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Perioperative challenges in management of diabetic patients undergoing non-cardiac surgery

World Journal of Diabetes 2021年第8期12卷 1255-1266页

作者： ursula galway Praveen Chahar Marc T Schmidt Jorge A Araujo-Duran Jeevan Shivakumar Alparslan Turan Kurt Ruetzler Department of General Anesthesiology Anesthesiology InstituteCleveland ClinicClevelandOH 44195United States Department of Intensive Care and Resuscitation Anesthesiology InstituteCleveland ClinicClevelandOH 44195United States Department of Outcomes Research Anesthesiology InstituteCleveland ClinicClevelandOH 44195United States

Prediabetes and diabetes are important disease processes which have several perioperative *** one third of the United States population is considered to have *** prevalence in surgical patients is even *** is due to the associated micro and macrovascular complications of diabetes that result in the need for subsequent surgical procedures.A careful preoperative evaluation of diabetic patients and patients at risk for prediabetes is essential to reduce perioperative mortality and *** preoperative evaluation involves an optimization of preoperative *** also includes optimization of antidiabetic medication regimens,as the avoidance of unintentional hypoglycemic and hyperglycemic episodes during the perioperative period is *** focus of the perioperative management is to ensure euglycemia and thus improve postoperative ***,prolonged preoperative fasting should be avoided and close monitoring of blood glucose should be initiated and continued throughout *** can be accomplished with either analysis in blood gas samples,venous phlebotomy or point-of-care *** capillary and arterial whole blood glucose do not meet standard guidelines for glucose testing,they can still be used to guide insulin dosing in the operating *** glycemic control goals may vary slightly in different protocols but overall the guidelines suggest a glucose range in the operating room should be between 140 mg/dL to 180 mg/*** hyperglycemia is detected in the operating room,blood glucose management may be initiated with subcutaneous rapid-acting insulin,with intravenous infusion or boluses of regular *** and electrolyte management are other perioperative *** diabetic ketoacidosis and hyperglycemic hyperosmolar nonketotic state are the two most serious acute metabolic complications of diabetes that must be recognized early and treated.

关键词： Diabetes mellitus Perioperative management Insulin Hyperglycaemia Anaesthesia Surgery

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