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Perioperative management of diabetes

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https://www.readbyqxmd.com/read/27903337/-risk-factors-for-perioperative-stroke-in-aged-patients-undergoing-nonneurologic-and-noncardiovascular-surgery
#1
B L Jiang, L Yao, Y Feng, J H Liu
Objective: To assess the incidence, risk factors, and outcomes of perioperative stroke in aged patients undergoing nonneurologic and noncardiovascular surgery. Methods: A total of 21 419 in-patients who were older than 65 years undergoing nonneurologic and noncardiovascular surgery in Peking University People's Hospital from January 2010 to May 2016 were retrospectively recruited in this study.The patients were divided into two groups: patients with perioperative stroke were allocated in stroke group, and the other patients were in the non-stroke group...
November 22, 2016: Zhonghua Yi Xue za Zhi [Chinese medical journal]
https://www.readbyqxmd.com/read/27876245/perioperative-medicine-and-taiwan-national-health-insurance-research-database
#2
REVIEW
C C Chang, C C Liao, T L Chen
"Big data", characterized by 'volume', 'velocity', 'variety', and 'veracity', being routinely collected in huge amounts of clinical and administrative healthcare-related data are becoming common and generating promising viewpoints for a better understanding of the complexity for medical situations. Taiwan National Health Insurance Research Database (NHIRD), one of large and comprehensive nationwide population reimbursement databases in the world, provides the strength of sample size avoiding selection and participation bias...
November 18, 2016: Acta Anaesthesiologica Taiwanica: Official Journal of the Taiwan Society of Anesthesiologists
https://www.readbyqxmd.com/read/27819771/glycemic-outcomes-three-years-after-implementation-of-a-perioperative-glycemic-control-algorithm-in-an-academic-institution
#3
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 is available to inform the management of patients with diabetes (DM) in the operating room and the immediate perioperative period. We describe the results of a perioperative glycemic control program that standardized intravenous insulin with a target glucose (BG) range of 120-180 mg/dL for patients with DM presenting with a BG level > 180mg/dL and included transition to subcutaneous insulin...
November 7, 2016: Endocrine Practice
https://www.readbyqxmd.com/read/27772602/aortic-valve-stenosis-in-a-dialysis-patient-waitlisted-for-kidney-transplantation
#4
Stefan Büttner, Helge Weiler, Carolin Zöller, Benjamin Koch, Andreas Zierer, Andreas M Zeiher, Helmut Geiger, Mariuca Vasa-Nicotera, Ingeborg A Hauser, Stephan Fichtlscherer
Management of dialysis patients with valvular heart disease waitlisted for kidney transplantation is challenging. Development of severe aortic valve stenosis can lead to the exclusion from the transplant program or even death while on the waiting list. In dialysis patients, surgical aortic valve replacement is associated with a high perioperative risk with increased morbidity and mortality. In contrast, transcatheter aortic valve implantation emerges as a viable option for dialysis patients. Herein, we present the long-term follow-up of successful kidney transplantation after TAVI in a diabetic patient receiving long-term hemodialysis...
November 2016: Annals of Thoracic Surgery
https://www.readbyqxmd.com/read/27771235/relationship-between-diabetic-variables-and-outcomes-after-coronary-artery-bypass-grafting-in-diabetic-patients
#5
Tom Kai Ming Wang, Andrew Woodhead, Tharumenthiran Ramanathan, James Pemberton
BACKGROUND: Nearly half of the patients undergoing coronary artery bypass grafting (CABG) have diabetes. There is mixed data as to whether preoperative (haemoglobin A1c{HbA1c}) and/or perioperative diabetes control is associated with mortality and morbidity after CABG. We reviewed the characteristics and outcomes of diabetic patients undergoing CABG with a focus on HbA1c, perioperative glucose levels and diabetic treatment regimens. METHODS: Diabetic patients undergoing CABG during July 2010 to June 2012 were studied (n=306)...
July 4, 2016: Heart, Lung & Circulation
https://www.readbyqxmd.com/read/27767680/postoperative-urinary-retention-in-patients-undergoing-elective-spinal-surgery
#6
David Altschul, Andrew Kobets, Jonathan Nakhla, Ajit Jada, Rani Nasser, Merritt D Kinon, Reza Yassari, John Houten
OBJECTIVE Postoperative urinary retention (POUR) is a common problem leading to morbidity and an increased hospital stay. There are limited data regarding its baseline incidence in patients undergoing spinal surgery and the risk factors with which it may be associated. The purpose of this study was to evaluate the incidence of POUR in elective spine surgery patients and determine the factors associated with its occurrence. METHODS The authors retrospectively reviewed the records of patients who had undergone elective spine surgery and had been prospectively monitored for POUR during an 18-month period...
