pdfjoiner

More documents

Recommendations

Info

Anaesthesia 2015 Guidelines doi:10.1111/anae.13233 Peri-operative management of the surgical patient with diabetes 2015 Association of Anaesthetists of Great Britain and Ireland Membership of the Working Party: P. Barker, P. E. Creasey, K. Dhatariya, 1 N. Levy, A. Lipp, 2 M. H. Nathanson (Chair), N. Penfold, 3 B. Watson and T. Woodcock 1 Joint British Diabetes Societies Inpatient Care Group 2 British Association of Day Surgery 3 Royal College of Anaesthetists Summary Diabetes affects 10–15% of the surgical population and patients with diabetes undergoing surgery have greater complication rates, mortality rates and length of hospital stay. Modern management of the surgical patient with diabetes focuses on: thorough pre-operative assessment and optimisation of their diabetes (as defined by a HbA1c < 69 mmol.mol 1 ); deciding if the patient can be managed by simple manipulation of pre-existing treatment during a short starvation period (maximum of one missed meal) rather than use of a variable-rate intravenous insulin infusion; and safe use of the latter when it is the only option, for example in emergency patients, patients expected not to return to a normal diet immediately postoperatively, and patients with poorly controlled diabetes. In addition, it is imperative that communication amongst healthcare professionals and between them and the patient is accurate and well informed at all times. Most patients with diabetes have many years of experience of managing their own care. The purpose of this guideline is to provide detailed guidance on the peri-operative management of the surgical patient with diabetes that is specific to anaesthetists and to ensure that all current national guidance is concordant. ................................................................................................................................................................. This is a consensus document produced by members of a Working Party established by the Association of Anaesthetists of Great Britain and Ireland (AAGBI). It has been seen and approved by the AAGBI Board of Directors. Date of review: 2020. Accepted: 12 August 2015 • What other guideline statements are available on this topic? The NHS Diabetes Guideline for the Peri-operative Management of the Adult Patient with Diabetes [1] was published in 2011 by NHS Diabetes (now part of NHS Improving Quality), and is due to be updated in 2015. • Why was this guideline developed? This guideline was developed to improve both the safety and the outcome of patients with diabetes undergoing surgical procedures. ................................................................................................................................................................. This is an open access article under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non-commercial and no modifications or adaptations are made. © 2015 The Authors. Anaesthesia published by John Wiley & Sons Ltd on behalf of Association of Anaesthetists of Great Britain and Ireland 1
Anaesthesia 2015 Barker et al. | Guidelines on peri-operative management of diabetes • How and why does this statement differ from existing guidelines? The 2011 guideline [1] deals with the whole patient pathway, from referral for surgery from primary care to discharge and follow-up. It is too broad in scope to be a working document for anaesthetists. This guideline summarises the existing guideline and focuses specifically on peri-operative care. Introduction The demographics describing the dramatic increase in the number of patients with diabetes are well known. Patients with diabetes require surgical procedures more frequently and have longer hospital stays than those without the condition [2]. The presence of diabetes or hyperglycaemia in