Anesthesia Essay

A. Type of Anesthesia

Although the comorbidities and type of surgery dictate certain decisions in managing patient care, anesthesiologists maintain various modalities for the perioperative period. These consist of anything from local to regional anesthesia, including neuraxial techniques and peripheral nerve blocks, as well as monitored anesthesia care with sedation to general anesthesia. Overlapping of different anesthetic types and combinations of regional analgesics to supplement general anesthesia occur frequently.

Debate on the superiority of regional anesthesia to general anesthesia continues to date. Current literature does not support any difference in mortality between regional and general anesthesia. The largest randomized study to date highlighting this issue, the General Anesthesia Local Anesthesia (GALA) study group, demonstrated no significant difference amongst patients receiving local versus general anesthesia for carotid endarterectomy surgery45. Following that randomized clinical trial, a retrospective review of the American College of Surgeons National Quality Improvement Program (ACS-NSQIP) reported similar results46. In another report from the ACS-NSQIP focusing on endovascular aortic repair, a lack of difference in mortality amongst local anesthesia, spinal anesthesia or general anesthesia emerged47. Moreover, meta-analyses of regional anesthesia versus general anesthesia for total hip arthroplasty and total knee arthroplasty revealed no difference in mortality.48, 49

Although there may be no difference in mortality, regional and local anesthesia offer other advantages compared to. sole general anesthesia. Such advantages may decrease morbidity associated with surgery and the patient’s existing medical st...

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... glucose measurements. Continuation into the immediate postoperative period remains important as well. Once in a steady state, treatment ought to be converted to a subcutaneous BBI regimen. For conversion from intravenous to subcutaneous insulin, a transition protocol should be employed 124.

Many diabetic patients undergo minor surgery in an ambulatory care setting. Basal insulin management must occur as outlined above. However, no evidence exists that perioperative blood glucose control improves outcomes after one-day surgery. Thus, it is not advisable to use a perioperative insulin drip, even if blood glucose values exceed the recommended goal. In the event of an excessively high blood glucose level, deliberation for postponement of elective surgery should be given. The definition of a cutoff point for cancellation should be in consensus with a hospital policy.