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Perioperative glycemic control

Giovanni Landoni, Antonio Pisano, Vladimir Lomivorotov, Gabriele Alvaro, Ludhmila Hajjar, Gianluca Paternoster, Caetano Nigro Neto, Nicola Latronico, Evgeny Fominskiy, Laura Pasin, Gabriele Finco, Rosetta Lobreglio, Maria Luisa Azzolini, Giuseppe Buscaglia, Alberto Castella, Marco Comis, Adele Conte, Massimiliano Conte, Francesco Corradi, Erika Dal Checco, Giovanni De Vuono, Marco Ganzaroli, Eugenio Garofalo, Gordana Gazivoda, Rosalba Lembo, Daniele Marianello, Martina Baiardo Redaelli, Fabrizio Monaco, Valentina Tarzia, Marta Mucchetti, Alessandro Belletti, Paolo Mura, Mario Musu, Giovanni Pala, Massimiliano Paltenghi, Vadim Pasyuga, Desiderio Piras, Claudio Riefolo, Agostino Roasio, Laura Ruggeri, Francesco Santini, Andrea Székely, Luigi Verniero, Antonella Vezzani, Alberto Zangrillo, Rinaldo Bellomo
OBJECTIVE: Of the 230 million patients undergoing major surgical procedures every year, more than 1 million will die within 30 days. Thus, any nonsurgical interventions that help reduce perioperative mortality might save thousands of lives. The authors have updated a previous consensus process to identify all the nonsurgical interventions, supported by randomized evidence, that may help reduce perioperative mortality. DESIGN AND SETTING: A web-based international consensus conference...
August 2, 2016: Journal of Cardiothoracic and Vascular Anesthesia
Georgios Antonios Margonis, Neda Amini, Kazunari Sasaki, Yuhree Kim, Katiuscha Merath, Stefan Buettner, Emmanouil Pikoulis, Nikolaos Andreatos, Doris Wagner, Efstathios Antoniou, Timothy M Pawlik
INTRODUCTION: There is limited evidence characterizing the impact of glycemic alterations on short-term outcomes among patients undergoing resection of colorectal liver metastases (CRLM). METHODS: Hyperglycemia was defined as a glucose value >125 mg/dl according to WHO definition. The impact of early postoperative hyperglycemia on short-term postoperative outcomes was assessed. RESULTS: The mean postoperative glucose value was 128 mg/dl; 30 (9...
September 27, 2016: Journal of Gastrointestinal Surgery: Official Journal of the Society for Surgery of the Alimentary Tract
Tsutomu Namikawa, Masaya Munekage, Hiroyuki Kitagawa, Tomoaki Yatabe, Hiromichi Maeda, Yuuki Tsukamoto, Kenichi Hirano, Takuji Asano, Yoshihiko Kinoshita, Kazuhiro Hanazaki
This clinical study aimed to compare a novel and conventional artificial pancreas (AP) used in surgical patients for perioperative glycemic control, with respect to usability, blood glucose measurements, and glycemic control characteristics. From July in 2010 to March in 2015, 177 patients underwent perioperative glycemic control using a novel AP. Among them, 166 patients were eligible for inclusion in this study. Intensive insulin therapy (IIT) targeting a blood glucose range of 80-110 mg/dL was implemented in 82 patients (49 %), and the remaining 84 patients (51 %) received a less-intensive regime of insulin therapy...
September 20, 2016: Journal of Artificial Organs: the Official Journal of the Japanese Society for Artificial Organs
Angélica de Fátima de Assunção Braga, Franklin Sarmento da Silva Braga, José Hélio Zen Junior, Maria José Nascimento Brandão, Giancarlo Antonio Marcondes, Thales Daniel Alves Barbosa
: Insulinoma is a functional neuroendocrine tumor derived from beta cells of the pancreatic islets of Langerhans, usually solitary, benign, and curable with surgery (enucleation). It rarely occurs during pregnancy and is clinically manifested by hypoglycemia, particularly in the first trimester of pregnancy. During pregnancy, both conservative therapeutic measures (medication) and surgical treatment are challenging regarding the impossibility of studies on drug teratogenicity as well as the maternal-fetal repercussions during surgery, such as hypoglycemia and changes due to stress...
August 11, 2016: Revista Brasileira de Anestesiologia
James D Capozzi, Eric R Lepkowsky, Marie M Callari, Ellen T Jordan, Jan A Koenig, Gregory H Sirounian
BACKGROUND: Diabetes mellitus has been associated with significant perioperative complications in joint arthroplasty. In addition, many patients are unaware of their dysglycemic status, and the prevalence of undiagnosed dysglycemia in joint arthroplasty patients is unknown. METHODS: Several years ago, we began routine hemoglobin A1c (HbA1c) level screening in all our patients planning to undergo elective total hip and total knee arthroplasties. We retrospectively reviewed the HbA1c levels in our initial 663 patients...
