• J Clin Anesth · Aug 2016

    Decisional practices and patterns of intraoperative glucose management in an academic medical center.

    • Katherine Grunzweig, Bala G Nair, Gene N Peterson, Mayumi Horibe, Moni B Neradilek, Shu-Fang Newman, Gail Van Norman, Howard A Schwid, Wei Hao, DellingerE PatchenEPDivision of General Surgery, Department of Surgery, University of Washington, Seattle, WA., and Irl B Hirsch.
    • School of Medicine, University of Washington, Seattle, WA.
    • J Clin Anesth. 2016 Aug 1; 32: 214-23.

    ObjectiveTo understand the decisional practices of anesthesia providers in managing intraoperative glucose levels.DesignThis is a retrospective cohort study.SettingOperating rooms in an academic medical center.PatientsAdult patients undergoing surgery.InterventionIntraoperative blood glucose management based on an institutional protocol.MeasurementsGlucose management data was extracted from electronic medical records to determine compliance to institutional glucose management protocol that prescribes hourly glucose measurements and insulin doses to maintain glucose levels between 100 to 140mg/dL. Effect of patient and surgery specific factors on compliance to glucose management protocol was explored.Main ResultsIn 1903 adult patients compliances to hourly glucose measurements was 72.5% and correct insulin adjustments was 12.4%. Insulin was under-dosed compared to the prescribed value by a mean of 0.85U/h (95% CI 0.76-0.95). Multivariate analysis showed that compliance to hourly glucose measurements decreased with increasing length of the procedure (OR=0.92 per hour, 95% CI 0.89-0.95) but increased with ASA status codes (OR=1.25 per ASA unit, 95% CI=1.06-1.49). Greater compliance to correct insulin adjustment was found in diabetic patients compared with non-diabetic patients (OR=1.31, 95% CI 1.09-1.55). On average, providers administered progressively more insulin with an additional 0.11U/h (95% CI=0.00-0.21] for every additional 10kg/m(2) of BMI and 0.20U/h (95% CI=0.01-0.39) less in diabetic patients than in non-diabetic patients. With the above practice pattern, the mean±SD of glucose level was 158±36mg/dL. Hypoglycemic (<60mg/dL) incident rate was 0.1% (9/8301 measurements) while hyperglycemic (>180mg/dL) incident rate was 28%. Glucose levels were within the target range (100-140mg/dL) only 28% of the time.ConclusionsLow compliance and considerable variability in initiating and following institutional glucose management protocol were observed.Copyright © 2016 Elsevier Inc. All rights reserved.

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