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Perioperative Glucose Control

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https://www.readbyqxmd.com/read/28532856/implementation-of-a-referral-to-discharge-glycemic-control-initiative-for-reduction-of-surgical-site-infections-in-gynecologic-oncology-patients
#1
Laura Hopkins, Jennifer Brown-Broderick, James Hearn, Janine Malcolm, James Chan, Wendy Hicks-Boucher, Filomena De Sousa, Mark C Walker, Sylvain Gagné
OBJECTIVE(S): To evaluate the frequency of surgical site infections before and after implementation of a comprehensive, multidisciplinary perioperative glycemic control initiative. STUDY METHODS: As part of a CUSP (Comprehensive Unit-based Safety Program) initiative, between January 5 and December 18, 2015, we implemented comprehensive, multidisciplinary glycemic control initiative to reduce SSI rates in patients undergoing major pelvic surgery for a gynecologic malignancy ('Group II')...
May 20, 2017: Gynecologic Oncology
https://www.readbyqxmd.com/read/28527646/high-dose-amino-acid-administration-achieves-an-anabolic-response-in-type-2-diabetic-patients-that-is-independent-of-glycaemic-control-a-randomized-clinical-trial
#2
Chelsia Gillis, Patricia S Roque, Jürgen Bläss, Albert Urwyler, Harald Schepperle, Guido Kunz, Thomas Peters, Thomas Schricker, Linda Wykes, Andrea Kopp Lugli
BACKGROUND & AIMS: Surgical stress provokes protein catabolism and hyperglycaemia that is enhanced in patients with type 2 diabetes (T2DM), and increases perioperative morbidity. This study hypothesized that perioperative administration of high dose intravenous (IV) amino acids (AA) will augment protein balance in T2DM patients receiving tight plasma glucose control via continuous IV insulin compared to standard plasma glucose control via subcutaneous (SC) insulin sliding scale. METHODS: Eighteen patients with well-controlled T2DM (HbA1C% < 7...
May 3, 2017: Clinical Nutrition: Official Journal of the European Society of Parenteral and Enteral Nutrition
https://www.readbyqxmd.com/read/28502888/prospective-study-of-postoperative-glycemic-control-with-a-standardized-insulin-infusion-protocol-after-infrainguinal-bypass-and-open-abdominal-aortic-aneurysm-repair
#3
Andrea M Steely, Lisa Smith, Peter W Callas, Muriel H Nathan, Julie E Lahiri, Andrew C Stanley, Georg Steinthorsson, Daniel J Bertges
INTRODUCTION: The aim of this study was to examine the effect of moderate postoperative glycemic control in diabetic and non-diabetic patients undergoing infrainguinal bypass (INFRA) or open abdominal aortic aneurysm (OAAA) repair. METHODS: In a single center prospective study, we investigated postoperative glycemic control using a standardized insulin infusion protocol after elective INFRA (n=53, 62%) and OAAA (n=33, 38%) between January 2013 and March 2015. The primary endpoint was optimal glycemic control, defined as having ≥85% of blood glucose values within the 80-150mg/dL target range...
May 11, 2017: Annals of Vascular Surgery
https://www.readbyqxmd.com/read/28437809/reactive-rather-than-proactive-diabetes-management-in-the-perioperative-period
#4
Inge Hommel, Petra J van Gurp, Alfons A den Broeder, Hub Wollersheim, Femke Atsma, Marlies E J L Hulscher, Cees J Tack
As perioperative hyperglycemia is associated with poor postoperative patient outcomes, clinical guidelines provide recommendations for optimal perioperative glucose control. It is unclear to what extent recommended glucose levels are met in daily practice, and little is known about factors that influence these levels. We describe blood glucose levels throughout the hospital care pathway in 375 non-critically ill patients with diabetes who underwent major surgery (abdominal, cardiac, or orthopedic) in 6 hospitals, examine determinants of these levels including adherence to 9 quality indicators for optimal perioperative diabetes care, and perform qualitative interviews to identify barriers for optimal care...
April 24, 2017: Hormone and Metabolic Research, Hormon- und Stoffwechselforschung, Hormones et Métabolisme
https://www.readbyqxmd.com/read/28385477/espen-guideline-clinical-nutrition-in-surgery
#5
Arved Weimann, Marco Braga, Franco Carli, Takashi Higashiguchi, Martin Hübner, Stanislaw Klek, Alessandro Laviano, Olle Ljungqvist, Dileep N Lobo, Robert Martindale, Dan L Waitzberg, Stephan C Bischoff, Pierre Singer
Early oral feeding is the preferred mode of nutrition for surgical patients. Avoidance of any nutritional therapy bears the risk of underfeeding during the postoperative course after major surgery. Considering that malnutrition and underfeeding are risk factors for postoperative complications, early enteral feeding is especially relevant for any surgical patient at nutritional risk, especially for those undergoing upper gastrointestinal surgery. The focus of this guideline is to cover nutritional aspects of the Enhanced Recovery After Surgery (ERAS) concept and the special nutritional needs of patients undergoing major surgery, e...
