Anaesthetists Handbook - MEDICAL EDUCATION at University ...

Management of patients with diabetes mellitus• Strokes (CVA)• Autonomic neuropathy (suggested by dizzy / fainting spells,irregular heartbeat, postural hypotension – see below).4. Other day surgical criteria to be fulfilled (see page 190).5. Investigations.• Urea and electrolytes.• HbA 1C levels.• ECG.• Blood pressure – lying down and standing (a drop in systolicblood pressure of > 20 mm Hg on standing is indicative ofpostural hypotension).Guidelines for the management of diabetic patients on the surgicalday unitAll diabetics to be scheduled first on their respective am or pm list.Aim to maintain blood glucose levels between 4-10 mmol L -1throughout the perioperative period.Measure capillary blood glucose levels on admission, intraoperativelyand postoperatively on the ward area.If the blood glucose is above 10 mmol L -1 on more than twooccasions start insulin sliding scale in accordance with Trust ClinicalGuidelines for the management of Diabetic Patients undergoingSurgery (UHCW 2005).Encourage oral intake as soon as possible. In case of 23-hoursurgery, delayed oral intake or postoperative nausea and vomiting(PONV), monitor blood glucose hourly till patient is eating anddrinking normally.Patient to take normal dose of insulin / OHA prior to evening meal.156 Anaesthetists Handbook January 2010