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ANESTHESIA ALERT
should be postponed; however, you should always consider comorbidities and
the risk of surgical complications. Postpone surgery if the patient is suffering
significant complications of hyperglycemia, such as severe dehydration,
ketoacidosis and hyperosmolar non-ketotic states, on the morning of surgery.
If the patient is only hyperglycemic, proceed with a plan for perioperative
glycemic control.
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Intraoperative monitoring and prevention
In patients with well-controlled diabetes, intraoperative blood glucose
levels should be maintained at less than 180mg/dl. Don't try to acutely
decrease (normalize) the level in the chronically elevated patient. To maintain
optimal blood glucose in the first set of patients, administer subcutaneous
rapid-acting insulin analogs perioperatively using the "rule of 1,800 or 1,500."
This is meant to represent the ratio of expected decrease in blood glucose
with each unit of insulin used. For example, if a patient's daily insulin dose is
60 units, 1 unit of insulin would reduce the blood glucose level by 25 to 30mg
(for example, 1,800/60 or 1,500/60).
Enact PONV-prevention protocols, as patients with diabetes are more prone
to post-op nausea, and need to return to normal feeding more quickly, to prevent glycemic complications. You can use dexamethasone 4mg, but you
should follow it with appropriate monitoring of blood glucose levels.
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Perioperative blood glucose monitoring and management
Check blood glucose levels upon the patient's arrival to the facility and
before discharge home. Perform intraoperative blood glucose monitoring
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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