June 2017: Clinical Nutrition: Official Journal of the European Society of Parenteral and Enteral Nutrition
https://www.readbyqxmd.com/read/28353565/perioperative-intravenous-glucocorticoids-can-decrease-postoperative-nausea-and-vomiting-and-pain-in-total-joint-arthroplasty-a-meta-analysis-and-trial-sequence-analysis
#6
REVIEW
Ping Chen, Xiwen Li, Lili Sang, Jiangfa Huang
BACKGROUND: This meta-analysis aimed to demonstrate the efficacy and safety of intravenous glucocorticoids for reducing pain intensity and postoperative nausea and vomiting (PONV) in patients undergoing total joint arthroplasty (TJA). METHODS: PubMed, Embase, the Cochrane Central Register of Controlled Trials (CENTRAL), Web of Science, and Google databases were searched for randomized controlled trials (RCTs) comparing intravenous glucocorticoids versus no intravenous glucocorticoids or sham for patients undergoing TJA...
March 2017: Medicine (Baltimore)
https://www.readbyqxmd.com/read/28270914/sepsis-induced-cardiac-dysfunction-and-%C3%AE-adrenergic-blockade-therapy-for-sepsis
#7
REVIEW
Takeshi Suzuki, Yuta Suzuki, Jun Okuda, Takuya Kurazumi, Tomohiro Suhara, Tomomi Ueda, Hiromasa Nagata, Hiroshi Morisaki
Despite recent advances in medical care, mortality due to sepsis, defined as life-threatening organ dysfunction caused by a dysregulated host response to infection, remains high. Fluid resuscitation and vasopressors are the first-line treatment for sepsis in order to optimize hemodynamic instability caused by vasodilation and increased vascular permeability. However, these therapies, aimed at maintaining blood pressure and blood flow to vital organs, could have deleterious cardiac effects, as cardiomyocyte damage occurs in the early stages of sepsis...
2017: Journal of Intensive Care
https://www.readbyqxmd.com/read/28256333/-the-effect-of-two-different-glycemic-management-protocols-on-postoperative-cognitive-dysfunction-in-coronary-artery-bypass-surgery
#8
Pinar Kurnaz, Zerrin Sungur, Emre Camci, Nukhet Sivrikoz, Gunseli Orhun, Mert Senturk, Omer Sayin, Emin Tireli, Hakan Gurvit
INTRODUCTION: Postoperative cognitive dysfunction (POCD) is an adverse outcome of surgery that is more common after open heart procedures. The aim of this study is to investigate the role of tightly controlled blood glucose levels during coronary artery surgery on early and late cognitive decline. METHODS: 40 patients older than 50 years undergoing elective coronary surgery were randomized into two groups. In the "Tight Control" group (GI), the glycemia was maintained between 80 and 120mgdL(-1) while in the "Liberal" group (GII), it ranged between 80-180mgdL(-1)...
February 27, 2017: Revista Brasileira de Anestesiologia
https://www.readbyqxmd.com/read/28209308/melatonin-and-cortisol-secretion-profile-in-patients-with-pineal-cyst-before-and-after-pineal-cyst-resection
#9
Martin Májovský, Lenka Řezáčová, Alena Sumová, Lenka Pospíšilová, David Netuka, Ondřej Bradáč, Vladimír Beneš
A pineal cyst is a benign affection of the human pineal gland on the borderline between pathology and normality. Only a small percentage of patients present with symptoms and a surgical treatment is indicated in highly selected cases. A melatonin secretion in patients with a pineal cyst before and after a pineal cyst resection has not been studied yet and the effect of surgery on human metabolism is unknown. The present study examined melatonin, cortisol and blood glucose secretion profiles perioperatively in a surgical group of 4 patients...
