Abstract
PurposeBlood glucose (BG) concentrations of patients with diabetes mellitus (DM) are monitored during surgery to prevent hypo- and hyperglycemia. Access to point-of-care test (POCT) glucose meters at an operating room will usually provide monitoring at shorter intervals and may improve glycemic control. However, these meters are not validated for patients under general anesthesia.MethodsThis cross-sectional study included 75 arterial BG measurements from 75 patients (71 with DM, mostly insulin dependent) who underwent elective non-cardiac surgery under general anesthesia. Arterial blood samples were taken at least 60 minutes after induction. One drop of blood was used for Accu Chek Inform II (ACI II) POCT BG meter and the residual blood was sent to the clinical laboratory for a Hexokinase Plasma reference method. A Bland–Altman plot was used to visualize the differences between both methods, and correlation was assessed using the intra-class correlation coefficient (ICC).ResultsThe results showed an estimated mean difference of 0.8 mmol/L between ACI II and the reference method, with limits of agreement equal to -0.6 and 2.2 mmol/L. In general, the reference method produced higher values than ACI II. ICC was 0.955 (95% CI 0.634–0.986), P < 0.001, and concordance correlation coefficient (CCC) was 0.955 (95% CI 0.933–0.970).ConclusionArterial BG measurements during surgery in patients with DM under general anesthesia using POCT BG meter are in general lower than laboratory measurements, but the ICC and CCC show a clinically acceptable correlation. We conclude that POCT measurements conducted on arterial specimens using the ACI II provide sufficiently accurate results for glucose measurement during surgery under general anesthesia.
Highlights
Blood glucose (BG) monitoring in diabetic patients during general anesthesia is important
BG concentrations can be measured by several methods, including point-of-care test (POCT) BG meters and laboratory methods
Mean glucose concentrations measured with the POCT Accu Chek Inform II (ACI II) and laboratory hexokinase method measurements were 9.5 ± 3.4 mmol/L versus 10.3 ± 3.7 mmol/L, respectively
Summary
Blood glucose (BG) monitoring in diabetic patients during general anesthesia is important. General anesthesia often induces hypotension, which can cause reduction of perfusion and thereby a reduction of blood refreshing, leading to less. Journal of Clinical Monitoring and Computing accurate capillary blood glucose measurement compared to the actual value in the systemic circulation. Fluid shifts during surgery are common due to blood loss, fluid administrations, and vasodilatory effect of anesthetics. This can affect capillary blood sampling, which may result in a lower glucose concentration [2]. Controlled capillary measurements depend on a lot of different factors which are not constant during general anesthesia. Arterial measurements are less disturbed by skin temperature and peripheral circulation.
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