Peri-Operative Care of Diabetic and Steroid Patients Flashcards
what is the body’s response to surgery?
it undergoes a stress response
what is the main hormone activated in the surgical stress response?
cortisol
what other hormones are activated in the surgical stress response?
catabolic hormones - glucagon, growth hormone, catecholamines
true or false: insulin level increase during the surgical stress response?
false.
insulin levels drop
what happens to plasma glucose levels in the surgical stress response?
they increase
what effect does the surgical stress response have on the heart and blood supply?
- increases heart rate and cardiac output
- increased arterial blood pressure
- increased blood supply to brain and muscles
what happens to the kidneys blood supply in the surgical stress response?
decreased blood flow to the kidneys
why does the surgical stress response increase the risk of thrombus formation?
there is an increase if plasma free fatty acids, triglycerides, cholesterol, and glucose
what negative effects does the surgical stress response have on CVS?
there is an increased risk of angina, MI, arrhythmias, AV/VF, and sudden death if the patient has risk factors
what system controls the surgical stress response?
hypothalamic pituitary axis
how often should diabetic patients have their glucose monitored intra-operatively?
BM measurements should be taken every 30 minutes
how is the balance between insulin and plasma glucose maintained peri-operatively?
patients are put on a variable rate insulin infusion (VRII)
what is the target glucose level in diabetic patients?
6mmol - 10mmol
why is hypoglycaemia bad in the post-operative period?
it’s a lack of nutrients and will cause poor wound healing
why is hyperglycaemia bad in the post-operative period?
it increased the risk of infection because bacteria love sugar - this will lead to poor wound healing
true or false: all insulin is stopped before surgery
false.
basal insulin is maintained to prevent the patient from entering DKA
why do patients on long-term steroids require special surgical management?
steroids are structurally similar to cortisol and act as negative feedback to shut down the HPA axis - therefore a stress response can’t take place
why is the stress response so important in surgery?
it promotes wound healing and helps the body get better faster
what is the importance of ACTH in the stress response?
when HPA axis is activated, it increases, increasing cortisol levels
what are anaesthetists trying to avoid in patients on long-term steroids?
addisonian crisis
what are the biological features of an addisonian crisis?
hypoglycaemia, hypotension, hyponatraemia, hyperkalaemia
what are the clinical features of an addisonian crisis?
nausea, vomiting, confusion, tachycardia, coma
what preventative measures can be taken in a surgical patient on long term steroids?
they are given IV hydrocortisone
