Blood glucose level to cancel cataract surgery

[coffeebythelake]

I used to do a lot of cataracts. Early in my career the preop nurse asked about a 480 blood sugar. I ordered 10u regular IV insulin and delayed the case until blood sugar less than 300. 15 minutes later it was 220. 30 minutes 80. My thought was the machine was off but the nurse could have given the wrong dose. That was the last time I gave insulin preop.

The ambulatory center isn’t a treatment facility. If a patient doesn’t meet discharge criteria preop then they won’t meet it post op. I don’t give insulin for hyperglycemia, labetalol for htn, or reglan/famotidine for full stomachs like some I have seen.

so you just proceed with the case without any treatment?

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[Hork Bajir]

Just the other day I had a patient for a cataract who was hypertensive to 180s in pre-op. Procedure starts, BP goes to 220s. In that setting, I’m giving labetolol, and make no apologies for doing so.

On one hand, would have been ridiculous to cancel a cataract for such a relatively common degree of pre-op HTN. On the other, if I send the patient out to the recovery room (and then home) with a systolic of >200, my license is on the line when that person strokes out at home later in the afternoon. So the person got their cataract fixed, and I gave a homeopathic dose of labetolol to buff the numbers and document that I was making a good faith attempt to treat.

Still, would rather be in a hospital caring for ASA 4 any day of the week than rotting in the eyeball center