Beruflich Dokumente
Kultur Dokumente
24 McCarthy JR, Trigg R, John C, Gough MJ, Horrocks M. Patient cancer recurrence: a retrospective analysis. Anesthesiology 2008; 109:
satisfaction for carotid endarterectomy performed under local 180–7
anaesthesia. Eur J Vasc Endovasc Surg 2004; 27: 654 –9 27 Exadaktylos AK, Buggy DJ, Moriarty DC, Mascha E, Sessler DI.
25 Cassuto J, Sinclair R, Bonderovic M. Anti-inflammatory Can anesthetic technique for primary breast cancer surgery
properties of local anesthetics and their present and affect recurrence or metastasis? Anesthesiology 2006; 105: 660– 4
potential clinical implications. Acta Anaesthesiol Scand 2006; 50: 28 Sessler DI, Ben-Eliyahu S, Mascha EJ, Parat MO, Buggy DJ. Can
265 – 82 regional analgesia reduce the risk of recurrence after breast
26 Biki B, Mascha E, Moriarty DC, Fitzpatrick JM, Sessler DI, Buggy DJ. cancer? Methodology of a multicenter randomized trial. Contemp
Anesthetic technique for radical prostatectomy surgery affects Clin Trials 2008; 29: 517 – 26
Editorial III
Management of diabetes during surgery: 30 yr of the Alberti regimen
In 1979, the British Journal of Anaesthesia published an starvation in type 1 diabetics, the restraining effects of
article by Alberti and Thomas1 in which they introduced basal insulin on catabolism are lost and that catabolism
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The recommendations for managing type II diabetic glucose. Several factors were noted to increase insulin
patients were based on a comparison of the glucose – requirements: the severity of surgery, particularly cardiac
insulin –potassium regimen with no therapy. They con- surgery, the presence of an infection, and the administration
cluded that there was improved metabolic control with the of glucocorticoids and catecholamines. The problem of
Alberti regimen in all diabetic patients treated with oral obesity with concomitant insulin resistance was recognized
hypoglycaemic drugs except in those well-controlled and it was recommended that if the diabetic patient was
patients undergoing minor surgery. It was recommended more than 50% heavier than their ideal body weight, then
that long-acting sulphonylureas, such as chlorpropamide, the dose of insulin should be increased two-fold.
should be stopped at least 3 days before surgery and bigua- The standard i.v. fluid in the Alberti regimen was
nides also discontinued because of the risk of lactic acido- glucose 10% infused at a rate of 100 to 125 ml h21. The
sis. A recent evaluation of metformin indicated that the risk of hyponatraemia from the prolonged infusion of
problems of lactic acidosis may have been exaggerated,10 glucose solutions is now well recognized.15 The authors
and the inadvertent failure to stop metformin before stated that sodium chloride solution 0.9% was an accepta-
cardiac surgery did not increase mortality and morbidity.11 ble fluid for i.v. use in diabetic patients but that lactate-
In type 1 diabetic patients, four regimens were exam- containing solutions such as Hartmann’s solution should
ined: no insulin – no glucose, insulin s.c. with glucose i.v., be avoided.16 The evidence to support the contention that
combined regimen for up to 24 h, and combined regimen lactate-containing solutions should not be used because
for 72 h. The no insulin –no glucose regimen failed to they enhance the glycaemic response to surgery is very
control glucose adequately and was associated with a weak and was reviewed recently.17 If the volume of
marked increase in circulating NEFA and ketone body glucose solution i.v. needed to be restricted, for example,
concentrations, raised urea excretion, and markedly negative to give sodium chloride 0.9%, then the use of 20% or
potassium, phosphate, calcium, and magnesium balances. 50% glucose infused centrally was recommended.
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