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Perioperative Glucose Control

Cyrus Jahansouz, Christopher Staley, Scott Kizy, Hongliang Xu, Ann V Hertzel, Jessi Coryell, Stephanie Singroy, Matthew Hamilton, Meri DuRand, David A Bernlohr, Michael J Sadowsky, Alexander Khoruts, Sayeed Ikramuddin
OBJECTIVE: The aim of this study was to test whether the perioperative composition of intestinal microbiota can contribute to variable outcomes following vertical sleeve gastrectomy (VSG). SUMMARY OF BACKGROUND DATA: Although bariatric surgery is the most effective treatment for obesity, metabolic outcomes are variable. METHODS: Diet-induced obese mice were randomized to VSG or sham surgery, with or without exposure to antibiotics that selectively suppress mainly gram-positive (fidaxomicin, streptomycin) or gram-negative (ceftriaxone) bacteria on postoperative days (POD) 1-4...
March 8, 2018: Annals of Surgery
M Gachabayov, A J Senagore, S K Abbas, S B Yelika, K You, R Bergamaschi
BACKGROUND: The aim of this study was to determine whether perioperative stress hyperglycemia is correlated with surgical site infection (SSI) rates in non-diabetes mellitus (DM) patients undergoing elective colorectal resections within an SSI bundle. METHODS: American College of Surgeons National Surgical Quality Improvement Program data of patients treated at a single institution in 2006-2012 were supplemented by institutional review board-approved chart review...
March 6, 2018: Techniques in Coloproctology
Akina Tohya, Atsushi Kohjitani, Sachi Ohno, Kaoru Yamashita, Yozo Manabe, Mitsutaka Sugimura
Background: Secretion of hormones, which antagonize the action of insulin, is facilitated in response to surgery, and acute resistance to the action of insulin develops. Our aim is to elucidate the effects of intraoperative glycemic control by glucose-insulin (GI) infusion on postoperative complications and outcomes in major oral and maxillofacial surgery. Findings: Thirty patients aged ≥ 60 years undergoing a radical operation of oral malignant tumors with tissue reconstruction (≥ 8 h) were analyzed...
2018: JA Clin Rep
Willem van den Boom, Rebecca A Schroeder, Michael W Manning, Tracy L Setji, Gic-Owens Fiestan, David B Dunson
OBJECTIVE: Hemoglobin A1c (A1C) is used in assessment of patients for elective surgeries because hyperglycemia increases risk of adverse events. However, the interplay of A1C, glucose, and surgical outcomes remains unclarified, with often only two of these three factors considered simultaneously. We assessed the association of preoperative A1C with perioperative glucose control and their relationship with 30-day mortality. RESEARCH DESIGN AND METHODS: Retrospective analysis on 431,480 surgeries within the Duke University Health System determined the association of preoperative A1C with perioperative glucose (averaged over the first 3 postoperative days) and 30-day mortality among 6,684 noncardiac and 6,393 cardiac surgeries with A1C and glucose measurements...
February 13, 2018: Diabetes Care
Rodolfo J Galindo, Maya Fayfman, Guillermo E Umpierrez
Perioperative hyperglycemia is common after cardiac surgery, reported in 60% to 90% of patients with diabetes and in approximately 60% of patients without history of diabetes. Many observational and prospective randomized trials in critically-ill cardiac surgery patients support a strong association between hyperglycemia and poor clinical outcome. Despite ongoing debate about the optimal glucose target, there is strong agreement that improved glycemic control reduces perioperative complications.
March 2018: Endocrinology and Metabolism Clinics of North America
Tsutomu Namikawa, Masaya Munekage, Tomoaki Yatabe, Hiroyuki Kitagawa, Kazuhiro Hanazaki
Surgical stress induces hyperglycemia and gives rise to glucose toxicity, which causes infectious diseases, resulting in unfavorable surgical outcomes. Intensive insulin treatment can control short- and long-term complications in patients with not only diabetes mellitus, but also surgical diabetes; however, it is associated with an increased risk of hypoglycemia. The wearable artificial pancreas was originally developed to control glucose levels in patients with type 1 diabetes, progressing to a device with enhanced stability and safety for these patients...