May 2017: Journal of Clinical Neuroscience: Official Journal of the Neurosurgical Society of Australasia
https://www.readbyqxmd.com/read/28183563/effect-of-basal-insulin-dosage-on-blood-glucose-concentration-in-ambulatory-surgery-patients-with-type-2-diabetes
#10
Linda J Demma, Karen T Carlson, Elizabeth W Duggan, John Gordon Morrow, Guillermo Umpierrez
STUDY OBJECTIVE: Among patients with type 2 diabetes treated with insulin, perioperative hyperglycemia and hypoglycemia may cause undesirable symptoms, surgery delay or cancellation, or unexpected hospitalization. Our objective was to compare preoperative glargine dosing regimens on perioperative glycemic control in patients undergoing ambulatory surgery. DESIGN: Observational study. SETTING: Pre- and postoperative holding areas. PATIENTS: One hundred fifty patients with type 2 diabetes using a once daily, evening insulin glargine regimen undergoing ambulatory surgery were included...
February 2017: Journal of Clinical Anesthesia
https://www.readbyqxmd.com/read/28161384/hospitalization-costs-and-clinical-outcomes-in-cabg-patients-treated-with-intensive-insulin-therapy
#11
Saumeth Cardona, Francisco J Pasquel, Maya Fayfman, Limin Peng, Sol Jacobs, Priyathama Vellanki, Jeff Weaver, Michael Halkos, Robert A Guyton, Vinod H Thourani, Guillermo E Umpierrez
BACKGROUND: The financial impact of intensive (blood glucose [BG] 100-140mg/dl [5.5-7.8mM] vs. conservative (141-180mg/dl (7.9-10.0mM) glucose control in the ICU in patients, with and without diabetes, undergoing coronary artery bypass graft (CABG) surgery is not known. METHODS: This post-hoc cost analysis determined differences in hospitalization costs, resource utilization and perioperative complications in 288 CABG patients with diabetes (n=143) and without diabetes (n=145), randomized to intensive (n=143) and conservative (n=145) glucose control...
April 2017: Journal of Diabetes and its Complications
https://www.readbyqxmd.com/read/28121034/alternatives-to-antibiotics-for-prevention-of-surgical-infection
#12
REVIEW
I B M Ploegmakers, S W M Olde Damink, S O Breukink
BACKGROUND: Surgical-site infection (SSI) is still the second most common healthcare-associated infection, after respiratory tract infection. SSIs are associated with higher morbidity and mortality rates, and result in enormous healthcare costs. In the past decade, several guidelines have been developed that aim to reduce the incidence of SSI. Unfortunately, there is no consensus amongst the guidelines, and some are already outdated. This review discusses the recent literature regarding alternatives to antibiotics for prevention of SSI...
January 2017: British Journal of Surgery
https://www.readbyqxmd.com/read/28109102/-long-term-outcomes-of-off-pump-coronary-artery-bypass-grafting-in-patients-aged-over-75-years
#13
Yi Guo, Chong-Lei Ren, Chang-Qing Gao, Cang-Song Xiao, Hua-Jun Zhang
OBJECTIVE: To investigate the long-term outcomes of off-pump coronary artery bypass grafting (OPCAB) in patients aged over 75 years and analyze the risk factors affecting the outcomes of the procedure. METHODS: Clinical data were reviewed for 97 consecutive patients aged 75 years or above receiving OPCAB at our center between November, 2000 and November, 2013. The perioperative data including length of ICU stay, duration of mechanical ventilation, incidence of postoperative complications and mortality rate of the patients were analyzed...
January 20, 2017: Nan Fang Yi Ke da Xue Xue Bao, Journal of Southern Medical University
https://www.readbyqxmd.com/read/28096825/determination-of-the-value-of-glycated-hemoglobin-hba1c-and-fructosamine-in-assessing-the-risk-of-perioperative-complications-after-cardiac-surgery-in-patients-with-type-2-diabetes
#14
Anetta M Kowalczuk-Wieteska, Marta Wróbel, Dominika Rokicka, Aleksandra Szymborska-Kajanek, Jerzy Foremny, Paweł Nadziakiewicz, Marian Zembala, Krzysztof Strojek
INTRODUCTION: Patients with diabetes have a worse postoperative course and longer length of hospital stay after surgery. A good indicator of proper long-term (3 months) glycemic control is glycated hemoglobin (HbA1c), and fructosamine in the short term (2-3 weeks). AIM: To determine the degree of glycemic control evaluated preoperatively by HbA1c and/or fructosamine influence on the postoperative course of patients with diabetes undergoing coronary artery bypass grafting (CABG) in 2014-2015...
