Hyperglycemia assessment in the post-anesthesia care unit

Vinicius Rodovalho Pereira; Rodrigo Akio Azuma; Bruno Emanuel Oliva Gatto; João Manoel Silva Junior; Maria Jose Carvalho Carmona; Luiz Marcelo Sá Malbouisson

doi:10.1016/j.bjane.2015.08.005

Scientific Article

Hyperglycemia assessment in the post-anesthesia care unit

Avaliação de hiperglicemia na sala de recuperação pós-anestésica

Vinicius Rodovalho Pereira; Rodrigo Akio Azuma; Bruno Emanuel Oliva Gatto; João Manoel Silva Junior; Maria Jose Carvalho Carmona; Luiz Marcelo Sá Malbouisson

http://dx.doi.org/10.1016/j.bjane.2015.08.005 Braz J Anesthesiol, vol.67, n6, p.565-570, 2017

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Abstract

Abstract Background and objectives Hyperglycemia in surgical patients may cause serious problems. Analyzing this complication in this scenario contributes to improve the management of these patients. The aim of this study was to evaluate the prevalence of hyperglycemia in the post-anesthetic care unit (PACU) in non-diabetic patients undergoing elective surgery and analyze the possible risk factors associated with this complication. Methods We evaluated non-diabetic patients undergoing elective surgeries and admitted in the PACU. Data were collected from medical records through precoded questionnaire. Hyperglycemia was considered when blood glucose was >120 mg.dL-1. Patients with hyperglycemia were compared to normoglycemic ones to assess factors associated with the problem. We excluded patients with endocrine-metabolic disorders, diabetes, children under 18 years, body mass index (BMI) below 18 or above 35, pregnancy, postpartum or breastfeeding, history of drug use, and emergency surgeries. Results We evaluated 837 patients. The mean age was 47.8 ± 16.1 years. The prevalence of hyperglycemia in the postoperative period was 26.4%. In multivariate analysis, age (OR = 1.031, 95% CI 1.017-1.045); BMI (OR = 1.052, 95% CI 1.005-1.101); duration of surgery (OR = 1.011, 95% CI 1.008-1.014), history of hypertension (OR = 1.620, 95% CI 1.053-2.493), and intraoperative use of corticosteroids (OR = 5.465, 95% CI 3.421-8.731) were independent risk factors for postoperative hyperglycemia. Conclusion The prevalence of hyperglycemia was high in the PACU, and factors such as age, BMI, corticosteroids, blood pressure, and duration of surgery are strongly related to this complication.

Keywords

Elective surgery, Hyperglycemia, Prevalence, Risk factors, Post-anesthetic care unit

Resumo

Resumo Justificativa e objetivos Hiperglicemia em pacientes cirúrgicos pode ocasionar graves problemas. Nesse contexto, analisar essa complicação contribui para o melhor manejo desses pacientes. O objetivo do estudo foi avaliar a prevalência de hiperglicemia na sala de recuperação pós-anestésica (SRPA) em pacientes não diabéticos submetidos a cirurgias eletivas e analisar os possíveis fatores de risco associados a essa complicação. Métodos Foram avaliados pacientes não diabéticos submetidos a cirurgias eletivas e admitidos na SRPA. Os dados foram coletados dos prontuários por meio de questionário pré-codificado. Foi considerada hiperglicemia quando a glicemia era > 120 mg.dL-1. Pacientes com hiperglicemia foram comparados com os normoglicêmicos para avaliar fatores associados ao problema. Foram excluídos os pacientes com distúrbios endócrino-metabólicos, diabéticos, menores de 18 anos, índice de massa corpórea (IMC) menor do que 18 ou maior do que 35, gestação, puerpério ou aleitamento materno, antecedente de uso de drogas e cirurgias de urgência. Resultados Foram avaliados 837 pacientes. A média de idade foi 47,8 ± 16,1 anos. A prevalência de hiperglicemia no pós-operatório foi de 26,4%. Na análise multivariada, idade (OR = 1,031; IC 95% 1,017-1,045); IMC (OR = 1,052; IC 95% 1,005-1,101); tempo cirúrgico (OR = 1,011; IC 95% 1,008-1,014); antecedente de hipertensão (OR = 1,620; IC 95% 1,053-2,493) e uso de corticoides intraoperatório (OR = 5,465; IC 95% 3,421-8,731) representaram fatores de risco independentes para hiperglicemia no pós-operatório. Conclusão Hiperglicemia apresentou alta prevalência na SRPA e fatores como idade, IMC, corticoides, hipertensão arterial e tempo de cirurgia são fortemente relacionados a essa complicação.

Palavras-chave

Cirurgia eletiva, Hiperglicemia, Prevalência, Fatores de risco, Sala de recuperação anestésica

References

Vanhorebeek I, Langouche L, Van den Berghe G. Tight blood glucose control: what is the evidence?. Crit Care Med. 2007;35:S496-502.

McCowen KC, Malhotra A, Bistrian BR. Stress-induced hyperglycemia. Crit Care Clin. 2001;17:107-24.

Pozzilli P, Leslie RD. Infections and diabetes: mechanisms and prospects for prevention. Diabet Med. 1994;11:935-41.

Ljungqvist O, Nygren J, Soop M. Metabolic perioperative management: novel concepts. Curr Opin Crit Care. 2005;11:295-9.

Krinsley JS. Effect of an intensive glucose management protocol on the mortality of critically ill adult patients. Mayo Clin Proc. 2004;79:992-1000.

Thorell A, Nygren J, Hirshman MF. Surgery-induced insulin resistance in human patients: relation to glucose transport and utilization. Am J Physiol. 1999;276:E754-61.

