title: Perioperative blood glucose management in patients undergoing tumor hepatectomy.
abstract: OBJECTIVE
  To determine whether our institutional insulin management (modified Atlanta) protocol is efficient and safe in controlling blood glucose levels in the perioperative period in surgical patients undergoing tumor hepatectomy.
  
  
  METHODS
  Retrospective study.
  
  
  METHODS
  Large community hospital.
  
  
  METHODS
  20 consecutive patients undergoing liver resection for hepatocellular carcinoma, liver metastasis, or other hepatobiliary tumors.
  
  
  METHODS
  All patients continuously received intravenous glucose (5% dextrose in water, one mL/kg/hr); insulin was administered according to a strict algorithm, and dose adjustments were based on measurements of whole-blood glucose intraoperatively at one-hour intervals, and in the intensive care unit (ICU). Lower and upper blood glucose limits were set at 85 mg/dL and 110 mg/dL, respectively, in the operating room (OR). In the ICU, lower and upper limits were 90 mg/dL and 140 mg/dL, respectively.
  
  
  RESULTS
  Intraoperatively, 51.3% of measurements were within the target range. In the ICU, 75.2% of measurements showed a blood glucose level of 90 - 140 mg/dL. Two of 78 (2.6%) and two of 363 (0.5%) measurements had a blood glucose level < 70 mg/dL in the OR and ICU, respectively. The lowest blood glucose levels were 65 mg/dL (OR) and 66 mg/dL (ICU).
  
  
  CONCLUSIONS
  The modified Atlanta protocol is efficient and safe in controlling blood glucose levels in the perioperative period of hepatic tumor resection. Because of decreased insulin needs in the ICU, the use of a more liberal algorithm successfully reduced the risk of hypoglycemia.
authors.affiliation: Department of Anesthesiology and Critical Care Medicine, OLV Clinic, 9300 Aalst, Belgium. guy.cammu@olvz-aalst.be
authors.forename: Guy
authors.initials: G
authors.lastname: Cammu
authors.forename: Koen
authors.initials: K
authors.lastname: Vermeiren
authors.forename: Patrick
authors.initials: P
authors.lastname: Lecomte
authors.forename: Steven
authors.initials: S
authors.lastname: De Gendt
authors.forename: Thierry
authors.initials: T
authors.lastname: Deloof
authors.forename: Luc
authors.initials: L
authors.lastname: Foubert
mesh_terms: D000368:Aged; D000465:Algorithms; D001661:Biliary Tract Neoplasms / Q000601:surgery; D001786:Blood Glucose / Q000187:drug effects* / Q000378:metabolism; D006528:Carcinoma, Hepatocellular / Q000601:surgery; D004305:Dose-Response Relationship, Drug; D005260:Female; D005947:Glucose / Q000008:administration & dosage / Q000378:metabolism*; D006498:Hepatectomy / Q000379:methods*; D006801:Humans; D007003:Hypoglycemia / Q000209:etiology / Q000517:prevention & control; D007004:Hypoglycemic Agents / Q000008:administration & dosage; D007328:Insulin / Q000008:administration & dosage*; D007362:Intensive Care Units; D008113:Liver Neoplasms / Q000601:surgery; D008297:Male; D008875:Middle Aged; D019990:Perioperative Care / Q000379:methods; D012189:Retrospective Studies
chemical_list: D001786:Blood Glucose; D007004:Hypoglycemic Agents; D007328:Insulin; D005947:Glucose