HTHSCI 2F03 Lecture Notes - Lecture 18: Chronic Obstructive Pulmonary Disease, Tracheotomy, Corneal Abrasion
26 Dec 2020
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Surgery stress hormones antagonise insulin. Put pt. first on list and inform surgeon and anaesthetist. Some centres prefer to use gki infusions. Sliding scale may not be necessary for minor ops. If in doubt, liaise c diabetes specialist nurse. Stop long-acting insulin the night before. Omit am insulin if surgery is in the morning. Check cpg hrly and adjust insulin rate. Switch to sc regimen around a meal. If glucose control poor (fasting >10mm): treat as iddm. Omit oral hypoglycaemics on the am of surgery. Eating post-op: resume oral hypoglycaemics c meal. Check fasting glucose on am of surgery. Consult specialist team ore. restarting po rx. Need to steroid to cope c stress. Consider cover if high-dose steroids w/i last yr. Major surgery: hydrocortisone 50-100mg iv c pre-med then 6-8hrly for 3d. Minor: as for major but hydrocortisone only for 24h. Best to avoid operating in jaundiced pts.
