Surgery--Complications Clinical Trial
Official title:
An Optimization in the Postoperative Treatment in Head and Neck--surgical Patients -- Improvement in Glycemic Control to Reduce the Incidence of Hyperglycaemia and Associated Complications.
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.
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.
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