surgical patients has been shown to lead to increased morbidity and mortality, with perioperative mortality rates up to 50% greater than the non-diabetic population [2]. The reasons for these adverse outcomes are multifactorial, but include: failure to identify patients with diabetes or hyperglycaemia [3, 4]; multiple co-morbidities including microvascular and macrovascular complications [5]; complex polypharmacy and insulin prescribing errors [6]; increased peri-operative and postoperative infections [2, 7, 8]; associated hypoglycaemia and hyperglycaemia [2]; a lack of, or inadequate, institutional guidelines for management of inpatient diabetes or hyperglycaemia [2, 9]; and inadequate knowledge of diabetes and hyperglycaemia management amongst staff delivering care [10]. Anaesthetists and other peri-operative care providers should be knowledgeable and skilled in the care of patients with diabetes. Management of diabetes is a vital element in the management of surgical patients with diabetes. It is not good enough for the diabetic care to be a secondary, or sometimes forgotten, element of the peri-operative care package. Previous guidelines In April 2011 NHS Diabetes (now part of NHS Improving Quality) published a document: NHS Diabetes Guideline for the Peri-operative Management of the Adult Patient with Diabetes, in association with the Joint British Diabetes Societies (JBDS) [1] (an almost identical version, Management of Adults with Diabetes Undergoing Surgery and Elective Procedures: Improving Standards, is available at www.diabetologists-abcd.org.uk/JBDS/JBDS.htm). This comprehensive guideline provided both background information and advice to clinicians caring for patients with diabetes. Some of the recommendations in that document were due for review in the light of new evidence and, in addition, it was felt that anaesthetists and other practitioners caring for patients with diabetes in the peri-operative period needed shorter, practical advice. The Association of Anaesthetists of Great Britain and Ireland (AAGBI) offered to co-author this shortened guideline, in collaboration with colleagues involved with the 2011 document. The previous 2011 NHS Diabetes guidelines will also be updated in 2015. The risks of poor diabetic control Studies have shown that high pre-operative and perioperative glucose and glycated haemoglobin (HbA1c) levels are associated with poor surgical outcomes. These findings have been seen in both elective and emergency surgery including spinal [11], vascular [12], colorectal [13], cardiac [14, 15], trauma [16], breast [17], orthopaedic [18], neurosurgical, and hepatobiliary surgery [19, 20]. One study showed that the adverse outcomes include a greater than 50% increase in mortality, a 2.4-fold increase in the incidence of postoperative respiratory infections, a doubling of surgical site infections, a threefold increase in postoperative urinary tract infections, a doubling in the incidence of myocardial infarction, and an almost twofold increase in acute kidney injury [2]. Paradoxically, there are some data to show that the outcomes of patients with diabetes may not be different from, or may indeed be better than, those without diabetes if the diagnosis is known before surgery [21]. The reasons for this are unknown, but may be due to increased vigilance surrounding glucose control for those with a diagnosis of diabetes. Referral from primary care and planning surgery The aim is to ensure that diabetes is as well controlled as possible before elective surgery and to avoid delays to surgery due to poor control. The Working Party supports the consensus advice published in the 2011 NHS Diabetes guideline that the HbA1c should be < 69 mmol.mol 1 (8.5%) for elective cases [1], and 2 © 2015 The Authors. Anaesthesia published by John Wiley & Sons Ltd on behalf of Association of Anaesthetists of Great Britain and Ireland
