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Should Continuous Subcutaneous Insulin Infusion (CSII) Pumps Be Used During the Perioperative Period? Development of

Lcdr Shannan Rotruck1, Lcdr Lauren Suszan2, Robert Vigersky3

  • 1is a staff anesthetist at Walter Reed National Military Medical Center in Bethesda, Maryland.

AANA Journal
|October 4, 2019
PubMed

Insights

Continuous subcutaneous insulin infusion (CSII) pumps can be safely used in surgical patients with diabetes mellitus (DM) when a protocol is followed. This approach mimics natural insulin delivery, improving glycemic control during the perioperative period.

Area of Science:

  • Endocrinology
  • Anesthesiology
  • Metabolic Disorders

Background:

  • Diabetes Mellitus (DM) affects 30.3 million Americans.
  • Over 400,000 individuals with DM use Continuous Subcutaneous Insulin Infusion (CSII) pumps for blood glucose control.
  • CSII more closely mimics physiologic insulin delivery compared to daily injections.

Purpose of the Study:

  • To examine the literature on the use of CSII pumps in surgical patients with DM during the perioperative period.
  • To assess the safety and efficacy of CSII pumps for maintaining glycemic control in this population.
  • To develop a decision-making algorithm for anesthesia providers caring for patients with CSII pumps.

Main Methods:

  • A literature search strategy was formulated to identify studies on CSII pump use in the perioperative period.
  • Seven sources were identified, including one case study and three retrospective cohort studies.
  • Methodologic limitations of the identified studies were noted.

Main Results:

  • Evidence suggests that CSII pumps can be safely utilized during the perioperative period.
  • The safe use of CSII pumps is contingent upon the implementation of an established protocol.
  • A multidisciplinary team developed a decision-making algorithm for anesthesia providers.

Conclusions:

  • CSII pumps can be safely managed in surgical patients with DM when a protocol is in place.
  • A structured approach is essential to minimize risks associated with CSII pump use in the perioperative setting.
  • The developed algorithm aims to assist anesthesia providers in managing these patients effectively.

Keywords:
Continuous subcutaneous insulin infusiondiabetes mellitushyperglycemiahypoglycemiainsulin

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