Hyperglycaemia and ambulatory surgery (the H2A study)

Polderman, J; Eshuis, Jan H.; DeVries, J. H.; Hollmann, Markus W.; Preckel, Benedikt; Hermanides, Jeroen

doi:10.1097/00003643-201206001-00102

Cited by 3 publications

(41 citation statements)

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“…[31][32][33][34][35] Furthermore, preoperative hyperglycemia and elevated HbA1c levels are predictive for postoperative hyperglycemia after ambulatory surgery. 10 These data suggest that improvement of preoperative glucose regulation in patients with DM should be pursued and the surgical procedure even postponed both for better perioperative glycemic control and prevention of postoperative complications. 11 This holds true especially for ambulatory surgery when monitoring of blood glucose is often limited.…”

Section: Perioperative Hyperglycemia and Complicationsmentioning

confidence: 95%

“…6,[15][16][17] In a prospective cohort study in ambulatory patients, DM was found to be a risk factor for postoperative complications after minor ambulatory surgery, such as postoperative infections or unplanned admissions. 10 Hyperglycemia (glucose .7.…”

Section: Perioperative Hyperglycemia and Complicationsmentioning

confidence: 99%

“…64 The fear of hypokalemia when administering insulin infusion without potassium during short procedures does not seem to be justified. 10 Insulin pumps can be continued intraoperatively, especially if the surgical procedure is expected to be of short duration. However, some considerations should be taken into account.…”

Section: Intraoperative Considerationsmentioning

confidence: 99%

“…However, it is known that DM is an important risk factor for postoperative complications (such as wound infections or unplanned admissions) in surgical outpatients. 10 The recently updated Joint British Diabetes Societies/National Health Service (JBDS/NHS) guideline states that sameday admission should be standard of care in patients with DM unless other serious comorbidities are present. 11 Therefore, the preoperative assessment plays a major role in the management of DM during ambulatory surgery.…”

Section: Introductionmentioning

confidence: 99%

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Ambulatory anesthesia: optimal perioperative management of the diabetic patient

Polderman¹,

Wilpe²,

Eshuis³

et al. 2016

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Given the growing number of patients with diabetes mellitus (DM) and the growing number of surgical procedures performed in an ambulatory setting, DM is one of the most encountered comorbidities in patients undergoing ambulatory surgery. Perioperative management of ambulatory patients with DM requires a different approach than patients undergoing major surgery, as procedures are shorter and the stress response caused by surgery is minimal. However, DM is a risk factor for postoperative complications in ambulatory surgery, so should be managed carefully. Given the limited time ambulatory patients spend in the hospital, improvement in management has to be gained from the preanesthetic assessment. The purpose of this review is to summarize current literature regarding the anesthesiologic management of patients with DM in the ambulatory setting. We will discuss the risks of perioperative hyperglycemia together with the pre-, intra-, and postoperative considerations for these patients when encountered in an ambulatory setting. Furthermore, we provide recommendations for the optimal perioperative management of the diabetic patient undergoing ambulatory surgery.

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Section: Perioperative Hyperglycemia and Complicationsmentioning

confidence: 95%

Section: Perioperative Hyperglycemia and Complicationsmentioning

confidence: 99%

Section: Intraoperative Considerationsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Ambulatory anesthesia: optimal perioperative management of the diabetic patient

Polderman¹,

Wilpe²,

Eshuis³

et al. 2016

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“…Экспериментальным путем доказано, что уровень стрессовых реакций напрямую зависит от объема хирургической травмы. Малый объем травмы оказывает незначительное влияние на развитие гликемии [18]. Данный постулат представляется особенно важным в рамках программ ускоренного выздоровления.…”

Section: патофизиологическое обоснованиеunclassified

Enchanсed recovery. Relevance, history, pathophysiology.

Vorobev¹,

Белобородов²,

Тухиев³

2022

ECU

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Introduction. The Enhanced Recovery Program (ERP), Fast Track surgery (FTS), and ERAS (enhanced recovery after surgery/rapid recovery after surgery programs) is a multimodal and multidisciplinary treatment strategy designed to reduce the duration of disability and improve the quality of medical care. This program includes preparation at the preoperative stage, the use of minimally invasive techniques for performing surgical intervention and active management of the postoperative period to reduce the duration of inpatient treatment, rehabilitation time and the fastest possible return of patients to normal life. One of the key factors for the success of the ERP is the introduction of multidisciplinary interaction at all stages of examination and treatment. The history of the development of enhanced recovery programs is briefly described, the relevance of the development and application of an optimized treatment strategy, the problems of integration and multidisciplinary are described. The review of the features of the pathophysiology of perioperative stress and practical conclusions justifying the development and application of elements of the enhanced recovery program are presented.

