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Perioperative management of diabetes

Monique Mostert, Anthony Bonavia
BACKGROUND Besides providing anesthesia for surgery, the anesthesiologist's role is to optimize the patient for surgery and for post-surgical recovery. This involves timely identification and treatment of medical comorbidities and abnormal laboratory values that could complicate the patient's perioperative course. There are several potential causes of anion and non-anion gap metabolic acidosis in surgical patients, most of which could profoundly affect a patient's surgical outcome. Thus, the presence of an acute acid-base disturbance requires a thorough workup, the results of which will influence the patient's anesthetic management...
October 18, 2016: American Journal of Case Reports
Walter Dorigo, Gabriele Piffaretti, Filippo Benedetto, Antonino Tarallo, Patrizio Castelli, Francesco Spinelli, Aaron Fargion, Carlo Pratesi
OBJECTIVE: The aim of this study was to retrospectively compare early and late results of aortobifemoral bypass and endovascular recanalization with the kissing stent technique in the management of TransAtlantic Inter-Society Consensus II (TASC II) C and D lesions in the aortoiliac district in a multicenter study. METHODS: From January 2006 to December 2013, 210 open and endovascular interventions for TASC II class C and D aortoiliac obstructive lesions were performed at three Italian teaching hospitals...
September 12, 2016: Journal of Vascular Surgery
N Domenick, R A Chaer, P D Thirumala, J Balzer, B Long, M S Makaroun, E D Avgerinos
OBJECTIVE: Late stroke and death rates are anticipated to be higher in patients undergoing carotid endarterectomy (CEA) compared to healthy counterparts. However, little is known regarding predictors, other than the baseline comorbidities. We have recently shown that dual intraoperative Somatosensory Evoked Potentials (SSEP) and electroencephalogram (EEG) monitoring improves the ability to predict perioperative strokes. We seek to determine if dual intraoperative monitoring (IOM) can further predict long-term strokes and death...
August 10, 2016: Annals of Vascular Surgery
Timothy M Brock, Mark Shirley, Michelle Bardgett, Mark Walker, David J Deehan
PURPOSE: Whilst inadequate glycaemic control is associated with an increase in perioperative complications following total knee arthroplasty, the impact of glycaemic control in this at-risk patient group remains ill-defined. Identification of at-risk patients would allow targeted pre-operative glycaemic control intervention. METHODS: One hundred consecutive patients with a diagnosis of diabetes mellitus and one hundred age, sex and BMI matched patients without diabetes undergoing total knee arthroplasty in a single institution were analysed between 2008 and 2013...
August 8, 2016: Knee Surgery, Sports Traumatology, Arthroscopy: Official Journal of the ESSKA
G Sharma, M Boules, S Punchai, A Strong, D Fryolich, N H Zubaidah, C O'Rourke, S A Brethauer, J Rodriguez, K El-Hayek, M Kroh
BACKGROUND: Currently there is no consensus on management of ventral hernias encountered during bariatric surgery (BS). This study aims to evaluate the incidence and outcomes of concomitant ventral hernia repair (VHR) during BS at our institution. METHODS: Patients who had concomitant VHR during BS from 2004 to 2015 were identified. Data collected included baseline demographics, comorbidities, perioperative parameters, surgical approach and postoperative outcomes...
August 5, 2016: Surgical Endoscopy
Panagiotis Kerezoudis, Brandon A McCutcheon, Meghan Murphy, Tarek Rayan, Hannah Gilder, Lorenzo Rinaldo, Daniel Shepherd, Patrick R Maloney, Brian R Hirshman, Bob S Carter, Mohamad Bydon, Fredric Meyer, Giuseppe Lanzino
INTRODUCTION: Large-scale studies examining the incidence and predictors of perioperative complications after surgical clipping of unruptured intracranial aneurysms (UIA) using nationally representative prospectively collected data are lacking in the literature. METHODS: Using the American College of Surgeons' National Surgical Quality Improvement Program (ACS-NSQIP) dataset, we conducted a retrospective analysis of the complications experienced by patients that underwent surgical management of a UIA between the years of 2007 and 2013...
