Newly Published
Perioperative Medicine  |   June 2017
Accuracy of Capillary and Arterial Whole Blood Glucose Measurements Using a Glucose Meter in Patients under General Anesthesia in the Operating Room
Author Notes
  • From the Department of Laboratory Medicine and Pathology (B.S.K., L.J.D.), Mayo Clinic School of Health Sciences (B.S.K., C.M.L., L.K.S., A.E.W., M.E.S.-M.), Department of Anesthesiology and Perioperative Medicine (C.M.L., L.K.S., A.E.W., M.E.S.-M., T.B.C.), Division of Biomedical Statistics and Informatics (C.M.W.-W.), and Department of Biomedical Engineering and Physiology (T.B.C.), Mayo Clinic, Rochester, Minnesota.
  • Submitted for publication October 10, 2016. Accepted for publication April 26, 2017.
    Submitted for publication October 10, 2016. Accepted for publication April 26, 2017.×
  • Acknowledgments: The authors acknowledge Mayo Clinic Anesthesia Clinical Research Unit study coordinators Wayne Weber, R.R.T., and Melissa Passe, R.R.T., for their help with data extraction; Man Li, Lavonne M. Liedl, R.R.T., and the staff of the Mayo Clinic Anesthesia Clinical Research Unit for their efforts in identifying, recruiting, and consenting participants; Sarah Wolhart, R.N., for help in preparing the protocol; and the staff of the Mayo Clinic Clinical Research and Trials Unit for performing point-of-care measurements.
    Acknowledgments: The authors acknowledge Mayo Clinic Anesthesia Clinical Research Unit study coordinators Wayne Weber, R.R.T., and Melissa Passe, R.R.T., for their help with data extraction; Man Li, Lavonne M. Liedl, R.R.T., and the staff of the Mayo Clinic Anesthesia Clinical Research Unit for their efforts in identifying, recruiting, and consenting participants; Sarah Wolhart, R.N., for help in preparing the protocol; and the staff of the Mayo Clinic Clinical Research and Trials Unit for performing point-of-care measurements.×
  • Research Support: Supported by grant No. UL1 TR000135 from the National Center for Advancing Translational Sciences, Bethesda, Maryland, the Mayo Clinic Department of Laboratory Medicine and Pathology, Rochester, Minnesota, and the Mayo Clinic Department of Anesthesiology, Rochester, Minnesota.
    Research Support: Supported by grant No. UL1 TR000135 from the National Center for Advancing Translational Sciences, Bethesda, Maryland, the Mayo Clinic Department of Laboratory Medicine and Pathology, Rochester, Minnesota, and the Mayo Clinic Department of Anesthesiology, Rochester, Minnesota.×
  • Competing Interests: Dr. Karon has received travel support from Nova Biomedical Corporation, Waltham, Massachusetts. The other authors declare no competing interests.
    Competing Interests: Dr. Karon has received travel support from Nova Biomedical Corporation, Waltham, Massachusetts. The other authors declare no competing interests.×
  • Correspondence: Address correspondence to Dr. Curry: 200 First Street SW, Rochester, Minnesota 55905. curry.timothy@mayo.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
Perioperative Medicine / Endocrine and Metabolic Systems / Quality Improvement
Perioperative Medicine   |   June 2017
Accuracy of Capillary and Arterial Whole Blood Glucose Measurements Using a Glucose Meter in Patients under General Anesthesia in the Operating Room
Anesthesiology Newly Published on June 1, 2017. doi:10.1097/ALN.0000000000001708
Anesthesiology Newly Published on June 1, 2017. doi:10.1097/ALN.0000000000001708
Abstract

Background: The aim of this study was to evaluate the use of a glucose meter with surgical patients under general anesthesia in the operating room.

Methods: Glucose measurements were performed intraoperatively on 368 paired capillary and arterial whole blood samples using a Nova StatStrip (Nova Biomedical, USA) glucose meter and compared with 368 reference arterial whole blood glucose measurements by blood gas analyzer in 196 patients. Primary outcomes were median bias (meter minus reference), percentage of glucose meter samples meeting accuracy criteria for subcutaneous insulin dosing as defined by Parkes error grid analysis for type 1 diabetes mellitus, and accuracy criteria for intravenous insulin infusion as defined by Clinical and Laboratory Standards Institute guidelines. Time under anesthesia, patient position, diabetes status, and other variables were studied to determine whether any affected glucose meter bias.

Results: Median bias (interquartile range) was −4 mg/dl (−9 to 0 mg/dl), which did not differ from median arterial meter bias of −5 mg/dl (−9 to −1 mg/dl; P = 0.32). All of the capillary and arterial glucose meter values met acceptability criteria for subcutaneous insulin dosing, whereas only 89% (327 of 368) of capillary and 93% (344 of 368) arterial glucose meter values met accuracy criteria for intravenous insulin infusion. Time, patient position, and diabetes status were not associated with meter bias.

Conclusions: Capillary and arterial blood glucose measured using the glucose meter are acceptable for intraoperative subcutaneous insulin dosing. Whole blood glucose on the meter did not meet accuracy guidelines established specifically for more intensive (e.g., intravenous insulin) glycemic control in the acute care environment.