A Comparison of Two Regimens for the Management of Diabetes during Open-heart Surgery

Elliott, Martin J.; Gill, Geoffrey; Home, Philip; Noy, George A.; Holden, Michael P.; Alberti, K. G. M. M.

doi:10.1097/00000542-198404000-00017

Cited by 17 publications

(7 citation statements)

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“…The failure of many children to mount an appropriate insulin response to hyperglycaemia during hypothermia has lead to the suggestion that glucose-containing fluids should be totally avoided during hypothennic open-heart surgery (Benzing et al 1983). An exaggerated hyperglycaemic response to endogenous and exogenous catecholamines has been reported during hypo-thermic CPB (Elliott et al 1984). If exogenous insulin needs to be administered during CPB, larger than anticipated doses may be required due to the large volume of distribution, as well as adsorption to bypass tubing (Thomas, Hinds & Rees 1983;Hirsch et al 1991).…”

Section: Discussionmentioning

confidence: 99%

“…If exogenous insulin needs to be administered during CPB, larger than anticipated doses may be required due to the large volume of distribution, as well as adsorption to bypass tubing (Thomas, Hinds & Rees 1983;Hirsch et al 1991). The warming phase of CPB is associated with a rapid rise in serum glucose concentration and insulin requirements (Elliott et al 1984).…”

Section: Discussionmentioning

confidence: 99%

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Anaesthetic management of an insulin‐dependent diabetic child during cardiopulmonary bypass

Stevenson

Modlinski

Silverman

et al. 1993

Pediatric Anesthesia

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Anaesthetic management of an insulin‐dependent diabetic child during cardiopulmonary bypass

Stevenson

Modlinski

Silverman

et al. 1993

Pediatric Anesthesia

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“…Myocardial glucose uptake and oxidation at the expense of FFA oxidation occurs during the first hour after crossclamp release 45 . Rewarming is associated with a rapid increase in plasma glucose and a similar increase in insulin requirements 52 . In a study of patients who were not diabetic, one group of researchers found that BG levels returned to baseline within two postoperative hours, 52 but other researchers indicate that patients who are diabetic experienced a continued rise in glucose levels 27 , 52 .…”

Section: Behavioral Objectivesmentioning

confidence: 99%

“…Rewarming is associated with a rapid increase in plasma glucose and a similar increase in insulin requirements 52 . In a study of patients who were not diabetic, one group of researchers found that BG levels returned to baseline within two postoperative hours, 52 but other researchers indicate that patients who are diabetic experienced a continued rise in glucose levels 27 , 52 . One group of researchers terminated their investigation because patients experienced erratic BG levels, including extreme hypoglycemia, during the immediate postoperative period 34 …”

Section: Behavioral Objectivesmentioning

confidence: 99%

“…During CABG procedures, dextrose‐based prime and cardioplegia solutions should be avoided, and lactate‐based solutions should be used with caution in patients who are known to be diabetic. Blood glucose monitoring during CABG procedures using a continuous monitoring device provides more information than intermittent sampling because glucose levels change rapidly 30 , 52 . At a minimum, blood glucose levels should be monitored every 15 minutes during CABG procedures.…”

Section: Behavioral Objectivesmentioning

confidence: 99%

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Perioperative blood glucose control during adult coronary artery bypass surgery

Lorenz¹,

Lorenz²,

Codd³

2005

AORN Journal

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Coronary artery bypass graft (CABG) procedures are among the most frequently performed surgical procedures in the United States. People with cardiovascular disease who also have diabetes have a greater risk of poor outcomes after CABG procedures than patients who do not have diabetes. This literature review examines current information regarding perioperative blood glucose (BG) control. It emphasizes BG control in adults during the hypothermic period of cardiopulmonary bypass. Hyperglycemia, not the diagnosis of diabetes, significantly increases the risk of adverse clinical outcomes, longer hospitalizations, and increased health care costs.

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The Care of the Diabetic Patient During Surgery

Gill

Alberti

2004

International Textbook of Diabetes Mellitus

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Most diabetic patients will require surgery at some time in their lives, and this presents problems for glycemic control. Surgery involves a period of starvation, and also the metabolic response to trauma includes counterregulatory hormone hypersecretion (e.g., adrenaline, cortisol, etc.), which opposes insulin action. The major factor influencing the management of diabetes during surgery is assessment of the patient's insulin reserves. Thus, those on insulin treatment (whether they are true type 1, or insulin‐treated type 2 patients) should be assumed to have little or no endogenous insulin reserves, and a system of continuous insulin and glucose delivery is necessary. Those not on insulin, however, clearly have their own insulin reserves and, provided they have reasonable preoperative glycemic control, for all but major surgery simple glycemic observation is usually all that is needed. Delivery of insulin and glucose may be by “separate lines” (intravenous (IV) glucose infusion with a separate IV insulin pump), or by a combined glucose–potassium–insulin infusion. The latter is easier to manage on lower‐staffed general wards, and the former is particularly flexible and suitable for critical care situations with more metabolically unstable patients and higher levels of staffing. Whichever system is used, patients must have regular blood glucose and plasma electrolyte monitoring, with appropriate insulin adjustments to maintain good glycemic control. With good preoperative control and assessment, and well organized and appropriate perioperative management, the risks of surgery in diabetic patients should in most cases be similar to nondiabetic rates.

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A Comparison of Two Regimens for the Management of Diabetes during Open-heart Surgery

Cited by 17 publications

References 0 publications

Anaesthetic management of an insulin‐dependent diabetic child during cardiopulmonary bypass

Anaesthetic management of an insulin‐dependent diabetic child during cardiopulmonary bypass

Perioperative blood glucose control during adult coronary artery bypass surgery

The Care of the Diabetic Patient During Surgery

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