Blood Glucose Regulation During Living-Donor Liver Transplant Surgery

Abstract

Objectives: The goal of this study was to compare the effects of 2 different regimens on blood glucose levels of living-donor liver transplant. Materials and Methods:The study participants were randomly allocated to the dextrose in water plus insulin infusion group (group 1, n = 60) or the dextrose in water infusion group (group 2, n = 60) using a sealed envelope technique. Blood glucose levels were measured 3 times during each phase. When the blood glucose level of a patient exceeded the target level, extra insulin was administered via a different intravenous route. The following patient and procedural characteristics were recorded: age, sex, height, weight, body mass index, end-stage liver disease, Model for End-Stage Liver Disease score, total anesthesia time, total surgical time, and number of patients who received an extra bolus of insulin. The following laboratory data were measured pre-and postoperatively: hemoglobin, hematocrit, platelet count, prothrombin time, international normalized ratio, potassium, creatinine, total bilirubin, and albumin. Results: No hypoglycemia was noted. The recipients exhibited statistically significant differences in blood glucose levels during the dissection and neohepatic phases. Blood glucose levels at every time point were significantly different compared with the first dissection time point in group 1. Excluding the first and second anhepatic time points, blood glucose levels were significantly different as compared with the first dissection time point in group 2 (P < .05). Conclusions:We concluded that dextrose with water infusion alone may be more effective and result in safer blood glucose levels as compared with dextrose with water plus insulin infusion for living-donor liver transplant recipients. Exogenous continuous insulin administration may induce hyperglycemic attacks, especially during the neohepatic phase of living-donor liver transplant surgery. Further prospective studies that include homogeneous patient subgroups and diabetic recipients are needed to support the use of dextrose plus water infusion without insulin.

Mobile Game: Tecnologia Educacional Para Cuidados Domiciliares Do Paciente Submetido Ao Transplante Hepático

“…A insulina, em muitos casos, tem uma ação importante para prevenir a hiperglicemia, visto que alguns imunossupressores utilizados na terapêutica pós-THx têm efeitos de reduzir a secreção da insulina pelo órgão [21][22][23] . Autores internacionais pontuam a necessidade do controle rigoroso da glicemia no sentido de prevenir disfunção precoce do enxerto, além de minimizar o risco de infecções [24][25] .…”

“…Estudos de produções tecnológicas desenvolvidos com o apoio do método DCU destacam no passo a passo da construção da ferramenta a participação dos usuários. Esses autores explicam que a participação permite aos usuários o ajuste e a reformulação de etapas que não estão claras [19][20][21][22][23][24][25][26][27][28][29][30][31][32] . Ainda, pautando a importância do DCU em metodologias ágeis para avaliação de usabilidade, o método DCU pode trazer benefícios para empresas, pesquisadores e usuários.…”

Mobile Game: Educational Technology for Home Care of Patients Undergoing Liver Transplantation

“…Insulin, in many cases, has an important action to prevent hyperglycemia, since some immunosuppressants used in post-HTx therapy have the effect of reducing insulin secretion by the organ [21][22][23] . International authors point out the need for strict blood glucose control in order to prevent early graft dysfunction, in addition to minimizing the risk of infections [24][25] .…”

“…Studies of technological productions developed with the UCD method support highlight user participation in the step-by-step of tool construction. These authors explain that participation allows users to adjust and reformulate steps that are not clear [19][20][21][22][23][24][25][26][27][28][29][30][31][32] . Furthermore, based on the importance of UCD in agile methodologies for usability assessment, the UCD method can bring benefits to companies, researchers and users, as it includes improving user experience, customer satisfaction and reducing rework as well as identifying opportunities for innovation 32 .…”