An Optimization in the Postoperative Treatment in Head and Neck--surgical Patients.

University of Copenhagen

Status

Unknown

Conditions

Hyperglycemia Stress

Surgery--Complications

Hyperglycemia Steroid-induced

Treatments

Other: Prevention of hyperglycemia

Study type

Interventional

Funder types

Other

Identifiers

NCT04021186

DM-HHC

Details and patient eligibility

About

Based on glycemic load (overall increase in blood glucose), it is investigated whether better glycemic control (large fluctuations in blood glucose to abnormal values are attempted) can improve the postoperative phase of head and neck surgical patients who receive Dexamethasone (glucocorticoid). Furthermore it is examined whether this optimization in treatment can result in reduced hospitalization time and fewer re-admissions.

Hypothesis:

Continuous blood glucose measurement and insulin therapy will optimize the postoperative phase of the embedded head and neck patient receiving Dexamethasone by reducing the incidence of hyperglycaemia and associated complications.

Full description

After surgical intervention, an insulin resistance condition will occur because of the following stress response. This condition will for the majority of cases results in poor glycemic control - and there will be a risk of hyperglycaemia in the hospitalized patient. This condition affects all cells in the body and therefore has associated complications such as bigger risk at multiple infections, longer healingprocess, poorer fluid balance, etc. Hyperglycaemia is associated with a poorer outcome for the patient, which can cause an increase in hospitalization days and multiple re-admissions. It is also common for the postoperative patient to experience nausea and pain as a result of both surgery and anesthesia and immobilization. To counter this, the patient receives Dexamethasone (steroid treatment).

This experiment is based on the fact that there is still insufficient attention at this postoperative insulin resistance. In a large randomized study from 2001(Van den Berghe), insulin therapy was initiated for intensive patients. This study points out that even moderate increases in blood glucose are associated with increased morbidity and that insulin therapy is both capable of reducing mortality and morbidity.

Enrollment

40 estimated patients

Sex

All

Ages

18+ years old

Volunteers

No Healthy Volunteers

Inclusion criteria

All embedded head and neck-surgical patients receiving large packs of pre-medication, including 8-16 mg glucocorticoid.
>18 yrs.
Expected admission time of a minimum of 1 day

Exclusion criteria

Patients who do not understand and / or speak Danish
Patients who are demented
Patients included in primary robot surgery
Ear-surgical patients
Sinus surgery patients
Day surgery patients
Plastic surgical patients
Patients who are scheduled to transfer to ICU
Patients with Diabetes Mellitus type I
Patients on dialysis
If all preoperative blood samples and tests are not completed
Type 2 diabetics in insulin therapy
Anesthesia patients
Patients who have received large packages of pre-medication twice - eg. due to cancelled operation.