How is hyperglycemia treated intraoperatively

How is hyperglycemia treated intraoperatively?

• ·       The high end of a normal range for fasting serum glucose is 110 mg per dL; however, hyperglycemia in inpatients need not be treated until it reaches a higher level.
• ·       The one good agent for treating intraoperative hyperglycemia is intravenous insulin.
• ·       Onset takes minutes, peak effect is achieved in 15 to 30 minutes, and duration of effect is less than an hour, facilitating titration.
• ·       Insulin may be administered by continuous infusion or as intermittent boluses; the bolus consumes less lead time and eliminates the risk of pump misprogramming or malfunction.
• ·       Subcutaneous insulin is less ideal for use during general anesthetics or complex procedures because variable peripheral blood flow will alter the uptake and duration of action.
• ·       Most other therapies for DM2 are not fit for intraoperative use.
• ·       Oral agents cannot be easily administered, are not reliably absorbed, and have too long a duration of action to be practical perioperatively.
• ·       They may be taken on the day of surgery before minor procedures.
• ·       In this case, sitagliptin should be discontinued to avoid hypoglycemia.
• ·       Metformin, a biguanide, increases the risk of lactic acidosis during periods of hypoperfusion. 

• ·       Metformin is discontinued for 3 or more days before extensive procedures when a large-volume blood loss is possible.