October 21, 2016: Journal of Neurosurgery. Spine
https://www.readbyqxmd.com/read/27761041/acute-post-operative-diabetic-ketoacidosis-atypical-harbinger-unmasking-latent-diabetes-mellitus
#7
Rudrashish Haldar, Ankur Khandelwal, Devendra Gupta, Shashi Srivastava, Prabhat K Singh
Hyperglycaemia following surgical and anaesthetic stress is a well-established entity which might have undesirable clinical consequences in known diabetics. We encountered a rare event where an undiagnosed diabetic patient developed ketoacidosis in the immediate post-operative period which was her initial presenting symptom of deranged glucoregulation. Presumably, the stress induced by surgery and anaesthesia lead to the genesis of this event. We discuss the management of this case. In addition, we highlight the importance of glycosylated haemoglobin as a subject of future research in identifying such "at risk" patients and for stratifying the risk of hyperglycaemic complications in perioperative settings...
October 2016: Indian Journal of Anaesthesia
https://www.readbyqxmd.com/read/27752032/starvation-ketoacidosis-as-a-cause-of-unexplained-metabolic-acidosis-in-the-perioperative-period
#8
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
https://www.readbyqxmd.com/read/27633164/a-comparison-between-aortobifemoral-bypass-and-aortoiliac-kissing-stents-in-patients-with-complex-aortoiliac-obstructive-disease
#9
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
https://www.readbyqxmd.com/read/27521822/somatosensory-evoked-potentials-and-electroencephalography-during-carotid-endarterectomy-predict-late-stroke-but-not-death
#10
Natalie Domenick Sridharan, Rabih A Chaer, Partha D Thirumala, Jeffrey Balzer, Becky Long, Edith Tzeng, Michel S Makaroun, Efthymios D Avgerinos
BACKGROND: Late stroke and death rates are anticipated to be higher in patients undergoing carotid endarterectomy (CEA) compared with healthy counterparts. However, little is known regarding predictors other than the baseline comorbidities. We have recently shown that dual intraoperative somatosensory evoked potentials (SSEPs) and electroencephalography (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
https://www.readbyqxmd.com/read/27502788/inadequate-pre-operative-glycaemic-control-in-patients-with-diabetes-mellitus-adversely-influences-functional-recovery-after-total-knee-arthroplasty-patients-with-impaired-glycaemic-control-exhibit-poorer-functional-outcomes-at-1-year-post-arthroplasty
#11
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
https://www.readbyqxmd.com/read/27495345/outcomes-of-concomitant-ventral-hernia-repair-performed-during-bariatric-surgery
#12
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
https://www.readbyqxmd.com/read/27490305/predictors-of-30-day-perioperative-morbidity-and-mortality-of-unruptured-intracranial-aneurysm-surgery
#13
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
https://www.readbyqxmd.com/read/27450209/the-effects-of-optimal-perioperative-glucose-control-on-morbidly-obese-patients-undergoing-bariatric-surgery
#14
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
https://www.readbyqxmd.com/read/27442676/comparison-of-the-effects-of-remifentanil-based-general-anesthesia-and-popliteal-nerve-block-on-postoperative-pain-and-hemodynamic-stability-in-diabetic-patients-undergoing-distal-foot-amputation-a-retrospective-observational-study
#15
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)
https://www.readbyqxmd.com/read/27414481/consensus-on-surgical-aspects-of-managing-osteomyelitis-in-the-diabetic-foot
#16
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
https://www.readbyqxmd.com/read/27353847/resection-of-hepatocellular-carcinoma-in-elderly-patients-and-the-role-of-energy-balance
#17
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
https://www.readbyqxmd.com/read/27346595/pre-and-postoperative-evaluation-of-transcranial-doppler-pulsatility-index-of-the-middle-cerebral-artery-in-patients-with-severe-carotid-artery-stenosis
#18
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
https://www.readbyqxmd.com/read/27322091/perianesthetic-management-of-patients-with-thyroid-stimulating-hormone-secreting-pituitary-adenomas
#19
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
https://www.readbyqxmd.com/read/27301370/perioperative-glycemic-control-in-plastic-surgery-review-and-discussion-of-an-institutional-protocol
#20
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
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