Pre-operative Hypoglycemia in Patients Presenting for Surgery: A Hospital Based Cross-sectional Study
Introduction: Peri-operative glycemic control is an important factor for post-operative recovery and is well protocoled for diabetic patients in every setup. It is not always so with non-diabetic patients. This study aimed to observe the pre-operative glucose level and prevalence of hypoglycemia in patients presenting for surgery and its association with the duration of nil per oral period (NPO), age and intravenous fluids used in the pre-operative period. Methods: A cross-sectional study was conducted in the Department of Anesthesiology in a Nepalese medical college including all the patients posted for elective surgery over a period of three months. Socio-demographic and clinical details of the participants were collected in the operating theatre. Duration of NPO period and intravenous fluid prescribed in the pre-operative fasting period were recorded. A glucose strip test was performed on all the participants. Results: Participants were found to have fasted for an unnecessarily longer duration (12.84±2.27 hours). The incidence of hypoglycemia in patients posted for elective surgery was very high (43.3%). Ringer lactate and normal saline were equally prescribed (38.4%) and dextrose-normal saline was prescribed in the rest of the participants. Gender and type of intravenous fluids were positively correlated whereas NPO period was negatively correlated in overall participants though statistically insignificant. In hypoglycemic participants, we observed that lower glucose was influenced by pre-operative fluids, age and NPO duration. Conclusion: Pre-operative use of glucose-containing fluids during NPO period is an important step to prevent hypoglycemia and related consequences.
Takesue Y, Tsuchida T. Strict glycemic control to prevent surgical site infections in gastroenterological surgery. Ann Gastroenterol Surg. 2017;1(1):52-9. DOI: https://dx.doi.org/10.1002/ags3.12006
Amiel SA, Gale E. Physiological responses to hypoglycemia. Counter regulation and cognitive function. Diabetes care. 1993; 16 (suppl 3):48- 55. DOI: https://doi.org/10.2337/diacare.16.3.48
Ko GTC, Wai HPS, Tang JSF. Effects of age on plasma glucose levels in non-diabetic Hong Kong chinese. Croat Med J. 2006;47(5):709-13. PMID: 17042062
Fathallah N, Slim R, Larif S, Hmouda H, Ben Salem C. Drug induced hyperglycemia and diabetes. Drug Saf. 2015;38(12):1153-68. DOI: https://doi.org/10.1007/s40264-015-0339-z
Duggan EW, Carlson K, Umpierrez GE. Peri-operative hyperglycemia management: An update. Anesthesiology. 2017;126(3):547-560. DOI: https://doi.org/10.1097/aln.0000000000001515
Pattajoshi S, Nerurkar AA, Tendolkar BA. A cross sectional observational analysis of pre-operative blood glucose levels in nondiabetic patients presenting for surgery. Res inno in anesth. 2017;2(2):29-33. [Link]
Workgroup on Hypoglycemia, American Diabetes Association. Defining and reporting hypoglycemia in diabetes: A report from the American Diabetes Association Workgroup on Hypoglycemia. Diabetes Care. 2005;28:1245– 9. DOI: https://doi.org/10.2337/diacare.28.5.1245
Graham BB, Keniston A, Gajic O, Trillo Alvarez CA, Medvedev S, Douglas IS. Diabetes mellitus does not adversely affect outcomes from a critical illness. Crit Care Med. 2010;38:16–24. DOI: https://doi.org/10.1097/ccm.0b013e3181b9eaa5
Krinsley JS, Grover A. Severe hypoglycemia in critically ill patients: Risk factors and outcomes. Crit Care Med. 2007;35:2262– 7. DOI: https://doi.org/10.1097/01.ccm.0000282073.98414.4b
Hermanides J, Bosman RJ, Vriesendorp TM, Dotsch R, Rosendaal FR, Zandstra DF, et al. Hypoglycemia is associated with intensive care unit mortality. Crit Care Med. 2010;38:1430– 4. DOI: https://doi.org/10.1097/ccm.0b013e3181de562c
Leese GP, Savage MW, Chattington PD, Vora JP. The diabetic patient with hypertension. Postgrad Med J. 1996;72:263–8. DOI: https://doi.org/10.1136/pgmj.72.847.263
Rice MJ, Pitkin AD, Coursin DB. Review article: Glucose measurement in the operating room: More complicated than it seems. Anesth Analg. 2010;110:1056–65. DOI: https://doi.org/10.1213/ane.0b013e3181cc07de
Hong M, Yon H. Influence of pre-operative fasting time in blood glucose in older patients. K Korean Acad Nurs. 2011;41(2):157-64. DOI: https://doi.org/10.4040/jkan.2011.41.2.157.
Shah M, Mazoorullah Haq TU, Akhtar T. The effect of preanesthetic fasting on blood glucose in children undergoing surgery. J Pak Med Assoc. 1990;40(10)243-5). PMID: 2123262
D Roberts, T Meakem, C Dalton, D Haverstick, C Lynch III. Prevalence of Hyperglycemia in a Pre-Surgical Population. The Internet Journal of Anesthesiology. 2006;12(1). [Link]
Sprague JE, Arbeláez AM. Glucose Counterregulatory Responses to Hypoglycemia. Pediatr Endocrinol Rev. 2011; 9(1): 463–475. PMID: 22783644
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