title: Continuous subcutaneous insulin infusion during general anesthesia: a case report.
abstract: Care of the patient with diabetes mellitus presents numerous challenges to the anesthesia practitioner. There is no perfect way to care for these patients nor are any 2 patients with diabetes exactly alike. With the advent of subcutaneous insulin pumps, the anesthesia practitioner has another tool to assist him or her in giving high quality care. This case study describes the anesthesia care provided to a patient with type 1 diabetes who wore his continuous subcutaneous insulin infusion (CSII) pump during general anesthesia for surgical repair of a herniated lumbar disk. Importantly, the anesthesia plan involved a collaborative effort with the patient. Blood glucose levels were stable throughout the perioperative period. Little or no extra work was required of the CRNA. This case showed that the CSII could be used to minimize perioperative fluctuations in blood sugar. Postoperatively, the patient expressed a high degree of satisfaction with the anesthetic.
authors.affiliation: Charleston Area Medical Center School of Nurse Anesthesia, WVa, USA.
authors.forename: William A
authors.initials: WA
authors.lastname: White
authors.forename: Helen
authors.initials: H
authors.lastname: Montalvo
authors.forename: Joshua M
authors.initials: JM
authors.lastname: Monday
mesh_terms: D000328:Adult; D000768:Anesthesia, General / Q000451:nursing; D003922:Diabetes Mellitus, Type 1 / Q000150:complications / Q000188:drug therapy* / Q000451:nursing / Q000523:psychology; D004867:Equipment Design; D004869:Equipment Safety; D006801:Humans; D007004:Hypoglycemic Agents / Q000008:administration & dosage*; D007263:Infusions, Parenteral; D007328:Insulin / Q000008:administration & dosage*; D007332:Insulin Infusion Systems / Q000009:adverse effects / Q000523:psychology / Q000600:supply & distribution; D007405:Intervertebral Disc Displacement / Q000150:complications / Q000601:surgery*; D007430:Intraoperative Care / Q000379:methods* / Q000451:nursing / Q000523:psychology; D008159:Lumbar Vertebrae; D008297:Male; D009719:Nurse Anesthetists; D010347:Patient Care Planning; D017060:Patient Satisfaction; D012447:Sacrum; D016896:Treatment Outcome
chemical_list: D007004:Hypoglycemic Agents; D007328:Insulin