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Effect of dexamethasone administration for postoperative nausea and vomiting prophylaxis on glucose levels in adults with diabetes undergoing elective surgery: a systematic review with meta-analysis

Dimmen,

Timko,

Greenwood

et al. 2023

JBI Evidence Synthesis

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Objective: The objective of this review was to evaluate the effect of intravenous dexamethasone given intraoperatively for postoperative nausea and vomiting prophylaxis on maximal blood glucose level within the initial 24 hours following elective surgery in patients with diabetes. Introduction: Postoperative nausea and vomiting is a prevalent adverse effect of anesthesia that leads to morbidity, increased health care costs, and unanticipated hospital admissions. Dexamethasone is an effective prophylactic agent that confers secondary analgesic and anti-inflammatory benefits. However, its use in patients with diabetes remains controversial due to the potential for increased postoperative blood glucose levels. Inclusion criteria: This review considered studies with participants 18 years of age or older with type 1 or 2 diabetes undergoing an elective surgical procedure. Eligible studies reported postoperative blood glucose levels in adults with diabetes after receiving a single 4-10 mg prophylactic dose of intravenous dexamethasone intraoperatively for postoperative nausea and vomiting. The primary outcome was maximum blood glucose level in the first 24 hours after surgery. All study designs were eligible for inclusion. Studies were excluded if they lacked a control group with diabetes or if they did not report maximum blood glucose values in both groups. Methods: A search of MEDLINE, CINAHL Complete, Embase, Web of Science, TRIP database, and the Cochrane Database of Systematic Reviews was completed in October 2021. Gray literature resources were also searched. No date or language restrictions were applied. Methodological quality was assessed using JBI appraisal tools for randomized controlled trials, cohort studies, and case-control studies. A meta-analysis of maximal postoperative blood glucose level within 24 hours of surgery was performed, as well as subgroup analyses by dexamethasone dose, insulin treatment, and study design type. Results: Eleven studies (4 randomized controlled trials, 6 cohort studies, and 1 case-control study) were included in this review, with 1 study excluded from meta-analysis and results reported narratively. The total sample size of studies included in meta-analysis was 2567. The administration of dexamethasone significantly increased maximal blood glucose levels in the 24 hours immediately following surgery compared with control groups with diabetes, as demonstrated by randomized controlled trials (mean difference [MD] 39.56 mg/dL; 95% CI 16.18 to 62.94; P < 0.001; I 2 = 87%) and observational studies (MD 26.31 mg/dL; 95% CI 7.10 to 45.52; P = 0.007; I 2 = 92%). This increase in blood glucose was significant for all doses of dexamethasone: 4 mg (MD 40.81 mg/dL; 95% CI 2.42 to 79.19; P = 0.001; I 2 = 91%), 8 mg (randomized controlled trials only; MD 39.45 mg/dL; 95% CI 15.32 to 63.58; P = 0.001; I 2 = 86%), and mixed 4-10 mg dose (MD 30.82 mg/dL; 95% CI 6.75 to 54.88; P < 0.012; I 2 = 93%). Postoperative hyperglycemia persisted in studies using insulin treatment as well as those not using insulin protocols. The overall certainty of the findings ranged from very low for outcomes that included cohort studies to moderate when outcomes from randomized controlled trials were analyzed separately. However, the quantitative findings of the experimental and observational studies were clinically similar. Risk of bias presented minimal concerns in all included studies. Conclusions: Dexamethasone leads to transient postoperative hyperglycemia in patients with diabetes undergoing elective surgery when given as a single 4-10 mg intravenous dose for postoperative nausea and vomiting prophylaxis. The clinical relevance of hyperglycemia is debatable given its small magnitude and transient nature. Without more tightly controlled data, methodological consistency, and baseline blood glucose values, it is impossible to test causal links between hyperglycemia and preexisting patient factors (eg, hemoglobin A1C levels) or postoperative complications. Review registration: PROSPERO CRD42020185607

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Hyperglycaemia and ambulatory surgery (the H2A study)

Cited by 3 publications

References 0 publications

Ambulatory anesthesia: optimal perioperative management of the diabetic patient

Ambulatory anesthesia: optimal perioperative management of the diabetic patient

Enchanсed recovery. Relevance, history, pathophysiology.

Effect of dexamethasone administration for postoperative nausea and vomiting prophylaxis on glucose levels in adults with diabetes undergoing elective surgery: a systematic review with meta-analysis

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