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ANESTHESIA ALERT
every 1 to 2 hours, depending on the procedure duration (generally, longer
than 2 hours) and insulin type used. For patients who have received insulin
and those with lower blood glucose levels, monitor more often as appropriate.
Blood glucose under 70mg/dl (4.0mmol/l) is an alert value for hypoglycemia.
If the patient is symptomatically hypoglycemic, have the patient consume 15
to 20gm of glucose, repeated until blood glucose rises and symptoms resolve.
Avoid overzealous glucose administration, as hyperglycemia can lead to postop complications.
7
Post-operative discharge
Aim for blood glucose levels in the ideal range before discharge.
Observe patients until the possibility of hypoglycemia from perioperatively
administered insulin has been ruled out.
8
Post-discharge advice
Instruct patients to check blood glucose levels frequently while fasting.
Remind them to use their hypoglycemia treatments if they begin to feel symptomatic. Advise them to delay transition to daily pre-op antidiabetic regimens
if normal caloric intake is delayed. OSM
Dr. Joshi (g irish.joshi@utsouthwestern.edu) is professor of anesthesiology and
pain management at the University of Texas Southwestern Medical School in Dallas.
He's also the director of perioperative medicine and ambulatory anesthesia at
Parkland Health and Hospital Systems in Dallas.
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O U T PAT I E N T S U R G E R Y M A G A Z I N E O N L I N E | O C T O B E R 2012
