Diabetes and anaesthesia in the era of eras PDF
Preview Diabetes and anaesthesia in the era of eras
REFERENCES : Endotext.org Diabetes Manager : Perioperative Management of Diabetic Patients: New Controversies. Aldam, Levy & Hall BJA 2014 :Society of Ambulatory Anesthesia (SAMBA) Consensus Statement on Perioperative Blood Glucose Management in Diabetic Patients Undergoing Ambulatory Surgery PRINCIPLES OF ERAS : The patient presents for surgery in the best possible condition : The patient is maintained in the best possible condition peri-operatively : The patient then recovers faster from their surgery. ERAS AND DIABETES PERI-OPERATIVELY : The patient has well controlled diabetes – HbA1c is less than 8 : All complications of diabetes are considered thoughtfully and checked if necessary. : Perioperatively the blood glucose is kept within a suitable range. : Hypoglycaemia is bad. : Hyperglycaemia is bad. : Glycaemic variability is bad. : Ketoacidosis is REALLY bad. : Hyperosmolar states are REALLY bad. THE SAMBA ARTICLE : Take a focussed history – what is the usual BGL, what is the hypo point, is the patient fairly self-sufficient or do they need guidance? : How do we manage oral anti-diabetic medication? : How do we manage insulin? : Is there a blood glucose level at which we should cancel surgery? : What is the optimal intra-operative BGL? : How do we maintain optimal BGL? : What is the optimal peri-operative glucose monitoring? : How should we identify and treat hypoglycaemia? : What discharge advice should we give? THE BJA ARTICLE : Utility of HbA1c : Perioperative use of metformin : Optimal dose of peri-operative long acting insulin. : Ideal blood glucose range and measurement error. UTILITY OF HBA1C : Now being used : HbA1c over 8 has diagnostically been associated with quadrupled : High values mortality after strongly cardiac surgery. associated with poor outcomes PERIOPERATIVE USE OF METFORMIN : Traditionally stopped to avoid lactic acidosis. : No risk of hypoglycaemia : Continuation peri-operatively actually associated with better outcomes : Avoid combining with prolonged fasting and contrast media. : Peri-operative continuation now endorsed by Australian Prescriber OPTIMAL DOSE OF PERIOPERATIVE LONG- ACTING INSULIN : Long-acting (basal) insulin should be continued. : A dose modification may be required. : Patients are eating less. : Patients are exercising less. : Stress hormones may elevate BGL. : 80% of patients given 80% of the long-acting insulin had satisfactory BGLs. IDEAL BLOOD GLUCOSE RANGE : 6-10. : May need to be higher if HbA1c high. : Above the hypo point. : Check your meter is working and accurate.
Description:The list of books you might like
