The occurrence of hyperglycemia (elevated blood glucose) during open cardiac surgery is high. Hyperglycemia may be associated with increased vulnerability to surgical site infections.
In 2013, the mean deep sternal wound Infection rate was 0.72%. The following strategies were employed in National Heart Centre Singapore in reducing the incidence of Deep Sternal Wound Infection:
The anaesthesiologist in charge of the patient is responsible for facilitating optimal intraoperative blood glucose control. The medical team will monitor the intraoperative blood glucose concentration every 30 to 60 minutes. The objective is to maintain intraoperative blood glucose concentrations within the range of 4-8mmol/l. As part of patient monitoring, an infusion of insulin at 50units of insulin in 50 mls of water is made available for all cardiac surgical patients. Generally, a sliding scale method of guiding insulin administration for the blood glucose control is employed; however, the dosage and rate of infusion insulin can be modified at the discretion of the attending anaesthesiologist and according to each patient’s clinical requirements.
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