title: Glucose monitoring of patients with diabetes mellitus receiving general anesthesia: a study of the practices of anesthesia providers in a large community hospital.
abstract: Surgical stress causes hyperglycemia with potential complications (e.g., impaired granulocytic function and delayed wound healing) particularly when glucose levels exceed 250 mg/dL. Standards of care for patients with diabetes undergoing surgery may vary by geographic locale, type of surgical procedure, and type of diabetes. We explored whether anesthesia providers monitor glucose levels in patients with diabetes. Records of 100 patients with diabetes who underwent surgery under general anesthesia (length of procedure: range, 1.9-11.8 hours) were reviewed. Demographic information, glucose levels, frequency of glucose monitoring, and treatment used for diabetes management preoperatively, intraoperatively, and postoperatively were recorded. There were 46 males and 54 females, aged 62 +/- 13 years (55% currently treated with insulin). Of the study cohort, 89% had preoperative, 23% had intraoperative, and 54% had postoperative glucose monitoring performed. As expected, postoperative glucose concentrations were significantly higher than preoperative glucose levels (mean difference, 99 mg/dL, P < .01). The mean postoperative glucose level was 262 +/- 89 mg/dL with 30 of the 54 monitored patients having a postoperative glucose level greater than 250 mg/dL. Individuals treated with insulin and those who underwent major surgery were more likely to have glucose levels monitored. These results suggest that better strategies for monitoring glucose levels during the surgical period are needed.
authors.affiliation: University of Delaware, Newark, USA.
authors.forename: R E
authors.initials: RE
authors.lastname: Maser
authors.forename: J M
authors.initials: JM
authors.lastname: Ellers
authors.forename: G S
authors.initials: GS
authors.lastname: DeCherney
mesh_terms: D000368:Aged; D000768:Anesthesia, General; D015190:Blood Glucose Self-Monitoring; D003920:Diabetes Mellitus / Q000097:blood* / Q000601:surgery*; D005260:Female; D006764:Hospitals, Community; D006801:Humans; D008297:Male; D008875:Middle Aged; D016343:Monitoring, Intraoperative / Q000379:methods*; D009719:Nurse Anesthetists; D011182:Postoperative Care; D010818:Practice Patterns, Physicians'; D011300:Preoperative Care; D012189:Retrospective Studies