Publication Type:

Journal Article

Source:

Journal of the Indian Medical Association, Volume 108, Number 1, p.52-55 (2010)

URL:

http://www.scopus.com/inward/record.url?eid=2-s2.0-77957377039&partnerID=40&md5=8bbda20dc8118309b09769ae49c7e471

Keywords:

2, 4 thiazolidinedione derivative, acute heart infarction, adrenalin, antidiabetic agent, article, Blood Glucose, Blood glucose monitoring, bloodstream infection, bolus injection, catecholamine, clinical protocol, Clinical trial, comorbidity, control strategy, critical illness, diabetes mellitus, englitazone, glibenclamide, gliclazide, glipizide, glomerulus filtration rate, glucagon, Glucose, glucose blood level, glucose homeostasis, glucose transport, Growth Hormone, heart infarction, heart surgery, hemoglobin A1c, human, Humans, hydrocortisone, hyperglycemia, hyperosmolar coma, hypoglycemia, Hypoglycemic Agents, immune deficiency, infection control, infusion rate, insulin, insulin aspart, insulin dependent diabetes mellitus, insulin detemir, insulin glargine, insulin infusion, insulin lispro, insulin treatment, intensive care unit, isophane insulin, ketoacidosis, kidney failure, length of stay, metformin, pathophysiology, Perioperative Care, perioperative period, polyneuropathy, potassium, practice guideline, Stroke, tissue oxygenation, Wound healing

Abstract:

It is generally agreed that it is important to control blood glucose levels during the peri-operative period. However, there have been controversies surrounding the appropriateness of each regimen, as well as ideal glucose targets during surgery. This review focuses on a simple and practical strategy to control glucose during surgery, and sets out simple guidelines on instituting an insulin infusion protocol. From the available evidence, a fasting plasma glucose <90mg/dl, postprandial glucose <180mg/dl and an HbA1c <7% is ideal before elective surgery. The blood glucose must be maintained between 140 and 180mg/dl during the operative period as well as during the intensive care unit (ICU stay). Sliding scales are inappropriate for in-hospltal glucose control. A basal-bolus insulin regimen is ideal for hospitalised perl-operative subjects outside the ICU. In the ICU, it is best to use an insulin infusion protocol for glucose control. The ideal regimen should be individualised for each patient. The success of peri-operative glucose control requires teamwork between the various medical personnel involved in patient care.

Notes:

cited By (since 1996)1

Cite this Research Publication

A. Ga Unnikrishnan and Prusty, Vb, “Peri-operative management of glucose”, Journal of the Indian Medical Association, vol. 108, pp. 52-55, 2010.