martes, 1 de julio de 2014

Manejo perioperatorio de la diabetes

Manejo perioperatorio de la diabetes


Perioperative management of diabetes mellitus.
Salam R.
J Med Soc [serial online] 2014 [cited 2014 Jun 24];28:4-8.
Abstract
Patients with diabetes mellitus undergo surgery more frequently than non-diabetics. Diabetics tend to have increased morbidity and longer hospital stay following surgery, which may be due to higher risk of infection and co-morbidities such as cardiovascular complications and nephropathy. Studies have shown that pre-operative glycemic control have a significant impact on the risk of infections. Glycosylated hemoglobin below 7% is the usual pre-operative target, but values between 8% and 9% may be acceptable depending on individual circumstances. Recent guidelines from Australia and UK no longer recommend withdrawal of oral hypoglycemic agents including metformin before surgery. Cardiac-related and overall mortality are greater with increased post-operative blood glucose levels. American Association of Clinical Endocrinologists and the American Diabetes Association recommends target glucose levels <180 mg/dL in critically ill patients and <140 mg/dL in non-critically ill patients. Insulin-glucose infusion is the preferred mode of insulin therapy until patient is able to take adequate calorie orally. Sliding scale insulin is no longer recommended and supplemental insulin protocol is more appropriate. Hypoglycemia is also a major contributor to an adverse outcome and severe hypoglycemia should be avoided.
Keywords: Insulin-glucose infusion, Perioperative, Sliding scale insulin, Supplemental insulin, Wound infection


http://www.jmedsoc.org/temp/JMedSoc2814-3373967_092219.pdf
http://www.jmedsoc.org/downloadpdf.asp?issn=0972-4958;year=2014;volume=28;issue=1;spage=4;epage=8;aulast=Salam;type=2




http://www.jmedsoc.org/text.asp?2014/28/1/4/135214


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