October 2016: Clinical Neurology and Neurosurgery
Jessica A Zaman, Neil Shah, Glen E Leverson, Jacob A Greenberg, Luke M Funk
BACKGROUND: Bariatric surgery is the most effective treatment for morbidly obese type II diabetics. However, guidelines for perioperative glucose control are not well established. We examined management of perioperative glucose levels in diabetic patients undergoing bariatric surgery and determined the impact of optimal glucose control as defined by the American Society for Metabolic and Bariatric Surgery (ASMBS) on patient outcomes, including long-term diabetes resolution. METHODS: A single-institution, retrospective analysis of 155 morbidly obese diabetic patients who underwent laparoscopic gastric bypass (RYGB) or sleeve gastrectomy (LSG) from 2010 to 2014 was performed...
July 22, 2016: Surgical Endoscopy
Na Young Kim, Ki-Young Lee, Sun Joon Bai, Jung Hwa Hong, Jinwoo Lee, Jong Min Park, Shin Hyung Kim
Diabetic foot ulcer is the most common cause of diabetes-associated nontraumatic lower extremity amputation. Most patients who undergo lower extremity amputation for a diabetic foot have had diabetes for a long time and suffer from multiorgan disorder; thus, it can be a challenge to ensure sufficient anesthetic and analgesic effects while maintaining stable hemodynamics. Recently, peripheral nerve block has gained popularity owing to its attenuating effects of systemic concerns. This retrospective observational study aimed to compare the effects of remifentanil-based general anesthesia (GEA) and popliteal nerve block (PNB) on postoperative pain and hemodynamic stability in diabetic patients undergoing distal foot amputation...
July 2016: Medicine (Baltimore)
Sachin Allahabadi, Kareem B Haroun, Daniel M Musher, Benjamin A Lipsky, Neal R Barshes
BACKGROUND: The aim of this study was to develop consensus statements that may help share or even establish 'best practices' in the surgical aspects of managing diabetic foot osteomyelitis (DFO) that can be applied in appropriate clinical situations pending the publication of more high-quality data. METHODS: We asked 14 panelists with expertise in DFO management to participate. Delphi methodology was used to develop consensus statements. First, a questionnaire elicited practices and beliefs concerning various aspects of the surgical management of DFO...
2016: Diabetic Foot & Ankle
Marco Cannistrà, Raffaele Grande, Michele Ruggiero, Matteo Novello, Alessandra Zullo, Elisabetta Bonaiuto, Sebastiano Vaccarisi, Giuseppe Cavallari, Raffaele Serra, Bruno Nardo
INTRODUCTION: Progressive functional impairment with age has a significant impact on perioperative risk management. Chronic liver diseases induce a strong oxidative stress; in the elderly, in particular, impaired elimination of free radicals leads to insufficient DNA repair. The events associated with a weak response to growth factors after hepatectomy leads to a decline in liver regeneration. Hypercholesterolemia is highly prevalent in the elderly, which may alter the coenzyme Q10 (CoQ) levels and in turn the cellular energy balance...
September 2016: International Journal of Surgery
Umberto Marcello Bracale, Flavia Spalla, Federica Caioni, Domenico Solari, Donatella Narese, Felice Pecoraro, Luca Del Guercio
UNLABELLED: In the management of severe carotid artery stenosis particular importance must be given to the evaluation of the risk of perioperative cerebral ischemic events. Our study analysed the possible relationship between the pre-operative middle cerebral artery Gosling Index, calculated after transcranial Doppler (TCD), and intra-operative stump pressure (SP), in order to identify patients with higher risk of ischemic accidents. Moreover, we studied pre- and post- operative Gosling Index values in association with possible events during follow-up...
2016: Annali Italiani di Chirurgia
Matthew W Dyer, Amy Gnagey, Bryan T Jones, Roger D Pula, William L Lanier, John L D Atkinson, Jeffrey J Pasternak
BACKGROUND: Thyroid-stimulating hormone (TSH)-secreting pituitary adenomas are a rare cause of secondary hyperthyroidism. Anesthetic management of these patients has not been formally described in the literature. MATERIALS AND METHODS: Patients who underwent resection of a TSH-secreting pituitary adenoma during 1987 to 2012 at a single institution were identified. Preoperative thyroid hormone state, anesthetic management, and outcome were recorded. Hemodynamic associations with intraoperative events were compared between those who were hyperthyroid and euthyroid at the time of surgery...
