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