January 22, 2018: Journal of Artificial Organs: the Official Journal of the Japanese Society for Artificial Organs
Natsuhiro Yamamoto, Tomoya Irie, Shunsuke Takaki, Osamu Yamaguchi, Takahisa Goto
PURPOSE: Hyperglycemia is a common issue in infants after cardiac surgery for congenital heart disease. Poor glycemic control is suspected to be associated with adverse postoperative outcomes. This study was performed to investigate clinical factors contributing to hyperglycemia in the perioperative period in infats. METHODS: A total of 69 infants (aged 1-12 months) who were admitted to Yokohama City University Hospital Intensive Care Unit (ICU) after surgical repair of congenital heart diseases with cardiopulmonary bypass (CPB) were retrospectively analysed...
January 12, 2018: Journal of Anesthesia
Qiang Chen, Wei-Guo Zhang, Shu-Chang Chen
RATIONALE: The occurrence of hyperkalemia after esophagectomy is clinically rare. Patients who underwent esophagectomy often have a serum potassium level due to perioperative reduced intake, fluids loss, consumption and other reasons. These patients often require the artificial administration of potassium. Rapid fluid loss and physiological consumption lead to the deficiency of potassium, even hypokalemia. Patients often require the addition of a large amount of potassium after operation...
December 2017: Medicine (Baltimore)
Kanako Esaki, Masanori Tsukamoto, Eiji Sakamoto, Takeshi Yokoyama
BACKGROUND AND OBJECTIVES: Preoperative oral carbohydrate therapy has been suggested to attenuate postoperative insulin resistance. The purpose of this study was to investigate the effect of a carbohydrate-rich beverage given preoperatively on intraoperative glucose metabolism. METHODS AND STUDY DESIGN: This study was a randomised, open-label, placebo-controlled trial. Patients undergoing oral-maxillofacial surgery were divided into two groups. In the glucose group, patients took glucose (50 g/278 mL, p...
2018: Asia Pacific Journal of Clinical Nutrition
Vivien Leung, Kristal Ragbir-Toolsie
Hyperglycemia has long been recognized to have detrimental effects on postoperative outcomes in patients undergoing surgery. The manifestations of uncontrolled diabetes are manifold and can include risk of hyperglycemic crises, postoperative infection, poor wound healing, and increased mortality. There is substantial literature supporting the role of diligent glucose control in the prevention of adverse surgical outcomes, but considerable debate remains as to the optimal glucose targets. Hence, most organizations advocate the avoidance of hypoglycemia while striving for adequate glucose control in the perioperative period...
2017: Health Services Insights
Emel Çakar, Emel Yilmaz, Ekrem Çakar, Hakan Baydur
PURPOSE: The study was conducted to investigate the effect of preoperative oral carbohydrate loading on the preoperative discomforts and postoperative complications of patients undergoing elective thyroidectomy. DESIGN: A randomized controlled clinical trial. METHODS: Ninety patients scheduled for thyroidectomy were divided into three groups: (1) those receiving a carbohydrate-rich drink (CHD), (2) those receiving an overnight 5% glucose intravenous infusion, and (3) those fasting from midnight...
December 2017: Journal of Perianesthesia Nursing: Official Journal of the American Society of PeriAnesthesia Nurses
Lian Duan, Guo-Huang Hu, Meng Jiang, Cheng-Liang Zhang
OBJECTIVE: To analyze the perioperative clinical data of children with congenital heart disease complicated by acute kidney injury (AKI) after cardiopulmonary bypass (CPB) surgery, and to explore potential factors influencing the prognosis. METHODS: A retrospective analysis was performed among 118 children with congenital heart disease who developed AKI within 48 hours after CPB surgery. RESULTS: In the 118 patients, 18 died after 48 hours of surgery...
November 2017: Zhongguo Dang Dai Er Ke za Zhi, Chinese Journal of Contemporary Pediatrics
Faisal Jehan, Muhammad Khan, Joseph V Sakran, Mohammad Khreiss, Terence O'Keeffe, Albert Chi, Narong Kulvatunyou, Arpana Jain, El Rasheid Zakaria, Bellal Joseph
BACKGROUND: Plasma hemoglobin A1c (HbA1c) reflects quality of glucose control in diabetic patients. Literature reports that patients undergoing surgery with an elevated HbA1c level are associated with increased postoperative morbidity and mortality. The aim of our study was to evaluate the impact of HbA1c level on outcomes after emergency general surgery (EGS). METHODS: We performed a 3-year analysis of our prospectively maintained EGS database. Patients who had HbA1c levels measured within 3 months before surgery were included...
