eMedicine Specialties > Perioperative Care > Perioperative Care

Perioperative Management of the Diabetic Patient: Multimedia

Author: Mira Loh-Trivedi, PharmD, Clinical Pharmacy Specialist, Surgical Intensive Care Unit, Rush University Medical Center
Coauthor(s): David M Rothenberg, MD, FCCM, Professor, Department of Anesthesiology, Rush Medical College; Associate Dean, Academic Affiliations, Director, Section of Anesthesia-Critical Care, Director, Residency Education, Rush University Medical Center
Contributor Information and Disclosures

Updated: Jul 15, 2009

Multimedia

A positive "prayer sign" can be elicited on exami...Media file 1: A positive "prayer sign" can be elicited on examination with the patient unable to approximate the palmar surfaces of the phalangeal joints while pressing their hands together; this represents cervical spine immobility and the potential for a difficult endotracheal intubation.
A positive "prayer sign" can be elicited on exami...

A positive "prayer sign" can be elicited on examination with the patient unable to approximate the palmar surfaces of the phalangeal joints while pressing their hands together; this represents cervical spine immobility and the potential for a difficult endotracheal intubation.

More on Perioperative Management of the Diabetic Patient

References
Further Reading

References

  1. American Diabetes Association. All about diabetes. Available at http://www.diabetes.org/about-diabetes.jsp. Accessed July 14, 2009.

  2. Hall GM, Page SR. Diabetes and surgery. In: Page SR, Hall GM, eds. Emergency and Hospital Management. London, UK: BMJ Publishing; 1999.

  3. Hirsch IB, McGill JB, Cryer PE, White PF. Perioperative management of surgical patients with diabetes mellitus. Anesthesiology. Feb 1991;74(2):346-59. [Medline].

  4. Alberti KG, Thomas DJ. The management of diabetes during surgery. Br J Anaesth. Jul 1979;51(7):693-710. [Medline].

  5. Gavin LA. Perioperative management of the diabetic patient. Endocrinol Metab Clin North Am. Jun 1992;21(2):457-75. [Medline].

  6. Hollenberg M, Mangano DT, Browner WS, et al. Predictors of postoperative myocardial ischemia in patients undergoing noncardiac surgery.The Study of Perioperative Ischemia Research Group. JAMA. Jul 8 1992;268(2):205-9. [Medline].

  7. Risum O, Abdelnoor M, Svennevig JL, et al. Diabetes mellitus and morbidity and mortality risks after coronary artery bypass surgery. Scand J Thorac Cardiovasc Surg. 1996;30(2):71-5. [Medline].

  8. Rodriguez BL, Lau N, Burchfiel CM, et al. Glucose intolerance and 23-year risk of coronary heart disease and total mortality: the Honolulu Heart Program. Diabetes Care. Aug 1999;22(8):1262-5. [Medline][Full Text].

  9. Van den Berghe G, Wilmer A, Hermans G, et al. Intensive insulin therapy in the medical ICU. N Engl J Med. Feb 2 2006;354(5):449-61. [Medline][Full Text].

  10. Lazar HL, Chipkin SR, Fitzgerald CA, et al. Tight glycemic control in diabetic coronary artery bypass graft patients improves perioperative outcomes and decreases recurrent ischemic events. Circulation. Mar 30 2004;109(12):1497-502. [Medline][Full Text].

  11. van den Berghe G, Wouters P, et al. Intensive insulin therapy in the critically ill patients. N Engl J Med. Nov 8 2001;345(19):1359-67. [Medline].

  12. Krinsley JS. Effect of an intensive glucose management protocol on the mortality of critically ill adult patients. Mayo Clin Proc. Aug 2004;79(8):992-1000. [Medline][Full Text].

  13. [Best Evidence] Vlasselaers D, Milants I, Desmet L, et al. Intensive insulin therapy for patients in paediatric intensive care: a prospective, randomised controlled study. Lancet. Feb 14 2009;373(9663):547-56. [Medline].

  14. Furnary AP, Zerr KJ, Grunkemeier GL, Starr A. Continuous intravenous insulin infusion reduces the incidence of deep sternal wound infection in diabetic patients after cardiac surgical procedures. Ann Thorac Surg. Feb 1999;67(2):352-60; discussion 360-2. [Medline].

  15. Davidson PC, Steed RD, Bode BW. Glucommander: a computer-directed intravenous insulin system shown to be safe, simple, and effective in 120,618 h of operation. Diabetes Care. Oct 2005;28(10):2418-23. [Medline][Full Text].

