Anesthesiology Expert Discusses Inadequate Preoperative Testing of Diabetic Patient

Joseph O'Neill

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— Updated on November 28, 2017

Anesthesiology Expert WitnessThis case involves a female patient with a past medical history of diabetes who was brought to the hospital via ambulance following a forklift accident at her workplace. The patient was diagnosed with a severe leg fracture, and doctors elected to perform an open fixation procedure to repair the fracture. Surgery was performed on the same day that the patient was brought in to the emergency room. During the procedure, the patient’s blood sugar dropped dramatically, and the patient became severely hypoglycemic while recovering from anesthesia. The patient eventually slipped into a hypoglycemic coma and suffered significant brain damage.

Question(s) For Expert Witness

  • 1. How often do you provide anesthesia to diabetic patients?
  • 2. What type of monitoring is required after a surgical intervention to identify hypoglycemia?
  • 3. Are there specific guidelines for the perioperative management of diabetic patients?

Expert Witness Response E-001455

I have provided preoperative, intraoperative and postoperative care to many diabetic patients. With a high prevalence of diabetes in this country caring for diabetics under anesthesia is very common. The standard of care for safe anesthetic management requires checking a blood sugar in the immediate post-operative period. A fingerstick is a very easy and very common nursing procedure in the post-anesthesia care unit. It is ordered by the attending anesthesiologist. Specific guidelines for administering anesthesia to diabetic patients would depend on how brutal the diabetic is and how long the procedure is. However, every diabetic patient would receive at least pre-and post-operative glucose monitoring. Having been in a major academic medical center and teaching both physician resident anesthesiologists as well as student nurse anesthetists, I have taught the subject on nearly a daily basis in the clinical setting.

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