Hyperglycemia assessment in the post-anesthesia care unit / Avaliação de hiperglicemia na sala de recuperação pós-anestésica

Abstract Background and objectives Hyperglycemia in surgical patients may cause serious problems. Analyzing this complication in this scenario contributes to improve the management of these patients. The aim of this study was to evaluate the prevalence of hyperglycemia in the post-anesthetic care unit (PACU) in non-diabetic patients undergoing elective surgery and analyze the possible risk factors associated with this complication. Methods We evaluated non-diabetic patients undergoing elective surgeries and admitted in the PACU. Data were collected from medical records through precoded questionnaire. Hyperglycemia was considered when blood glucose was >120 mg.dL-1. Patients with hyperglycemia were compared to normoglycemic ones to assess factors associated with the problem. We excluded patients with endocrine-metabolic disorders, diabetes, children under 18 years, body mass index (BMI) below 18 or above 35, pregnancy, postpartum or breastfeeding, history of drug use, and emergency surgeries. Results We evaluated 837 patients. The mean age was 47.8 ± 16.1 years. The prevalence of hyperglycemia in the postoperative period was 26.4%. In multivariate analysis, age (OR = 1.031, 95% CI 1.017-1.045); BMI (OR = 1.052, 95% CI 1.005-1.101); duration of surgery (OR = 1.011, 95% CI 1.008-1.014), history of hypertension (OR = 1.620, 95% CI 1.053-2.493), and intraoperative use of corticosteroids (OR = 5.465, 95% CI 3.421-8.731) were independent risk factors for postoperative hyperglycemia. Conclusion The prevalence of hyperglycemia was high in the PACU, and factors such as age, BMI, corticosteroids, blood pressure, and duration of surgery are strongly related to this complication.

Resumo Justificativa e objetivos Hiperglicemia em pacientes cirúrgicos pode ocasionar graves problemas. Nesse contexto, analisar essa complicação contribui para o melhor manejo desses pacientes. O objetivo do estudo foi avaliar a prevalência de hiperglicemia na sala de recuperação pós-anestésica (SRPA) em pacientes não diabéticos submetidos a cirurgias eletivas e analisar os possíveis fatores de risco associados a essa complicação. Métodos Foram avaliados pacientes não diabéticos submetidos a cirurgias eletivas e admitidos na SRPA. Os dados foram coletados dos prontuários por meio de questionário pré-codificado. Foi considerada hiperglicemia quando a glicemia era > 120 mg.dL-1. Pacientes com hiperglicemia foram comparados com os normoglicêmicos para avaliar fatores associados ao problema. Foram excluídos os pacientes com distúrbios endócrino-metabólicos, diabéticos, menores de 18 anos, índice de massa corpórea (IMC) menor do que 18 ou maior do que 35, gestação, puerpério ou aleitamento materno, antecedente de uso de drogas e cirurgias de urgência. Resultados Foram avaliados 837 pacientes. A média de idade foi 47,8 ± 16,1 anos. A prevalência de hiperglicemia no pós-operatório foi de 26,4%. Na análise multivariada, idade (OR = 1,031; IC 95% 1,017-1,045); IMC (OR = 1,052; IC 95% 1,005-1,101); tempo cirúrgico (OR = 1,011; IC 95% 1,008-1,014); antecedente de hipertensão (OR = 1,620; IC 95% 1,053-2,493) e uso de corticoides intraoperatório (OR = 5,465; IC 95% 3,421-8,731) representaram fatores de risco independentes para hiperglicemia no pós-operatório. Conclusão Hiperglicemia apresentou alta prevalência na SRPA e fatores como idade, IMC, corticoides, hipertensão arterial e tempo de cirurgia são fortemente relacionados a essa complicação.

Association between Intraoperative and Post- Anesthetic Care Unit Respiratory Events among 12,641 Children in Southern Thailand.

Aims: The association between intraoperative respiratory events (IRE) and post-anesthetic care unit respiratory events (PARE) in children as well as the risk factors for PARE have not been described. The objectives of this study were to describe the association between IRE and PARE and to identify the risk factors of PARE in children at a tertiary care hospital in southern Thailand. Methodology: A historical cohort study based on the surveillance anesthetic database and chart review of children who received surgery at Songklanagarind Hospital during January 2005 to December 2011 was conducted. Demographic, surgery and anesthesia-related data were collected. The association between IRE and PARE and other potential risk factors were analyzed using cross tabulation. Multivariate logistic regression was employed to identify independent predictors for PARE, indicated by adjusted odds ratios (aOR) and their 95% confidence intervals (CI). Results: Overall, perioperative respiratory event (PRE) occurred in 531 out of 14153 children (315 IRE, 348 PARE). The association between PARE and IRE was strong, with adjusted odds ratios ranging from 3.1 (laryngospasm) to 18.5 (desaturation). Anesthesia-related risk factors for PARE were ASA classification 3 (aOR=3.1, 95%CI=1.9-5.0), jet ventilation (aOR=3.4, 95%CI=1.6-7.1), intubation with succinylcholine vs non-depolarizing muscle relaxant (aOR=1.9, 95%CI=1.4-2.5), use of intraoperative morphine vs fentanyl (aOR=2.4, 95%CI=1.7-3.3) and duration of anesthesia ≥ 3 hours (aOR=3.2, 95%CI=2.1-4.9). Conclusion: The magnitude of association between IRE and PARE was high. Increased vigilance and close monitoring by anesthesia personnel in high risk children and high risk surgery may prevent IRE and therefore also PARE, so that overall PRE can be reduced. Preventable risk factors for PARE such as using succinylcholine and morphine can be managed under discretion of the anesthesiologist.