June 23, 2016: Journal of Arthroplasty
Claudio Fiorillo, Fausto Rosa, Giuseppe Quero, Roberta Menghi, Giovanni Battista Doglietto, Sergio Alfieri
BACKGROUND: Hyperglycemia (HG) is widely known to be associated with increased postoperative complications after colorectal surgery. Very few data on the effects of HG on patients after gastric surgery for cancer are reported in literature. The aim of this study was to evaluate the effects of postoperative HG in non-diabetic patients undergoing gastrectomy for cancer. METHODS: One hundred and ninety-three consecutive gastrectomies for cancer performed between January 2010 and December 2015 were considered...
June 23, 2016: Gastric Cancer
Katsuya Tanaka, Yasuo M Tsutsumi
It is important for the anesthesiologists to understand pathophysiology of perioperative stress hyperglycemia, because it offers strategies for treatment of stress hyperglycemia. The effect of glucose tolerance is different in the choice of the anesthetic agent used in daily clinical setting. Specifically, the volatile anesthetics inhibit insulin secretion after glucose load and affects glucose tolerance. During minor surgery by the remifentanil anesthesia, the stress reaction is hard to be induced, suggesting that we should consider low-dose glucose load...
May 2016: Masui. the Japanese Journal of Anesthesiology
Joanna Świrska, Piotr Czuczwar, Agnieszka Zwolak, Beata Matyjaszek-Matuszek
OBJECTIVES: The aim of the study was to estimate whether diabetes was an independent risk factor for perioperative complications in patients undergoing gynecologic surgery. MATERIAL AND METHODS: The study population consisted of 182 women (diabetics and controls) who underwent elective gynecologic surgery. Each patient without diabetes from the control group and matched for age and body mass index diabetic patient were admitted with the same gynecologic diagnosis, underwent the same gynecologic procedure, were operated on in the same operating room and were hospitalized within the same time interval...
2016: Ginekologia Polska
John D Dortch, Dustin L Eck, Beth Ladlie, Sarvam P TerKonda
Perioperative hyperglycemia is a well-known risk factor for surgical morbidity such as wound healing, infection, and prolonged hospitalization. This association has been reported for a number of surgical subspecialties, including plastic surgery. Specialty-specific guidelines have become increasingly available in the literature. Currently, glucose management guidelines for plastic surgery are lacking. Recognizing that multiple approaches exist for perioperative glucose, protocol-based models provide the necessary structure and guidance for approaching glycemic control...
July 2016: Aesthetic Surgery Journal
Lwin Aung, Wei-Jei Lee, Shu Chun Chen, Kong-Han Ser, Chun-Chi Wu, Keong Chong, Yi-Chih Lee, Jung-Chien Chen
IMPORTANCE: The prevalence of early-onset type 2 diabetes mellitus (T2DM), which responds poorly to medical treatment, is increasing. Bariatric surgery has been well recognized for its effectiveness in the remission of T2DM, but its effectiveness and durability in the remission of early-onset T2DM has not yet been explored. OBJECTIVE: To compare the short- and long-term outcomes of bariatric surgery with a specific focus on the rate of remission of T2DM in patients with early-onset (age <40 years) and late-onset (age ≥40 years) T2DM...
September 1, 2016: JAMA Surgery
Philip R Schauer, Geltrude Mingrone, Sayeed Ikramuddin, Bruce Wolfe
Since the 2007 Diabetes Surgery Summit in Rome, Italy, and the subsequent publishing of the world's first guidelines for the surgical treatment of type 2 diabetes (T2D), much new evidence regarding the efficacy and safety of metabolic surgery has emerged. Additional observational cohort studies support the superior effects of surgery over medical treatment with respect to glycemic control, weight loss, and even reduction in mortality and microvascular complications associated with T2D. Furthermore, new safety data suggest that the perioperative morbidity and mortality of metabolic surgery (5% and 0...
June 2016: Diabetes Care
Kazuhiro Hanazaki, Masaya Munekage, Hiroyuki Kitagawa, Tomoaki Yatabe, Eri Munekage, Mai Shiga, Hiromichi Maeda, Tsutomu Namikawa
The incidence of diabetes is increasing at an unprecedented pace and has become a serious health concern worldwide during the last two decades. Despite this, adequate glycemic control using an artificial pancreas has not been established, although the 21st century has seen rapid developments in this area. Herein, we review current topics in glycemic control for both the wearable artificial pancreas for type 1 and type 2 diabetic patients and the bedside artificial pancreas for surgical diabetic patients. In type 1 diabetic patients, nocturnal hypoglycemia associated with insulin therapy remains a serious problem that could be addressed by the recent development of a wearable artificial pancreas...
