Post Anesthesia Care Unit Management

Perioperative Management of Diabetes Mellitus in Non-Cardiac Surgery Patients

• Purpose
• Scope
• Preoperative Instructions
• Preoperative Management
• Intraoperative Management
• Post Anesthesia Care Unit Management
• Algorithms
  • Hypoglycemia
  • Hyperglycemia
• References

Post Anesthesia Care Unit Management

1. PACU RN will take report of BS’s and treatment from anesthesia personnel.
2. Continue checking BS every two hours if the patient is prescribed or treated with any diabetic medication.
3. If BS > 180:
   1. Notify attending anesthesiologist.
   2. Regulate BS according to appropriate algorithm (document dose, route, site in MAR)
      1. Diabetics NOT ON INSULIN use Low Dose algorithm.
      2. Diabetics ON INSULIN use appropriate algorithm (Low, Medium or High Dose).
   3. All Insulin given in the perioperative period should be given subcutaneously (SQ) in abdomen (more reliable absorption) using an insulin syringe.
4. If BS < 70:
   1. Notify attending anesthesiologist.
   2. follow the HYPOGLYCEMIC ALGORITHM.
5. If BS < 100 but > 70 and Novolog has been given in the perioperative period:
   1. Notify attending anesthesiologist.
   2. Begin D5/.45% saline at 100 ml/hour.
6. Discharge from PACU when routine discharge criteria are met.
   1. Inpatients:
      1. PACU RN will report BS’s and treatment to unit RN and discharge to floor.
      2. If insulin has been given within 2 hours of discharge, an order will be placed to obtain at least one BS 2 hours after the last dose of insulin.
      3. Surgical staff will order BS to be checked at 0600 on post op day #1.
      4. All BS’s drawn after the perioperative period are to be reported to house staff or attending surgeon.
   2. All Insulin given in the perioperative period should be given subcutaneously (SQ) in abdomen (more reliable absorption) using an insulin syringe.
   3. Outpatients:
      1. Eating without nausea Instruct patient to take their next usual nutritional (premeal) dose of insulin and resume next scheduled dose of diabetic medication.
      2. Nauseous or Unable to eat Instruct patient to use their correctional sliding scale to cover meals. Resume usual dose of diabetic medication the next day. iii
      3. Patients should not be discharged within two hours of receiving Insulin without the order of an Anesthesiologist.
      4. All BS’s drawn after the perioperative period are to be reported to house staff or attending surgeon.