Page 1 and 2:
Recommendations for the Safe Transf
Page 3 and 4:
CONTENTS Section I Summary and Reco
Page 5 and 6:
SECTION II - BACKGROUND In 1996 the
Page 7 and 8:
SECTION IV - ORGANISATION AND COMMU
Page 9 and 10:
SECTION V - STAFFING REQUIREMENTS A
Page 11 and 12:
A p p ropriate re s p i ra t o ry s
Page 13 and 14:
SECTION VII - THE TRANSFER The tran
Page 15 and 16:
SECTION VIII - EQUIPMENT AND DRUGS
Page 17 and 18:
SECTION IX - EDUCATION AND TRAINING
Page 19 and 20:
SECTION X - RESOURCE IMPLICATIONS F
Page 21 and 22:
APPENDIX I INDICATIONS FOR INTUBATI
Page 23 and 24:
APPENDIX III ADDITIONAL INFORMATION
Page 25 and 26:
AAGBI SAFETY GUIDELINE Suspected An
Page 27 and 28:
GUIDELINES Suspected Anaphylactic R
Page 29 and 30:
Suspected anaphylactic reactions as
Page 31 and 32:
Page 33 and 34:
Page 35 and 36:
Page 37 and 38:
Page 39 and 40:
Page 41 and 42:
Page 43 and 44:
Page 45 and 46:
Page 47 and 48:
Page 49 and 50:
Page 51 and 52:
Page 53 and 54:
Page 55 and 56:
Storage of Drugs in Anaesthetic Roo
Page 57 and 58:
Storage of Drugs in Anaesthetic Roo
Page 59 and 60:
This guideline was originally publi
Page 61 and 62:
Anaesthesia 2015 Checketts et al. |
Page 63 and 64:
Page 65 and 66:
Page 67 and 68:
Page 69 and 70:
Anaesthesia 2016, 71, 1503 Correcti
Page 71 and 72:
Membership of the working party Dr
Page 73 and 74:
1. Summary 1.1 Safety, quality and
Page 75 and 76:
3. Responsibility of anaesthetists
Page 77 and 78:
3.4 The Trust - Medical Devices Man
Page 79 and 80:
4. Standards 4.1 Medical Devices Di
Page 81 and 82:
5. Responsibility of manufacturers
Page 83 and 84:
6. Choosing and trialling equipment
Page 85 and 86:
equipment officer is encouraged to
Page 87 and 88:
EU procurement thresholds Threshold
Page 89 and 90:
When negotiating a purchasing agree
Page 91 and 92:
9. Shared equipment Many types of e
Page 93 and 94:
Third party servicing is another op
Page 95 and 96:
11. Replacement 11.1 Planned equipm
Page 97 and 98:
number of re-uses (e.g. re-usable L
Page 99 and 100: Where new equipment is purchased th
Page 101 and 102: 14. Incident reporting and investig
Page 103 and 104: available from www.hse.gov.uk 14.4
Page 105 and 106: DB DoH EBME EC EU FRCA HN HSE IEC I
Page 107 and 108: 8. OPSI. Statutory Instrument 2006
Page 109 and 110: Eire Tel: 00353 1 676 4971 Website:
Page 111 and 112: Peri-operative management of the ob
Page 113 and 114: Guidelines Peri-operative managemen
Page 115 and 116: Recommendations 1 Every hospital sh
Page 117 and 118: 35 30 25 Prevalance (%) 20 15 10 5
Page 119 and 120: is an increased incidence of prolon
Page 121 and 122: Figure 2 Relationship between total
Page 123 and 124: techniques, and when used with neur
Page 125 and 126: Table 5 The STOP-BANG screening que
Page 127 and 128: Intra-operative care Preparation of
Page 129 and 130: Figure 3 Ramping position for obese
Page 131 and 132: eturn of airway reflexes with desfl
Page 133 and 134: Table 6 Dosing schedule for thrombo
Page 135 and 136: A review and meta-analysis by the S
Page 137 and 138: numbers of staff are needed to roll
Page 139 and 140: Table 7 Equipment for managing obes
Page 141 and 142: 11. Schneider HJ, Glaesmer H, Klots
Page 143 and 144: 44. Edholm D, Kullberg J, Haenni A,
Page 145 and 146: 75. McKay RE, Malhotra A, Cakmakkay
Page 147 and 148: 21 Portland Place, London, W1B 1PY
Page 149: This guideline was originally publi
Page 153 and 154: Anaesthesia 2015 Barker et al. | Gu
Page 165 and 166: Out of Hours Activity (Anaesthesia)
Page 167 and 168: Considerations for anaesthetists Th
Page 169 and 170: OAA / AAGBI Guidelines for Obstetri
Page 171 and 172: Contents 1. Key recommendations 2 2
Page 173 and 174: 2. Introduction This is the third v
Page 175 and 176: Recommendations Medical staff The t
Page 177 and 178: appointed directly from other count
