EXAM #2: SURGICAL COMPLICATIONS IN DM Flashcards
How does inflammation influence DM?
Inflammation exacerbates DM
How does the PreOp eval for elective surgery differ from the emergent eval?
Elective= time to get chronic conditions under control
In a DM patient what do you want to review in terms of cardiac history?
1) Stents
2) Echo
3) Functional status i.e. “can you walk around the block?”
In terms of anesthesiology, what do you need to be concerned about with a DM patient?
Neuropathy–esp. in terms of local/regional anesthesia
What are the elements of a PreOp Eval that should be done on the emergent patient?
1) Establish baseline
2) EKG
3) Blood work
4) Optimize the things that you can
Why are wound infections rampant in DM patients?
1) Reduced capillary perfusion
2) Reduced oxygen and nutrient delivery
3) Impaired circulation of antimicrobials
4) Hyperglycemia
What are the post-op blood glucose goals for s/p CABG patients?
Blood glucose less than or equal to 180 mg/dL
What did the NICE-SUGAR study find?
Intensive post-op insulin therapy INCREASED mortality
*Goal now is to be below 180-200 mg/dL
What is a major adverse effect associated with Metformin?
Lactic acidosis
What is the recommendation for oral glucose lowering agents?
Stop oral glucose medications
What is the glucose threshold for an insulin drip for a DM patient in the hospital?
300 mg/dL
What should you remember about combining insulin modalities?
Do not combine i.e. don’t do drip AND subQ
What is gastroparesis?
Delayed gastric emptying
When is DM gastroparesis concerning?
Intubation–full stomach
Post-op what CV complication should you be weary of in a DM patient?
“Silent” MI