June 17, 2016: Journal of Neurosurgical Anesthesiology
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
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
Dmitri Bezinover, Khaled Iskandarani, Vernon Chinchilli, Patrick McQuillan, Fuat Saner, Zakiyah Kadry, Thomas R Riley, Piotr K Janicki
BACKGROUND: End stage liver disease (ESLD) is associated with significant thrombotic complications. In this study, we attempted to determine if patients with ESLD, due to oncologic or autoimmune diseases, are susceptible to thrombosis to a greater extent than patients with ESLD due to other causes. METHODS: In this retrospective study, we analyzed the UNOS database to determine the incidence of thrombotic complications in orthotopic liver transplant (OLT) recipients with autoimmune and oncologic conditions...
2016: BMC Anesthesiology
Lukla Biasi, Sanjay D Patel, Talia Lea, Tommaso Donati, Konstantinos Katsanos, Judith S Partridge, Jugdeep K Dhesi, Hany Zayed
BACKGROUND: The incidence of Critical Limb Ischaemia (CLI) is exponentially rising among our aging population. There is a paucity of scientific evidence on best management and clinical outcome of infra-popliteal (IP) revascularisation in elderly CLI patients. METHODS: A prospectively collected database was analysed to identify consecutive octogenarian and nonagenarian patients who underwent IP revascularisation (bypass or angioplasty) for CLI (Rutherford 4-6) in a single centre between 2010-2014...
May 19, 2016: Journal of Cardiovascular Surgery
A Koscielny, M Kühnel, F Verrel, J C Kalff
Introduction: Although the perioperative management has been optimised over the past few decades, there has not been a remarkable improvement in the mortality rates of patients with a ruptured abdominal aortic aneurysm (rAAA). The aim of this retrospective trial was to define pre-, intra- and postoperative parameters which influence the perioperative and long-term outcome of patients and which can be modified by the operating team. Methods: A retrospective database analysis was performed in 49 patients who had undergone an operation of rAAA in our certified centre of vascular surgery between the beginning of 2006 and the end of 2012...
May 2, 2016: Zentralblatt Für Chirurgie
Peter Fasching, Joakim Huber, Martin Clodi, Heidemarie Abrahamian, Bernhard Ludvik
This position statement reflects the opinion of the Austrian Diabetes Association concerning the perioperative management of patients with diabetes mellitus based on the available scientific evidence. The paper covers necessary preoperative examinations from an internal/diabetological point of view as well as the perioperative metabolic control by means of oral antidiabetics and/or insulin therapy.
April 2016: Wiener Klinische Wochenschrift
Kelvin Kim, Diep Pham, Ran Schwarzkopf
The potential for using mobile applications (apps) as an effective tool to monitor patients in an outpatient setting is promising. Past studies have investigated the use of applications in preoperative and postoperative settings as well as in monitoring and treating chronic illnesses such as diabetes, congestive heart failure (CHF), and multiple sclerosis. However, there is limited data on its specific use in the context of total knee arthroplasty. Given the complicated nature and crucial role of patient adherence to protocols during the preparatory and recovery phases of the procedure, the use of an app can serve as a helpful tool in aiding patients throughout this process...
April 2016: Surgical Technology International
Marlin W Causey, Ayman Ahmed, Bian Wu, Warren J Gasper, Alex Reyzelman, Shant M Vartanian, Jade S Hiramoto, Michael S Conte
OBJECTIVE: Clinical decision making and accurate outcomes comparisons in advanced limb ischemia require improved staging systems. The Society for Vascular Surgery Lower Extremity Threatened Limb Classification System (Wound extent, Ischemia, and foot Infection [WIfI]) was designed to stratify limb outcomes based on three major factors-wound extent, ischemia, and foot infection. The Project or Ex-Vivo vein graft Engineering via Transfection III (PREVENT) III (PIII) risk score was developed to stratify patients by expected amputation-free survival (AFS) after surgical revascularization...
June 2016: Journal of Vascular Surgery
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