Download Update 11 - Update in Anaesthesia - WFSA

70Update in AnaesthesiaFigure 1. Which regime for my patient ?1. Decide on the type of surgeryMinor - patients expected to eat and drink within 4 hours of operationMajor - all other patients2. Then, is the patient Insulin or Non-insulin dependent ?3. Finally, are they - poorly controlled: delay surgery and change to soluble insulin three times dailybut if surgery urgent, use Major surgery regime- well controlled: use the appropriate regime from the Major or MinorGeneral Measures for all diabetics:Measure random sugar preoperatively - 4 hourly for IDDM- 8 hourly for NIDDMTest urine 8 hourly for ketones and sugarPlace first on operating listAim for a blood glucose of 6 - 10mmol/lFigure 2.Minor SurgeryNon insulin DependentPreoperatively - random blood sugarDiabetics on admission < 10 mmol/l Normal medication until day of op> 10 mmol/l Follow as for MAJOR SURGERYInsulin dependentDiabeticsThis regime only suitablefor patients whose randomsugar is < 10 mmol/l on admission,will only miss one meal preop &are first on the list for veryminor surgery eg cystoscopyDay of operationPostoperativelyPreoperativelyDay of operationOmit oral hypoglycaemicsBlood glucose- 1 hour preop andat least once during op(hourly if op > 1 hour long)postop - 2 hourly until eatingthen 8 hourlyRestart oral hypoglycaemics withfirst mealNormal medicationNo breakfast, no insulin, place firston list.Blood glucose- 1 hour preop andat least once during op(hourly if op > 1 hour long)postop - 2 hourly until eatingthen 4 hourlyPostoperativelyRestart normal S/C insulin regimewith first meal