Perioperative Glycemic Control

Interventions to improve glycemic control are known to improve outcomes. Multiple randomized clinical trials with diverse patient cohorts support intensive perioperative glucose control. Preoperative carbohydrate loading has resulted in reduced glucose levels after abdominal surgery and Cardiac Surgery (CS). Epidural analgesia during CS has been shown to reduce hyperglycemia incidence. After CS, hyperglycemia morbidity is multifactorial and attributed to glucose toxicity, increased oxidative stress, prothrombotic effects, and inflammation. Perioperative glycemic control is recommended based on randomized data not specific to populations undergoing CS and high-quality observational studies (class I, level B-R).

Insulin Infusion

Treatment of hyperglycemia (glucose >160-180 mg/dL [to convert to mmol/L, multiply by 0.0555]) with an insulin infusion for the patient undergoing CS may be associated with improved perioperative glycemic control. Postoperative hypoglycemia should be avoided, especially in patients with a tight blood glucose target range (ie, 80-110 mg/dL). Randomized clinical trials support insulin infusion protocols to treat hyperglycemia perioperatively; however, more high-quality, CS-specific studies are needed (class IIa, level B-NR).