December 2016: Kardiochirurgia i Torakochirurgia Polska, Polish Journal of Cardio-Thoracic Surgery
https://www.readbyqxmd.com/read/28048971/insulin-resistance-plays-a-potential-role-in-postoperative-cognitive-dysfunction-in-patients-following-cardiac-valve-surgery
#15
Ni Tang, Rongrong Jiang, Xiaobin Wang, Jian Wen, Li Liu, Jiali Wu, Chunxiang Zhang
Severe insulin resistance(IR) promotes the development of Alzheimer disease. IR and postoperative cognitive dysfunction (POCD) are a common complication during the cardiac perioperative period. The authors hypothesized that IR of individuals with cardiac valve surgery would have increased the risk of POCD. The purpose of the study was to analyze the association of IR and POCD after cardiac valve surgery. Total 131 patients who underwent valve replacement via cardiopulmonary bypass(CPB) were included. Cognitive function was assessed by a series of neuropsychological measurements at 1 day before and 7 days after the surgery...
December 31, 2016: Brain Research
https://www.readbyqxmd.com/read/27973934/patients-with-type-2-diabetes-anesthetic-management-in-the-ambulatory-setting-part-1-pathophysiology-and-associated-disease-states
#16
Bryant W Cornelius
The increasing prevalence of diabetes mellitus in the general population has many implications for the ambulatory anesthesia provider. Complications, particularly associated with poor glycemic control, can affect multiple organ systems and jeopardize the safety of any planned anesthetic. It is essential that anesthesiologists and sedation providers have in-depth knowledge of the pathophysiology of diabetes mellitus and the comorbid conditions that commonly accompany it. Anesthesiologists and sedation providers must also understand certain surgical and anesthetic considerations when planning an effective and safe anesthetic for diabetic patients...
2016: Anesthesia Progress
https://www.readbyqxmd.com/read/27921048/surgical-treatment-of-metabolic-syndrome
#17
REVIEW
Norbert Runkel, Rainer Brydniak
BACKGROUND: Bariatric surgery is gastrointestinal surgery for weight control, and metabolic surgery refers to the use of surgery to primarily and purposely treat type 2 diabetes mellitus (T2DM)/metabolic syndrome mellitus. METHODS: The most recent literature was reviewed for surgery and T2DM in a non-systematic fashion. RESULTS: Roux-Y gastric bypass, biliopancreatic diversion with duodenal switch, and sleeve gastrectomy (SG) are the dominant procedures today...
October 2016: Visceral Medicine
https://www.readbyqxmd.com/read/27901264/meta-analysis-of-lower-perioperative-blood-glucose-target-levels-for-reduction-of-surgical-site-infection
#18
REVIEW
F E E de Vries, S L Gans, J S Solomkin, B Allegranzi, M Egger, E P Dellinger, M A Boermeester
BACKGROUND: There is a clear association between hyperglycaemia and surgical-site infection (SSI). Intensive glucose control may involve a risk of hypoglycaemia, which in turn results in potentially severe complications. A systematic review was undertaken of studies comparing intensive versus conventional glucose control protocols in relation to reduction of SSI and other outcomes, including hypoglycaemia, mortality and stroke. METHODS: PubMed, Embase, CENTRAL, CINAHL and WHO databases from 1 January 1990 to 1 August 2015 were searched...
January 2017: British Journal of Surgery
https://www.readbyqxmd.com/read/27864588/impact-of-perioperative-hypoglycaemia-in-subjects-with-diabetes-undergoing-colorectal-surgery
#19
Si Ning Serene Goh, Ester Yeoh, Kok Yang Tan
INTRODUCTION: This study explores the association between perioperative hypoglycaemia and surgical outcomes in subjects with diabetes, undergoing colorectal surgery. METHODS: A retrospective review of 149 subjects with Type 2 Diabetes Mellitus (DM) who underwent colorectal surgery between 2010 and 2015 was performed. Perioperative glucose levels, glycated haemoglobin (HbA1c) measurements within 3 months of surgery and surgical complications based on Clavien-Dindo classification were analysed...
February 2017: International Journal of Colorectal Disease
https://www.readbyqxmd.com/read/27819771/glycemic-outcomes-3-years-after-implementation-of-a-peri-operative-glycemic-control-algorithm-in-an-academic-institution
#20
Lindsay M Arnold, Mufaddal Mahesri, Marie E McDonnell, Sara M Alexanian
OBJECTIVE: While hyperglycemia in the postoperative setting has been linked to an increase in surgical complications, limited data are available to inform the management of patients with diabetes in the operating room and the immediate peri-operative period. We describe the results of a peri-operative glycemic control program that standardized intravenous insulin with a target glucose (BG) range of 120 to 180 mg/dL for patients with diabetes presenting with a BG level >180 mg/dL and included transition to subcutaneous insulin...
February 2017: Endocrine Practice
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