September 2016: Journal of Artificial Organs: the Official Journal of the Japanese Society for Artificial Organs
Louis S Stryker
An estimated 29.1 million Americans are currently diagnosed with diabetes, and this number is expected to increase to 48.3 million Americans by 2050. Correspondingly, the present burden of diabetes among patients undergoing total joint arthroplasty is significant and rising. Diabetes as a chronic condition is a well-established risk factor for complication after total joint arthroplasty. A growing body of evidence also indicates that hyperglycemia in the perioperative period, and not the diagnosis of diabetes alone, is similarly associated with increased complication risk...
August 2016: Journal of Arthroplasty
Michael Taulo Lund, Marianne Kristensen, Merethe Hansen, Louise Tveskov, Andrea Karen Floyd, Mikael Støckel, Ben Vainer, Steen Seier Poulsen, Jørn Wulff Helge, Clara Prats, Flemming Dela
KEY POINTS: Hepatic insulin resistance in patients with obesity or type 2 diabetes has been suggested to result from hepatic mitochondrial dysfunction. High-resolution respirometry (HRR) can be used to assess oxidative phosphorylation by measuring the mitochondrial oxygen consumption rate in the individual complexes of the mitochondria. By using HRR, the present study demonstrates no difference in hepatic mitochondrial oxidative phosphorylation among subjects with obesity with or without type 2 diabetes and non-obese controls...
August 1, 2016: Journal of Physiology
Melanie Meersch, Christoph Schmidt, Alexander Zarbock
PURPOSE OF REVIEW: Chronic kidney disease (CKD) is an increasing health problem worldwide and is associated with a number of clinical challenges. In this paper, we review recent studies that deal with strategies for the management of patients with CKD undergoing surgery. RECENT FINDINGS: Effective strategies for nephroprotection are crucial for the handling of patients with CKD in the perioperative setting to prevent complications and to avoid the progression of CKD...
June 2016: Current Opinion in Anaesthesiology
Rachel E Thompson, Elizabeth K Broussard, David R Flum, Brent E Wisse
Hyperglycemia occurs frequently among patients undergoing colorectal surgery and is associated with increased risk of poor clinical outcomes, especially related to surgical site infections. Treating hyperglycemia has become a target of many enhanced recovery after surgery programs developed for colorectal procedures. There are several unique considerations for patients undergoing colorectal surgery including bowel preparations and alterations in oral intake. Focused protocols for those with diabetes and those at risk of hyperglycemia are needed in order to address the specific needs of those undergoing colorectal procedures...
March 2016: Current Diabetes Reports
Marzieh Akbarzadeh, Mohammad Hassan Eftekhari, Masih Shafa, Shohreh Alipour, Jafar Hassanzadeh
BACKGROUND: Insulin resistance is a measure of metabolic stress in the perioperative period. Before now, no clinical trial has determined the summative effects of glutamine, L-carnitine, and antioxidants as metabolic conditioning supplements in the perioperative period. OBJECTIVES: The purpose of this study was to determine the effects of a new conditioning supplement on perioperative metabolic stress and clinical outcomes in non-diabetic patients. PATIENTS AND METHODS: In this randomized controlled trial, 89 non-diabetic patients scheduled for coronary artery bypass grafting, with ejection fractions above 30%, were selected...
January 2016: Iranian Red Crescent Medical Journal
Lillian L Tsai, Hanna A Jensen, Vinod H Thourani
Hyperglycemia has been found to be associated with increased morbidity and mortality in surgical patients, yet, the optimal glucose management strategy during the perioperative setting remains undetermined. While much has been published about hyperglycemia and cardiac surgery, most studies have used widely varying definitions of hyperglycemia, methods of insulin administration, and the timing of therapy. This has only allowed investigators to make general conclusions in this challenging clinical scenario. This review will introduce the basic pathophysiology of hyperglycemia in the cardiac surgery setting, describe the main clinical consequences of operative hyperglycemia, and take the reader through the published material of intensive and conservative glucose management...
April 2016: Current Diabetes Reports
David Rometo, Mary Korytkowski
Bariatric surgery in patients with type 2 diabetes has been shown to improve glycemic control and reduce need for glucose-lowering medications. Some of these improvements occur in the early postoperative period prior to any weight loss. These early reductions in circulating glucose can be attributed to primarily perioperative caloric restriction and prolonged fasting. Inpatient glycemic targets for patients undergoing bariatric surgery are similar to those recommended for other surgical procedures as a way of minimizing risk for complications...
April 2016: Current Diabetes Reports
Carlos E Mendez, Paul J Der Mesropian, Roy O Mathew, Barbara Slawski
Hyperglycemia and acute kidney injury (AKI) are frequently observed during the perioperative period. Substantial evidence indicates that hyperglycemia increases the prevalence of AKI as a surgical complication. Patients who develop hyperglycemia and AKI during the perioperative period are at significantly elevated risk for poor outcomes such as major adverse cardiac events and all-cause mortality. Early observational and interventional trials demonstrated that the use of intensive insulin therapy to achieve strict glycemic control resulted in remarkable reductions of AKI in surgical populations...
January 2016: Current Diabetes Reports
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