Abstract
These two stages have been separated from all the earlier chapters for ease of description and understanding. It will cover the intra- and postoperative management not only in emergency major surgeries but also day care surgeries or procedures which may last for more than 2–4 h in diabetes till the discharge of a patient and subsequent follow-up for a reasonable time. The next three chapters will deal with other operational aspects of routine surgery, followed by the special situations in surgery in diabetes in two parts. We did not want to divert the attention in the control of blood glucose and accompanying parameters which are the most important aspects of making a patient as fit for surgery as can be. Now we will look at other monitoring aspects more from a clinical perspective in the intra- and postoperative management.
This is a preview of subscription content, log in via an institution to check access.
Access this chapter
Tax calculation will be finalised at checkout
Purchases are for personal use only
Notes
- 1.
Like poor efforts at hydration are the minimalist calorie supplements which do not meet the requirements to prevent catabolism. This has been discussed elsewhere much in detail.
- 2.
Severely infected diabetic foot or a large carbuncle could bring the patient a full-blown acidotic state where neither blood glucose control nor the acidosis looks amenable for control even after hours of struggle to reach the “safe” criteria described in this volume; the outcome would be refusal for surgery. In cases of such suboptimal control, it is desirable, and an act of commission would be to deliberately undertake to operate on such causes under regional anesthesia. This will save lives since these procedures can be completed in short periods of time. Otherwise patients will surely be lost. Secondly, these and some other situations, there cannot be any control since the cause of surgical condition is so powerfully responsible that unless that is removed even under suboptimal conditions, life and often the limb cannot be saved. See the chapter on regional anesthesia in this volume. There will be cases where they will have to be taken up under general anesthesia.
- 3.
The other situation in which a sudden spurt in the urine output may occur is during the recovery phase of acute renal failure. As the tubules regenerate, there could be really copious urine output sometimes. Such a situation can or at least should immediately discernible in contrast to diabetes insipidus on the basis of the descriptions given above. One characteristic of this recovery is the unregulated and at times heavy losses of electrolytes which have to be regulated under frequent monitoring of the same and by appropriately changing the concentrations of the intravenous fluids.
- 4.
A common dictum in serious surgical or acutely ill medical cases, particularly in Neurosurgery is that if a patient’s electrolytes can be maintained in a stable level the likelihood that he will survive will improve.
- 5.
One of the early lessons we learnt from our professor was when he said—I am a great believer in Nasogastric tube.
- 6.
We have described some aspects of the passage of nutrients through the body and its interactions with the body tissues with insulin and glucagon. More detail will be found in Chap. 11. In the same chapter, we will also describe the various subcutaneous insulin administration regimens pertaining to any patient who has recovered enough to start oral nutrition.
References
Kim RP, Edelman SV, Dennis D. Musculoskeletal complications of diabetes mellitus. Clin Diabet. 2001 Jul;19(3):132–5. https://doi.org/10.2337/diaclin.19.3.13.
Peters A, Kerner W. Perioperative management of the diabetic patient. Exp Clin Endocrinol Diabetes. 1995;103(4):213–8.
Gill GV, Alberti KGMM. The care of the diabetic patient during surgery in international textbook of diabetes mellitus. New York, NY: John Wiley & Sons; 2003.
Duncan AE, Abd-Elsayed A, Maheshwari A, Xu M, Soltesz E, Koch CG. Role of intraoperative and postoperative glucose concentrations in predicting outcomes after cardiac surgery. Anesthesiology. 2010;112(4):860–71.
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. 1999;67(2):352–62.
Desborough JP, Jones PM, Persaud SJ, Landon MJ, Howell SL. Isoflurane inhibits insulin secretion from isolated rat pancreatic islets of Langerhans. Br J Anaesth. 1993;71(6):873–6.
Lattermann R, Schricker T, Wachter U, Georgieff M, Goertz A. Understanding the mechanisms by which isoflurane modifies the hyperglycemic response to surgery. Anesth Analg. 2001;93(1):121–7.
Lundy JB, Slane ML, Frizzi JD. Acute adrenal insufficiency after a single dose of etomidate. J Intensive Care Med. 2007;22(2):111–7.
Fragen RJ, Shanks CA, Molteni A, Avram MJ. Effects of etomidate on hormonal responses to surgical stress. Anesthesiology. 1984;61(6):652–6.
Forman SA. Clinical and molecular pharmacology of etomidate. Anesthesiology. 2011;114(3):695–707.
Hall GM, Lacoumenta S, Hart GR, Burrin JM. Site of action of fentanyl in inhibiting the pituitary-adrenal response to surgery in man. Br J Anaesth. 1990;65(2):251–3.
Wolf AR, Eyres RL, Laussen PC, et al. Effect of extradural analgesia on stress responses to abdominal surgery in infants. Br J Anesth. 1993;70(6):654–60.
Desborough JP, Hall GM, Hart GR, Burrin JM. Midazolam modifies pancreatic and anterior pituitary hormone secretion during upper abdominal surgery. Br J Anaesth. 1991;67(4):390–6.
Australian Diabetes Society. Peri-operative diabetes management guidelines, July 2012, ADS working group of Vincent Wong, Glynis Ross, Jennifer Wong and David Chipps (chair).
Marks JB. Perioperative management of diabetes. Am Fam Physician. 2003;67(1):93–100.
Van den Berghe G, Wouters P, Weekers F, Verwaest C, Bruyninckx F, Schetz M, Vlasselaers D, Ferdinande P, Lauwers P, Bouillon R. Intensive insulin therapy in critically ill patients. N Engl J Med. 2001;345:1359–67.
Kelkar SK. Cranial diabetes a concept and its pathogenesis, Endocrine symposium, JIPMER; 2000.
Williams G, Pickup JC, editors. Handbook of diabetes. Hoboken, NJ: Blackwell Scientific Publication; 1992.
Zerr K, Furnary A, Grunkemeier G, et al. Glucose control lowers the risk of wound infection in diabetes after open heart operations. Ann Thorac Surg. 1997;63:356–61.
Stulberg JJ, Delaney CP, Neuhauser DV, Aron DC, Fu P, Koroukian SM. Adherence to surgical care improvement project measures and the association with postoperative infections. JAMA. 2010;303(24):2479–85.
Author information
Authors and Affiliations
Rights and permissions
Copyright information
© 2019 Springer Nature Singapore Pte Ltd.
About this chapter
Cite this chapter
Kelkar, S., Muley, S., Ambardekar, P. (2019). Intra- and Postoperative Management in Diabetes. In: Towards Optimal Management of Diabetes in Surgery. Springer, Singapore. https://doi.org/10.1007/978-981-13-7705-1_4
Download citation
DOI: https://doi.org/10.1007/978-981-13-7705-1_4
Published:
Publisher Name: Springer, Singapore
Print ISBN: 978-981-13-7704-4
Online ISBN: 978-981-13-7705-1
eBook Packages: MedicineMedicine (R0)