  16. [Best Evidence] Cameron CG, Bennett HA. Cost-effectiveness of insulin analogues for diabetes mellitus. CMAJ. Feb 17 2009;180(4):400-7. [Medline][Full Text].

  17. Alberti KG, Gill GV, Elliott MJ. Insulin delivery during surgery in the diabetic patient. Diabetes Care. May-Jun 1982;5 suppl 1:65-77. [Medline].

  18. Clement S, Braithwaite SS, Magee MF, et al. Management of diabetes and hyperglycemia in hospitals. Diabetes Care. Feb 2004;27(2):553-91. [Medline][Full Text].

  19. McAnulty GR, Robertshaw HJ, Hall GM. Anaesthetic management of patients with diabetes mellitus. Br J Anaesth. Jul 2000;85(1):80-90. [Medline][Full Text].

  20. [Guideline] Adams HP Jr, del Zoppo G, Alberts MJ, et al. Guidelines for the early management of adults with ischemic stroke: a guideline from the American Heart Association/American Stroke Association Stroke Council, Clinical Cardiology Council, Cardiovascular Radiology and Intervention Council, and the Atherosclerotic Peripheral Vascular Disease and Quality of Care Outcomes in Research Interdisciplinary Working Groups: the American Academy of Neurology affirms the value of this guideline as an educational tool for neurologists. Stroke. May 2007;38(5):1655-711. [Medline][Full Text].

  21. [Guideline] American Diabetes Association. Standards of medical care in diabetes--2008. Diabetes Care. Jan 2008;31 suppl 1:S12-54. [Medline][Full Text].

  22. Brooks-Brunn JA. Predictors of postoperative pulmonary complications following abdominal surgery. Chest. Mar 1997;111(3):564-71. [Medline][Full Text].

  23. Burgos LG, Ebert TJ, Asiddao C, et al. Increased intraoperative cardiovascular morbidity in diabetics with autonomic neuropathy. Anesthesiology. Apr 1989;70(4):591-7. [Medline].

  24. Butler SO, Btaiche IF, Alaniz C. Relationship between hyperglycemia and infection in critically ill patients. Pharmacotherapy. Jul 2005;25(7):963-76. [Medline].

  25. Chen D, Lee SL, Peterfreund RA. New therapeutic agents for diabetes mellitus: implications for anesthetic management. Anesth Analg. Jun 2009;108(6):1803-10. [Medline].

  26. Clarke RS. The hyperglycaemic response to different types of surgery and anaesthesia. Br J Anaesth. Jan 1970;42(1):45-53. [Medline].

  27. Gautam A, Baluch A, Kaye A, Frost EA. Modern strategies for the anesthetic management of the patient with diabetes. Middle East J Anesthesiol. Jun 2009;20(2):187-97. [Medline].

  28. Goldberg NJ, Wingert TD, Levin SR, Wilson SE, Viljoen JF. Insulin therapy in the diabetic surgical patient: metabolic and hormone response to low dose insulin infusion. Diabetes Care. Mar-Apr 1981;4(2):279-84. [Medline].

  29. Hoogwerf BJ. Postoperative management of the diabetic patient. Med Clin North Am. Sep 2001;85(5):1213-28. [Medline].

  30. Lindsberg PJ, Roine RO. Hyperglycemia in acute stroke. Stroke. Feb 2004;35(2):363-4. [Medline][Full Text].

  31. Lopez-Sendon J, Swedberg K, McMurray J, et al, for the Task ForceOn Beta-Blockers of the European Society of Cardiology. Expert consensus document on beta-adrenergic receptor blockers. Eur Heart J. Aug 2004;25(15):1341-62. [Medline][Full Text].

  32. Marks JB. Perioperative management of diabetes. Am Fam Physician. Jan 1 2003;67(1):93-100. [Medline][Full Text].

  33. Marso SP, Ellis SG, Gurm HS, Lytle BW, Topol EJ. Proteinuria is a key determinant of death in patients with diabetes after isolated coronary artery bypass grafting. Am Heart J. Jun 2000;139(6):939-44. [Medline].

  34. National Institutes of Health. Glucontrol study: comparing the effects of two glucose regimens by insulin in two intensive care unit patients. Available at http://www.clinicaltrials.gov/ct/show/NCT00107601.

  35. Pezzarossa A, Taddei F, Cimicchi MC, et al. Perioperative management of diabetic subjects. Subcutaneous versus intravenous insulin administration during glucose-potassium infusion. Diabetes Care. Jan 1988;11(1):52-8. [Medline].