Thorell A, Nygren J, Ljungqvist O. Insulin resistance: a marker of surgical stress. Curr Opin Clin Nutr Metab Care. 1999;2:69-78.

Van den Berghe G, Wouters P, Weekers F. Intensive insulin therapy in critically ill patients. N Engl J Med. 2001;345:1359-67.

Alvarez-Sabin J, Molina CA, Ribo M. Impact of admission hyperglycemia on stroke outcome after thrombolysis: risk stratification in relation to time to reperfusion. Stroke. 2004;35:2493-8.

Juvela S, Siironen J, Kuhmonen J. Hyperglycemia, excess weight, and history of hypertension as risk factors for poor outcome and cerebral infarction after aneurysmal subarachnoid hemorrhage. J Neurosurg. 2005;102:998-1003.

Suleiman M, Hammerman H, Boulos M. Fasting glucose is an important independent risk factor for 30-day mortality in patients with acute myocardial infarction: a prospective study. Circulation. 2005;111:754-60.

Timmer JR, van der Horst IC, Ottervanger JP. Prognostic value of admission glucose in non-diabetic patients with myocardial infarction. Am Heart J. 2004;148:399-404.

Laird AM, Miller PR, Kilgo PD. Relationship of early hyperglycemia to mortality in trauma patients. J Trauma. 2004;56:1058-62.

Vriesendorp TM, Morelis QJ, Devries JH. Early post-operative glucose levels are an independent risk factor for infection after peripheral vascular surgery. A retrospective study. Eur J Vasc Endovasc Surg. 2004;28:520-5.

Furnary AP, Gao G, Grunkemeier GL. Continuous insulin infusion reduces mortality in patients with diabetes undergoing coronary artery bypass grafting. J Thorac Cardiovasc Surg. 2003;125:1007-21.

Furnary AP, Wu Y, Bookin SO. Effect of hyperglycemia and continuous intravenous insulin infusions on outcomes of cardiac surgical procedures: the Portland Diabetic Project. Endocr Pract. 2004:21-33.

Gandhi GY, Nuttall GA, Abel MD. Intraoperative hyperglycemia and perioperative outcomes in cardiac surgery patients. Mayo Clin Proc. 2005;80:862-6.

American Diabetes A. Standards of medical care in diabetes 2013. Diabetes Care. 2013:S11-66.

Aldam P, Levy N, Hall GM. Perioperative management of diabetic patients: new controversies. Br J Anaesth. 2014;113:906-9.

Malerbi DA, Franco LJ. Multicenter study of the prevalence of diabetes mellitus and impaired glucose tolerance in the urban Brazilian population aged 30-69 yr. The Brazilian Cooperative Group on the Study of Diabetes Prevalence. Diabetes Care. 1992;15:1509-16.

Van den Berghe G, Wilmer A, Milants I. Intensive insulin therapy in mixed medical/surgical intensive care units: benefit versus harm. Diabetes. 2006;55:3151-9.

Carr ME. Diabetes mellitus: a hypercoagulable state. J Diabetes Complicat. 2001;15:44-54.

Blondet JJ, Beilman GJ. Glycemic control and prevention of perioperative infection. Curr Opin Crit Care. 2007;13:421-7.

Turina M, Miller FN, Tucker CF. Short-term hyperglycemia in surgical patients and a study of related cellular mechanisms. Ann Surg. 2006;243:845-51.

Mooradian AD. Mechanisms of age-related endocrine alterations. Part II. Drugs Aging. 1993;3:131-46.

Mooradian AD. Mechanisms of age-related endocrine alterations. Part I. Drugs Aging. 1993;3:81-97.

Lorentz MN, Albergaria VF, Lima FASd. Anestesia para obesidade mórbida. Rev Bras Anestesiol. 2007;57:199-213.

He Y, Zhai F, Ma G. Abdominal obesity and the prevalence of diabetes and intermediate hyperglycaemia in Chinese adults. Public Health Nutr. 2009;12:1078-84.

Hans P, Vanthuyne A, Dewandre PY. Blood glucose concentration profile after 10 mg dexamethasone in non-diabetic and type 2 diabetic patients undergoing abdominal surgery. Br J Anaesth. 2006;97:164-70.

Gulcan E, Bulut I, Toker A. Evaluation of glucose tolerance status in patients with asthma bronchiale. J Asthma. 2009;46:207-9.

Koskela HO, Salonen PH, Niskanen L. Hyperglycaemia during exacerbations of asthma and chronic obstructive pulmonary disease. Clin Respir J. 2013;7:382-9.

Giurini JM, Cook EA, Cook JJ. Diabetes: the latest trends in glycemic control. Clin Podiatr Med Surg. 2007;24:159-89.

Gottschalk A, Rink B, Smektala R. Spinal anesthesia protects against perioperative hyperglycemia in patients undergoing hip arthroplasty. J Clin Anesth. 2014;26:455-60.

Kilickan L, Yumuk Z, Bayindir O. The effect of combined preinduction thoracic epidural anaesthesia and glucocorticoid administration on perioperative interleukin-10 levels and hyperglycemia. A randomized controlled trial. J Cardiovasc Surg (Torino). 2008;49:87-93.

Finfer S, Chittock DR. Intensive versus conventional glucose control in critically ill patients. N Engl J Med. 2009;360:1283-97.

Hyperglycemia assessment in the post-anesthesia care unit

Avaliação de hiperglicemia na sala de recuperação pós-anestésica

Vinicius Rodovalho Pereira; Rodrigo Akio Azuma; Bruno Emanuel Oliva Gatto; João Manoel Silva Junior; Maria Jose Carvalho Carmona; Luiz Marcelo Sá Malbouisson

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