Abstract
Background: There is an association between transoperative hyperglycemia in diabetic surgical patients and adverse clinical outcomes. There is a ‘diabetes of injury’ and immunosuppression following any surgery to a varying extent. Cytokines are responsible for the host response but potentially hazardous if uncontrollable or in excess.
This paper discusses the understanding and management of hyperglycemia and diabetes in hospitalized surgical patients outside the critical care setting. We here outline the management of transoperative hyperglycemia and prevention of hazardous complications before, during and after surgery (i.e. in transoperative period).
Objectives: To reiterate method for the transoperative management of blood glucose levels in known diabetic non-cardiac surgery, non-ICU patients.
Material & Methods: The present article is based on observations on management and outcome of a study conducted on 55 diabetic patients undergoing elective surgeries at Anugrah Narayan Magadh Medical College Hospital, Gaya, Bihar, India during a two year period. No ICU cases were included in the study. Outcomes were comparable with the contemporary practice.
Conclusion: Surgery is a stressor that affects homeostasis. Excess cytokines cause insulin resistance and thus type-2 diabetes like state through a complex immuno-physiological response to surgery. A precise understanding of the cytokine response to surgical trauma may bring in interventions that would optimize the transoperative care of the patient, decrease morbidity and enhance recovery.
Outcomes of our study were comparable with the contemporary practice.
Keywords: Transoperative hyperglycemia, Cytokines, Metabolism, Surgical stress, Insulin resistance, Diabetes of injury.
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Corresponding Author
Rajiv Ranjan
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DOI: https://dx.doi.org/10.18535/jmscr/v6i11.137
