Education  |   March 2017
Perioperative Hyperglycemia Management: An Update
Author Notes
  • From the Departments of Anesthesiology (E.W.D., K.C.) and Medicine (G.E.U.), Emory University School of Medicine, Atlanta, Georgia.
  • This article has been selected for the Anesthesiology CME Program. Learning objectives and disclosure and ordering information can be found in the CME section at the front of this issue.
    This article has been selected for the Anesthesiology CME Program. Learning objectives and disclosure and ordering information can be found in the CME section at the front of this issue.×
  • This article is featured in “This Month in Anesthesiology,” page 1A.
    This article is featured in “This Month in Anesthesiology,” page 1A.×
  • Figures 1 and 2 were enhanced by Annemarie B. Johnson, C.M.I., Medical Illustrator, Vivo Visuals, Winston-Salem, North Carolina.
    Figures 1 and 2 were enhanced by Annemarie B. Johnson, C.M.I., Medical Illustrator, Vivo Visuals, Winston-Salem, North Carolina.×
  • Submitted for publication February 28, 2016. Accepted for publication November 17, 2016.
    Submitted for publication February 28, 2016. Accepted for publication November 17, 2016.×
  • Address correspondence to Dr. Duggan: Department of Anesthesiology, Emory University School of Medicine, 1364 Clifton Road, Office B-352, Atlanta, Georgia 30322. elizabeth.w.duggan@emory.edu. Information on purchasing reprints may be found at www.anesthesiology.org or on the masthead page at the beginning of this issue. Anesthesiology’s articles are made freely accessible to all readers, for personal use only, 6 months from the cover date of the issue.
Article Information
Education / Clinical Concepts and Commentary
Education   |   March 2017
Perioperative Hyperglycemia Management: An Update
Anesthesiology 3 2017, Vol.126, 547-560. doi:10.1097/ALN.0000000000001515
Anesthesiology 3 2017, Vol.126, 547-560. doi:10.1097/ALN.0000000000001515
A SUBSTANTIAL body of literature demonstrates a clear association between perioperative hyperglycemia and adverse clinical outcomes.1–3  The risk for postoperative complications and increased mortality relates to both long-term glycemic control and to the severity of hyperglycemia on admission and during the hospital stay.2  The underlying mechanism(s) relating hyperglycemia to poor outcomes is not completely understood. Past and current studies point to physiologic changes that occur in the hyperglycemic state that may contribute to poor outcomes. Elevated blood glucose (BG) levels impair neutrophil function and cause an overproduction of reactive oxygen species, free fatty acids (FFA), and inflammatory mediators. These pathophysiologic changes contribute to direct cellular damage and vascular and immune dysfunctions.4  Substantial evidence indicates that correction of hyperglycemia with insulin administration reduces hospital complications and decreases mortality in cardiac5  and general surgery6  patients. However, optimal glucose management during the perioperative period is widely debated. Recent randomized controlled trials targeting conventional targets for glycemic control do not demonstrate the significant risk of hypoglycemia7,8  as seen in previous studies using insulin to maintain tight BG control.9  The pendulum of inpatient care has since moved toward more moderate and individualized glycemic targets.
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