January 2018: Journal of Trauma and Acute Care Surgery
Rebecca Gerlach, Avery Tung
No abstract text is available yet for this article.
November 2017: Anesthesiology
Danielle M Diemer, Karen L Terry, Melissa Matthews, Ellen Romich, Heather Saran, M Cecilia Lansang
Though insulin dose reduction months after surgery is well-studied, there are limited data on immediate post-operative changes. OBJECTIVES: 1) To determine perioperative glycemic control in patients with type 2 diabetes (DM) on insulin who have undergone Roux-en-Y gastric bypass, and 2) to compare pre- and post-operative insulin regimens and dosage in these patients. RESEARCH DESIGN AND METHODS: A retrospective chart review was conducted on patients with type 2 DM, on insulin, who underwent Roux-en-Y bariatric surgery...
October 11, 2017: Endocrine Practice
So Hui Yun, Yun Suk Choi
BACKGROUND: Dexmedetomidine (DEX) is an α2-adrenergic receptor agonist with sedative and sympatholytic effects. It inhibits the stress response and insulin secretion. Therefore, postoperative changes to blood glucose levels were investigated when DEX was intraoperatively infused for sedation purposes in diabetic patients under spinal anesthesia. METHODS: Twenty diabetic patients were randomly allocated to two groups (n = 10). Group A patients were infused with DEX at a dose of 0...
December 2016: Anesthesiology and Pain Medicine
Hironori Hayashi, Hiroyuki Takamura, Ryosuke Gabata, Isamu Makino, Yoshinao Ohbatake, Shinichi Nakanuma, Tomoharu Miyashita, Hidehiro Tajima, Kazuhiro Hanazaki, Tetsuo Ohta
BACKGROUND We investigated the impact of using an artificial pancreas for glycemic control in liver transplant recipients. MATERIAL AND METHODS Between January 2014 and December 2016, glycemic control using an artificial pancreas was performed 13 times. The target blood glucose level was set at 80-110 mg/dL. We retrospectively analyzed the clinical course, including achievement rate of the target blood glucose range. RESULTS For perioperative glycemic control, an artificial pancreas was used 9 times. The total insulin dose and achievement rate of the target blood glucose level were 113...
October 3, 2017: Annals of Transplantation: Quarterly of the Polish Transplantation Society
A H Hulst, J A W Polderman, E Ouweneel, A J Pijl, M W Hollmann, J H DeVries, B Preckel, J Hermanides
Historically, metformin was withheld before surgery for fear of metformin-associated lactic acidosis. Currently, however, this risk is deemed to be low and guidelines have moved towards the continuation of metformin. We hypothesized that continuing metformin peri-operatively would lower postoperative serum glucose level without an effect on plasma lactate levels. We performed a single-blind multicentre randomized controlled trial in people with type 2 diabetes mellitus scheduled for non-cardiac surgery and continued (MF+ group) or withheld (MF- group) metformin before surgery...
September 20, 2017: Diabetes, Obesity & Metabolism
Judson B Williams, Eric D Peterson, Álvaro S Albrecht, Shuang Li, Sameer A Hirji, T Ferguson, Peter K Smith, Renato D Lopes
PURPOSE: Critically ill patients with hyperglycemia have worse prognosis. The degree to which glycemic control is achieved following CABG surgery and the association with clinical outcomes is not well understood. MATERIALS AND METHODS: We studied patients undergoing higher risk CABG surgery at 55 US hospitals. Good glycemic control was defined as 70-180mg/dL in the first 24h postoperatively. Generalized estimating equations logistic regression models were used to assess the relationship between glycemic control and clinical outcomes after adjusting for baseline characteristics...
December 2017: Journal of Critical Care
Rajesh Garg, Shelley Hurwitz, Raquel Rein, Brooke Schuman, Patricia Underwood, Shreya Bhandari
AIM: This study was conducted to evaluate the effect of continued follow-up by a hospital diabetes team on HbA1c at 1-year after discharge. METHODS: Adults with HbA1c ≥8% (64mmol/mol), undergoing an elective surgery, were treated in the perioperative period and randomized to continued care (CC) or the usual care (UC) after discharge. Patients in the CC group received weekly to monthly phone calls from a diabetes specialist nurse practitioner (NP) to review their home blood glucose values, diet, exercise, and medications...
August 24, 2017: Diabetes Research and Clinical Practice
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