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- December 1, 2008 |
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"Perioperative Glycemic Control"Dr. Alice Cheng (biography)
English - 2003-10-31 - 6 minutes
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Summary :
This presentation will discuss the 2003 CDA Guidelines for perioperative glycemic control, with a review of studies on hyperglycemia and surgical outcomes and supporting evidence for blood glucose targets in perioperative glycemic control.
The need for optimal perioperative glycemic control is becoming evident with information from studies looking at perioperative glycemia in relation to surgical outcomes. A retrospective cohort study by McAlister et al of the University of Alberta Hospital found that perioperative glycemic control was suboptimal in diabetic patients undergoing coronary artery bypass grafting, and that hyperglycemia on the first postoperative day was associated with in-hospital adverse outcomes (1). A prospective study by Furnary et al found that intravenous insulin lowered perioperative glycemia and reduced the incidence of deep sternal wound infection in diabetic patients who underwent open heart surgery (2), and a randomized controlled study of surgical ICU patients by Van den Berghe et al showed that maintaining the blood glucose level at or below 6.1 mmol/L with intensive insulin therapy was associated with reduced morbidity and mortality (3). These studies demonstrate the need for good perioperative glycemic control to reduce the incidence of adverse outcomes, and this is reflected in the 2003 CDA Guidelines for perioperative glycemic control.
Copyright © 2003 E-MedHosting.com Inc
Learning objectives :
The participant will be able to:
- Describe the short- and long-term effects of hyperglycemia on surgical outcomes
- Outline the evidence for perioperative glycemic control and appropriate targets
- Discuss the 2003 CDA Clinical Practice Guidelines recommendations for perioperative glycemic control
Bibliographic references :
1. McAlister FA, Man J, Bistritz L, Amad H, Tandon P. “Diabetes and Coronary Artery Bypass Surgery: An examination of perioperative glycemic control and outcomes.” Diabetes Care. 2003 May;26(5):1518-24.
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=12716815&dopt=Abstract
2. 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 Feb;67(2):352-60; discussion 360-2.
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=10197653&dopt=Abstract
3. 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 the critically ill patients.N Engl J Med. 2001 Nov 8;345(19):1359-67.
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=11794168&dopt=Abstract
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