Perioperative Management of Pediatric Surgical Patients with Diabetes Mellitus

Taking into account that stress and diabetic hyperglycemia is an independent risk factor for increased mortality in surgical patients with metabolic syndrome, an increase in the time spent by patients in intensive care units and the cost of treatment, it is important to carry out treatment, in particular, infusion therapy with the appointment of drugs that do not increase glucose levels and help to reduce the need for insulin in patients with diabetes mellitus in the postoperative period. Aim is to assess the effectiveness of the drug Xylat as an integral component of intensive care for patients with metabolic syndrome in perioperative period. Materials and methods. The study was conducted in 21 women with metabolic syndrome who underwent urgent surgical intervention for tumors in pelvic area. All patients received Xylat (Yuria-Pharm) – 5-6 ml/kg/day, 50-70 drops/min for 3 days in the postoperative period. The control group consisted of 15 women with metabolic syndrome, who underwent surgical treatment in the regional clinical hospital for ovarian tumors, but received alternative infusion therapy during the postoperative period (according to archived case histories). Results. The data of our study showed that the drug Xylatum (Yuria-Pharm) helps to reduce the risk of the severity of stress hyperglycemia, suppresses the risk of lactacidemia, provides energy support for postoperative patients with diabetes mellitus with an insulin+independent metabolism, and stimulates the production of endogenous insulin in critically ill patients. Conclusions. With the use of Xylate, the tolerance to carbohydrates increases. It has a very low glycemic index, antiketogenic properties, does not adversely affect the central nervous system, the exchange of hormones and neurotransmitters. The research was carried out in accordance with the principles of the Helsinki Declaration. The study protocol was approved by the Local Ethics Committee of these Institutes. The informed consent of the patient was obtained for conducting the studies. No conflict of interest was declared by the authors. Key words: surgical patients, diabetes mellitus, hyperglycemia, infusion therapy, metabolic syndrome, Xylatum.

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Evaluation and perioperative management of patients with diabetes mellitus. A challenge for the anesthesiologist

Brazilian Journal of Anesthesiology (English Edition) ◽

10.1016/j.bjane.2017.06.002 ◽

2018 ◽

Vol 68 (1) ◽

pp. 75-86

Author(s):

João Paulo Jordão Pontes ◽

Florentino Fernandes Mendes ◽

Mateus Meira Vasconcelos ◽

Nubia Rodrigues Batista

Keyword(s):

Diabetes Mellitus ◽

Perioperative Management ◽

Patients With Diabetes

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Point-of-care ultrasound defines gastric content in elective surgical patients with diabetes mellitus: a prospective cohort study

10.21203/rs.2.11800/v1 ◽

2019 ◽

Author(s):

Li Zhou ◽

Yi Yang ◽

Lei Yang ◽

Wei Cao ◽

Heng Jing ◽

...

Keyword(s):

Diabetes Mellitus ◽

Risk Factors ◽

Gastric Content ◽

Point Of Care ◽

Surgical Patients ◽

Eye Disease ◽

Diabetic Patients ◽

Clear Fluid ◽

Full Stomach ◽

Patients With Diabetes

Abstract Background Delayed gastric emptying and the resultant “full stomach” is the most important risk factor for perioperative pulmonary aspiration. Using point-of-care gastric sonography, we aimed to investigate the prevalence of full stomach and its risk factors in elective surgical patients with diabetes mellitus. Methods Diabetic and non-diabetic elective surgical patients were included from July 2017 to April 2018 in a 1:1 ratio. Gastric ultrasound was performed 2h after ingesting clear fluid or 6h after a light meal. Full stomach was defined by the presence of gastric content in both semi-recumbent and right lateral decubitus positions. For patients with full or intermediate stomach, consecutive ultrasound scan was performed until empty stomach was detected. Logistic regression analyses were used to identify risk factors associated with full stomach. Results Fifty-two diabetic and fifty non-diabetic patients were analyzed. The prevalence of full stomach was 48.1% (25/52) in diabetic patients, with 44.0% for 2-hour fast after clear fluid and 51.9% for 6-hour fast after a light meal, significantly higher than 8% (4/50) in non-diabetic patients (P=0.000). The average time to empty stomach in diabetic patients was 146.50±40.91 mins for clear liquid and 426.50±45.25 mins for light meal, respectively. Further analysis indicated that presence of diabetes-related eye disease was an independent risk factor of full stomach in diabetic patients (OR=4.83, P=0.010). Conclusions Almost half of diabetic patients have a full stomach following the current preoperative fasting guideline. Preoperative ultrasound assessment of gastric content in diabetic patients is recommended, especially for those with diabetes mellitus-related eye disease. Key words: diabetes mellitus; gastric emptying; regurgitation and aspiration; ultrasonography

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Evaluating Perioperative Glycemic Control of Non-cardiac Surgical Patients with Diabetes

Military Medicine ◽

10.1093/milmed/usaa467 ◽

2020 ◽

Author(s):

L Alan Todd ◽

Robert A Vigersky

Keyword(s):

Diabetes Mellitus ◽

Cardiac Surgery ◽

Blood Glucose ◽

Glycemic Control ◽

Medical Record ◽

Electronic Medical Record ◽

Perioperative Period ◽

Poor Glycemic Control ◽

Surgical Patients ◽

Patients With Diabetes

ABSTRACT Introduction Hyperglycemia during the perioperative period has generally been accepted as a contributor of poor outcomes in patients with diabetes mellitus undergoing surgery. Although an optimal glycemic range has not been clearly established in the literature, a consensus among national medical organizations generally recommends serum glucose levels to be maintained less than 180 mg/dL during the perioperative period. Materials and Methods The primary purpose of this evidence-based project was to identify the range of blood glucose values obtained from adult patients with diabetes mellitus undergoing non-cardiac surgery at a large military medical facility. The secondary purpose of this project was to assess the need for change in future practice. A retrospective review of the electronic medical record was conducted to identify adult surgical patients with diabetes scheduled for non-cardiac surgery. Preoperative and postoperative blood glucose values were obtained from the electronic medical record. The frequency of blood glucose values maintained within the recommended range of 140-180 mg/dL was recorded. Additional demographic data were collected to include age, height, weight, body mass index, length of surgery, and insulin/oral glycemic medications. Results Of the 9,449 surgeries performed between January 1, 2013, and December 31, 2013, there were 762 (8%) adult non-cardiac surgical patients identified with either a diagnosis of diabetes or a blood glucose value reported during the perioperative period. The recommended blood glucose range of 140-180 mg/dL was achieved in 31.3% (179 of 572) of patients before surgery and 28.6% (71 of 248) after surgery. A blood glucose value was not recorded before or after surgery in 24.9% (190 of 762) of patients identified as having pre-diabetes or diabetes. Conclusion Diabetes is a frequent finding in surgical patients. Monitoring blood glucose values during the perioperative period may allow for early treatment and prevent complications related to poor glycemic control. The results of this project revealed 2 potential areas of improvement in the care of non-cardiac surgical patients with diabetes: (1) improving compliance with obtaining blood glucose values before and after surgery and (2) reducing the incidence of postoperative hyperglycemia (>180 mg/dL) which potentially could prevent avoidable complications related to poor glycemic control.

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