  36. Raucoules-Aime M, Ichai C, Roussel LJ, et al. Comparison of two methods of i.v. insulin administration in the diabetic patient during the perioperative period. Br J Anaesth. Jan 1994;72(1):5-10. [Medline].

  37. Raucoules-Aime M, Lugrin D, Boussofara M, et al. Intraoperative glycaemic control in non-insulin-dependent and insulin-dependent diabetes. Br J Anaesth. Oct 1994;73(4):443-9. [Medline].

  38. Raucoules-Aime M, Roussel LJ, Rossi D, et al. Effect of severity of surgery on metabolic control and insulin requirements in insulin-dependent diabetic patients. Br J Anaesth. Feb 1995;74(2):231-3. [Medline][Full Text].

  39. Rittler P, Broedl UC, Hartl W, Goke B, Jauch K. [Diabetes mellitus - perioperative management] [German]. Chirurg. May 2009;80(5):410, 412-5. [Medline].

  40. Sinert R, Adamson O, Johnson E, Tran D, Silverberg M. The incidence of previously undiagnosed diabetes mellitusin patients with soft tissue infections [abstract]. Acad Emerg Med. May 2001;8(5):538.

  41. Umpierrez GE, Isaacs SD, Bazargan N, et al. Hyperglycemia: an independent marker of in-hospital mortality in patients with undiagnosed diabetes. J Clin Endocrinol Metab. Mar 2002;87(3):978-82. [Medline][Full Text].

  42. Vanhaeverbeek M. Peri-operative care: management of the diabetic patient. A novel controversy about tight glycemic control. Acta Clin Belg. 1997;52(5):313-9. [Medline].

Further Reading

Related eMedicine Topics

Clinical Trials
National Guideline Clearinghouse

Keywords

perioperative management of the diabetic patient, diabetic patient, diabetes, diabetes mellitus, diabetic management, preoperative care and diabetes, postoperative care and diabetes, diabetes and surgery, diabetic surgical care, diabetic surgery, diabetic surgical patients, type 1 diabetes, type I diabetes, insulin-dependent diabetes, IDDM, type 2 diabetes, type II diabetes, noninsulin-dependent diabetes, NIDDM, non-insulin-dependent diabetes, non-insulin dependent diabetes, DB, DM, insulin control, hypoglycemia, hyperglycemia, diabetic ketoacidosis, ketoacidosis

Contributor Information and Disclosures

Author

Mira Loh-Trivedi, PharmD, Clinical Pharmacy Specialist, Surgical Intensive Care Unit, Rush University Medical Center
Mira Loh-Trivedi, PharmD is a member of the following medical societies: American College of Chest Physicians, American College of Clinical Pharmacy, and Society of Critical Care Medicine
Disclosure: Nothing to disclose.

Coauthor(s)

David M Rothenberg, MD, FCCM, Professor, Department of Anesthesiology, Rush Medical College; Associate Dean, Academic Affiliations, Director, Section of Anesthesia-Critical Care, Director, Residency Education, Rush University Medical Center
David M Rothenberg, MD, FCCM is a member of the following medical societies: American Medical Association, American Society of Anesthesiologists, Chicago Medical Society, and Society of Critical Care Medicine
Disclosure: Nothing to disclose.

Medical Editor

David S Schade, MD, Chief, Division of Endocrinology and Metabolism, Professor, Department of Internal Medicine, University of New Mexico School of Medicine and Health Sciences Center
David S Schade, MD is a member of the following medical societies: American College of Physicians, American Diabetes Association, American Federation for Medical Research, Endocrine Society, New Mexico Medical Society, New York Academy of Sciences, and Society for Experimental Biology and Medicine
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: eMedicine Salary Employment

Managing Editor

Donna Leco Mercado, MD, Director of Medical Consultation, Department of Internal Medicine, Baystate Medical Center; Assistant Professor, Tufts University School of Medicine
Donna Leco Mercado, MD is a member of the following medical societies: Sigma Xi
Disclosure: Nothing to disclose.

CME Editor

Mark Cooper, MBBS, PhD, FRACP, Head, Diabetes & Metabolism Division, Baker Heart Research Institute, Professor of Medicine, Monash University
Disclosure: Nothing to disclose.

Chief Editor

William A Schwer, MD, Professor, Department of Family Medicine, Rush Medical College; Chairman, Department of Family Medicine, Rush-Presbyterian-St Luke's Medical Center
William A Schwer, MD is a member of the following medical societies: American Academy of Family Physicians
Disclosure: Nothing to disclose.

 
 
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