Chapter 44 - Coexisting Diabetes Mellitus in Neurosurgical Patients

Abstract

Hyperglycemia in the perioperative period is a common occurrence in the neurosurgical and neurocritical patient population and has shown an association with increased incidence of adverse outcomes. It has been proved that cerebral glucose levels are a poor mirror of peripheral blood glucose values. Hypoglycemia in the hospital setting is mostly iatrogenic in nature and has been shown to have proven harmful effects on the brain necessitating careful and cautious perioperative glycemic monitoring of neurologically injured patients. In this chapter we discuss the interactions between blood glucose level and the neurological system and the management of neurosurgical and neurocritical patients with hyperglycemia. Blood pressure fluctuations in the hypertensive neurosurgical patient are detrimental as they affect cerebral perfusion. Therefore hypotension and extreme hypertension should be prevented in hypertensive neurosurgical patients. Perioperative management of hypertensive neurosurgical patients with pharmacological agents and strategies is reviewed in this chapter.