PERI-OPERATIVE :
PERI-OPERATIVE The physical stress associated with surgery typically results in acute hyperglycemia, which adversely affects immune function and wound healing.
MAJOR SURGERY :
MAJOR SURGERY Improved postoperative glycemic control (4.5 – 6.0 mmol/L) using a continuous intravenous insulin infusion along with continuous feeding significantly decreases morbidity and mortality for patients who require postoperative intensive care and mechanical ventilation after major surgery.
Intensive insulin management requires the development of protocols and staff training to ensure effectiveness and to minimize hypoglycemia.
MINOR AND MODERATE SURGERY :
MINOR AND MODERATE SURGERY The appropriate perioperative glycemic targets for minor or moderate surgeries are less clear.
It is reasonable to target glucose levels of 5.0 - 11.0 mmol/L in these cases.
RISK OF HYPOGLYCEMIA :
RISK OF HYPOGLYCEMIA The benefits of improved perioperative glycemic control must be weighed against the risk of perioperative hypoglycemia, which may be masked by the actions of anesthetic agents, or other drugs. The risk of hypoglycemia can be reduced by frequent capillary glucose monitoring.
PERIOPERATIVE GLYCEMIC CONTROL- RECOMMENDATIONS :
PERIOPERATIVE GLYCEMIC CONTROL- RECOMMENDATIONS A continuous IV insulin infusion should be used to achieve glycemic levels of 4.5 to 6.0 mmol/L in postoperative patients who require intensive care and mechanical ventilation and demonstrate hyperglycemia (random PG > 6.1 mmol/L) [Grade A, Level 1A].
A continuous IV insulin infusion should be used to maintain intraoperative glycemic levels between 5.0 and 11.0 mmol/L for patients with diabetes undergoing cardiac surgery [Grade C, Level 3].
Perioperative glycemic levels should be maintained between 5.0 and 11.0 mmol/L for most other surgical situations [Grade D, Consensus].