Page 179 and 180: Peripartum care Pre-operative asses
Page 181 and 182: Intravenous patient-controlled opio
Page 183 and 184: depression. In the absence of contr
Page 185 and 186: of clinical deterioration, as recom
Page 187 and 188: 5. Training and education Each obst
Page 189 and 190: • Skills and drills training: ana
Page 191 and 192: • The midwife caring for a woman
Page 193 and 194: 7. Support services, equipment, fac
Page 195 and 196: Equipment for PCA must be available
Page 197 and 198: 8. The future The delivery of healt
Page 199 and 200: The following national guidelines s
Page 201 and 202:
19. Obstetric Anaesthetists’ Asso
Page 203 and 204:
21 Portland Place, London, W1B 1PY
Page 205 and 206:
At the first meeting held on 9 th M
Page 207 and 208:
Methods to estimate/establish publi
Page 209 and 210:
Recommendations The WP recommends:
Page 211 and 212:
Anaesthesia, 2007, 62, pages 1199-1
Page 213 and 214:
Anaesthesia, 2007, 62, pages 1199-1
Page 216 and 217:
OPTION 3 - PRESUMED CONSENT. ‘Pre
Page 218 and 219:
Power of Attorney) while requiring
Page 220 and 221:
Needle-stick injury and HIV testing
Page 222 and 223:
egain capacity, and the absence of
Page 224 and 225:
treatment if it was understood that
Page 226 and 227:
Page 228 and 229:
Management of hypertension before e
Page 230 and 231:
Page 232 and 233:
Page 234 and 235:
Page 236 and 237:
Page 238 and 239:
Page 240 and 241:
AAGBI Safety Guideline Management o
Page 242 and 243:
Malignant Hyperthermia Crisis Task
Page 244 and 245:
MEMBERSHIP OF THE WORKING PARTY Dr
Page 246 and 247:
Section 1 Recommendations 1. Transf
Page 248 and 249:
Section 3 Introduction In 1997 it w
Page 250 and 251:
This process may require many telep
Page 252 and 253:
Section 6 Accompanying the patient
Page 254 and 255:
Section 7 Monitoring, drugs and equ
Page 256 and 257:
heavily congested areas, but not al
Page 258 and 259:
APPENDIX 1 Departure checklist Do a
Page 260 and 261:
13. Bercault N, Wolf M, Runge I, Fl
Page 262 and 263:
21 Portland Place, London W1B 1PY T
Page 264 and 265:
Membership of the Working Party Dr
Page 266 and 267:
Infection control in anaesthesia An
Page 268 and 269:
Page 270 and 271:
Page 272 and 273:
Page 274 and 275:
Page 276 and 277:
AAGBI SAFETY GUIDELINE Immediate Po
Page 278 and 279:
Guidelines Immediate post-anaesthes
Page 280 and 281:
Whitaker et al. | Guidelines: Immed
Page 282 and 283:
Page 284 and 285:
Page 286 and 287:
Page 288 and 289:
Page 290 and 291:
Page 292 and 293:
Page 294 and 295:
Page 296 and 297:
The Royal College of Anaesthetists
Page 299 and 300:
Contents ❚ Foreword 4 Introductio
Page 301 and 302:
Introduction ❚ The Good Anaesthet
Page 303 and 304:
Related guidelines and sources of i
Page 305 and 306:
Domain A: knowledge, skills and per
Page 307 and 308:
Page 309 and 310:
Page 311 and 312:
Domain B: safety and quality Attrib
Page 313 and 314:
Page 315 and 316:
Page 317 and 318:
Domain C: communication, partnershi
Page 319 and 320:
Page 321 and 322:
Page 323 and 324:
Domain D: maintaining trust Attribu
Page 325 and 326:
Page 327 and 328:
Page 329 and 330:
Day Case and Short Stay Surgery 2 P
Page 331 and 332:
GUIDELINES Day case and short stay
Page 333 and 334:
Guidelines: Day case and short stay
Page 335 and 336:
Page 337 and 338:
Page 339 and 340:
Page 341 and 342:
Page 343 and 344:
Page 345 and 346:
Page 347 and 348:
Page 349 and 350:
Page 351 and 352:
Page 353 and 354:
Page 355 and 356:
Page 357 and 358:
Page 359 and 360:
Page 361:
The Association of Anaesthetists of
Page 364 and 365:
Page 366 and 367:
Anaesthesia 2012 Hartle et al. | Ch
Page 368 and 369:
Page 370 and 371:
Page 372 and 373:
Page 374 and 375:
Page 376 and 377:
Page 378 and 379:
Page 380:
21 Portland Place, London, W1B 1PY
show all

pdfjoiner

Create successful ePaper yourself

Delete template?

Save as template?