nondiabetic patients following renal transplant. Prasad et al .…”

Section: Discussionmentioning

confidence: 99%

Intraoperative blood glucose levels in nondiabetic patients undergoing elective major surgery under general anaesthesia receiving different crystalloid solutions for maintenance fluid

et al. 2013

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“…[21][22][23] Results from the only randomized controlled trial of intraoperative glucose management indicated that targeting lower glucose values in the operating room did not confer benefit. 22 At the same time, a large body of evidence shows an association between 26,27 It may be prudent, safer, and more effective to improve glucose control, and therefore, decrease HbA 1c well before surgery. Our study has several limitations.…”

Section: Discussionmentioning

confidence: 99%

The relationship between glycosylated hemoglobin and perioperative glucose control in patients with diabetes

Moitra

Greenberg

Arunajadai

et al. 2010

Can J Anesth/J Can Anesth

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“…As many as 25% of general and vascular surgical patients are documentably diabetic, and an additional cohort exhibit glucose dyshomeostasis in response to surgical stress 11,20 . Indeed, both short‐term hyperglycemia and hyperinsulinemia in nondiabetic surgical patients are associated with decreased monocyte HLA‐DR expression, which correlates with surgical infection 14 .…”

Section: Compliance With Prophylactic Strategies: (We Must Do Better)mentioning

confidence: 99%

“…Indeed, both short‐term hyperglycemia and hyperinsulinemia in nondiabetic surgical patients are associated with decreased monocyte HLA‐DR expression, which correlates with surgical infection 14 . Intensive attention to glycemic control, in cardiac surgical patients, with a modified insulin clamp technique accomplished moderate success with nondiabetics and diabetics achieving blood sugars of 162 ± 8 mg/dL and137 ± 12 mg/dL, respectively 20 . It seems reasonable to assume that patients followed by less intensive strategies would suffer more frequent periods of hyperglycemia.…”

Section: Compliance With Prophylactic Strategies: (We Must Do Better)mentioning

confidence: 99%

Transforming the Surgical "Time-Out" Into a Comprehensive "Preparatory Pause"

et al. 2007

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We propose expansion of the standard "time-out" into a comprehensive "preparatory pause" encompassing five well-documented perioperative risk avoidance strategies: beta-adrenergic blockade, DVT prophylaxis, preoperative antibiotics, normothermia, and euglycemia. Although all members of the surgical team acknowledge the clear benefit of these five prophylactic strategies, published national compliance even in the target patient population is a disappointingly consistent 50%. We have developed and field-tested a "preparatory pause" form that we appended to our "surgical time-out." By politely challenging our surgical team as to the inclusion of these five risk avoidance strategies in 167 consecutive patients, we increased our compliance to more than 90% for each preventive measure. We have not attempted to quantify the physical and psychological benefit of complication avoidance due to the enhanced activation of these five prophylactic strategies. Using published surgical complication prevalence data, with and without these accepted risk avoidance measures, we estimate the number of complications per 100 patients avoided. Utilizing the Medicare payment schedule for each complication, we approximate the purely financial benefit of the "preparatory pause" to be $88,640 per 100 patients, or almost $900 per patient. The now standard surgical "time-out" is designed to avoid the gratifyingly uncommon problem of "wrong patient,""wrong procedure," and "wrong site." Many surgeons negotiate an entire career without stumbling over these disastrous problems. We propose expansion of the "time-out" to include five well-documented perioperative risk avoidance strategies that many of us overlook all too often.

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Intraoperative glucose control in diabetic and nondiabetic patients during cardiac surgery

Cited by 30 publications

References 31 publications

Intraoperative blood glucose levels in nondiabetic patients undergoing elective major surgery under general anaesthesia receiving different crystalloid solutions for maintenance fluid

Intraoperative blood glucose levels in nondiabetic patients undergoing elective major surgery under general anaesthesia receiving different crystalloid solutions for maintenance fluid

The relationship between glycosylated hemoglobin and perioperative glucose control in patients with diabetes

Transforming the Surgical "Time-Out" Into a Comprehensive "Preparatory Pause"

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