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Anesthesiol Res Pract. 2012; 2012: 690362.
Published online Feb 13, 2012. doi:  10.1155/2012/690362
PMCID: PMC3286889
Perioperative Glucose Control in Neurosurgical Patients
Daniel Agustín Godoy, 1 * Mario Di Napoli, 2 Alberto Biestro, 3 and Rainer Lenhardt 4
1Neurocritical Care Unit, Sanatorio Pasteur, Catamarca, Argentina
2Neurological Service, San Camillo de' Lellis General Hospital, 02100 Rieti, Italy
3Intensive Treatment Center, Hospital de Clínicas, Montevideo, Uruguay
4Department of Anesthesiology and Perioperative Medicine, University of Louisville, Louisville, KY 40202, USA
*Daniel Agustín Godoy: dagodoytorres/at/yahoo.com.ar
Academic Editor: Masahiko Kawaguchi
Received July 31, 2011; Revised September 29, 2011; Accepted October 21, 2011.
Abstract
Many neurosurgery patients may have unrecognized diabetes or may develop stress-related hyperglycemia in the perioperative period. Diabetes patients have a higher perioperative risk of complications and have longer hospital stays than individuals without diabetes. Maintenance of euglycemia using intensive insulin therapy (IIT) continues to be investigated as a therapeutic tool to decrease morbidity and mortality associated with derangements in glucose metabolism due to surgery. Suboptimal perioperative glucose control may contribute to increased morbidity, mortality, and aggravate concomitant illnesses. The challenge is to minimize the effects of metabolic derangements on surgical outcomes, reduce blood glucose excursions, and prevent hypoglycemia. Differences in cerebral versus systemic glucose metabolism, time course of cerebral response to injury, and heterogeneity of pathophysiology in the neurosurgical patient populations are important to consider in evaluating the risks and benefits of IIT. While extremes of glucose levels are to be avoided, there are little data to support an optimal blood glucose level or recommend a specific use of IIT for euglycemia maintenance in the perioperative management of neurosurgical patients. Individualized treatment should be based on the local level of blood glucose control, outpatient treatment regimen, presence of complications, nature of the surgical procedure, and type of anesthesia administered.
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