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Perioperative management of diabetes

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https://www.readbyqxmd.com/read/29455221/perioperative-lumbar-drain-utilization-in-transsphenoidal-pituitary-resection
#1
Shatha Alharbi, Griffith Harsh, Abdulrazag Ajlan
OBJECTIVE: To evaluate lumbar drain (LD) efficacy in transnasal resection of pituitary macroadenomas in preventing postoperative cerebrospinal fluid (CSF) leak, technique safety, and effect on length of hospital stay. METHODS: We conducted a retrospective data review of pituitary tumor patients in our institution who underwent surgery between December 2006 and January 2013. All patients were operated on for complete surgical resection of pituitary macroadenoma tumors...
January 2018: Neurosciences: the Official Journal of the Pan Arab Union of Neurological Sciences
https://www.readbyqxmd.com/read/29407052/perioperative-management-of-hyperglycemia-and-diabetes-in-cardiac-surgery-patients
#2
REVIEW
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
https://www.readbyqxmd.com/read/29397139/management-of-antiplatelet-therapy-in-patients-with-coronary-stents-undergoing-noncardiac-surgery-association-with-adverse-events
#3
A Rodriguez, N Guilera, A Mases, P Sierra, J C Oliva, C Colilles
BACKGROUND: Perioperative discontinuation of antiplatelet therapy (APT) in patients with coronary stents has been associated with major adverse cardiac events. Our aim was to analyse the perioperative management of APT in such patients and its relationship to the incidence of major adverse cardiac and cerebrovascular events (MACCE) and major bleeding events (MBE) in noncardiac surgery. METHODS: We completed a prospective multicentre observational study of patients with coronary stents undergoing noncardiac surgery in 11 hospitals in Spain...
January 2018: British Journal of Anaesthesia
https://www.readbyqxmd.com/read/29353319/management-strategies-for-noncardiac-surgery-following-a-coronary-artery-event
#4
REVIEW
Thomas F Whayne, Sibu P Saha
PURPOSE OF REVIEW: Coronary artery event includes acute coronary syndrome (ACS), percutaneous coronary intervention (PCI), and coronary artery bypass graft (CABG) surgery. Following such an event, risk of noncardiac surgery is increased. Of major concern is what can make this surgery safer? RECENT FINDINGS: High functional capacity improves cardiovascular (CV) risk; at least 4.0 metabolic equivalents (METs) on stress test are favorable. Risk scores can suggest need for further evaluation...
January 20, 2018: Current Cardiology Reports
https://www.readbyqxmd.com/read/29339167/comparison-of-anticoagulant-therapy-for-atrial-fibrillation-novel-oral-anticoagulants-versus-vitamin-k-antagonists
#5
REVIEW
Sean T Chen, Manesh R Patel
In patients with non-valvular atrial fibrillation (NVAF), oral anticoagulation is important for prevention of stroke and systemic embolism (SE). While Vitamin K antagonists (VKAs) have historically been the standard of care, these medications are limited by numerous food and drug interactions with onerous requirements for frequent monitoring and dose adjustments. Over the past decade, several novel oral anticoagulants (NOACs) have been developed to directly inhibit factor IIa/thrombin (dabigatran) or activated factor X (apixaban, rivaroxaban, edoxaban)...
January 12, 2018: Progress in Cardiovascular Diseases
https://www.readbyqxmd.com/read/29328746/operating-department-practitioners-care-of-the-patient-with-diabetes-in-the-perioperative-period
#6
Nicola Morley
Diabetes mellitus (DM) is a of group metabolic diseases which are defined by hyperglycaemia affecting multiple organs. The condition is found in people of all ages and ethnicities. Diabetes mellitus affects 180 million people worldwide and increasing numbers of patients are presenting with diabetic complications and the need for surgical intervention. This article describes the pathophysiology of DM and the management of the condition, particularly type I and type 2, in the perioperative phase of the surgical patient journey...
April 2017: Journal of Perioperative Practice
https://www.readbyqxmd.com/read/29317312/perioperative-management-of-adult-diabetic-patients
#7
Cheisson Gaëlle, Jacqueminet Sophie, Cosson Emmanuel, Ichai Carole, Leguerrier Anne-Marie, Nicolescu-Catargi Bogdan, Ouattara Alexandre, Tauveron Igor, Valensi Paul, Benhamou Dan
A patient should be referred to a diabetologist perioperatively in several circumstances: preoperative recognition of a previously unknown diabetes or detection of glycaemic imbalance (HbA1c <5% or >8%); during hospitalisation, recognition of a previously unknown diabetes, persisting glycaemic imbalance despite treatment or difficulty resuming previously used chronic treatment; postoperatively and after discharge from hospital, for all diabetic patients in whom HbA1c is >8%.
January 6, 2018: Anaesthesia, Critical Care & Pain Medicine
https://www.readbyqxmd.com/read/29310400/clinical-analysis-of-hyperkalemia-after-esophagectomy-a-case-report
#8
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)
https://www.readbyqxmd.com/read/29281103/incidence-and-predictive-factors-of-sepsis-following-adult-spinal-deformity-surgery
#9
Scott L Zuckerman, Nikita Lakomkin, Blaine P Stannard, Constantinos G Hadjipanayis, Christopher I Shaffrey, Justin S Smith, Joseph S Cheng
BACKGROUND: Surgery for adult spinal deformity (ASD) improves quality of life, yet morbidity is high. Sepsis is a challenging postoperative complication that can result in death and drive inpatient resources. OBJECTIVE: To identify the incidence and risk factors for development of sepsis within 30 days following ASD surgery. METHODS: Adult patients who underwent thoracolumbar spinal deformity correction between 2008 and 2014 were identified in the National Surgical Quality Improvement Program database...
December 21, 2017: Neurosurgery
https://www.readbyqxmd.com/read/29275829/risk-modeling-to-optimize-patient-selection-for-management-of-the-descending-thoracic-aortic-aneurysm
#10
Akiko Tanaka, Harleen K Sandhu, Wande B Pratt, Rana Afifi, Charles C Miller, Kristofer Charlton-Ouw, Maria E Codreanu, Naveed U Saqib, Ali Azizzadeh, Hazim J Safi, Anthony L Estrera
BACKGROUND: A single-institutional study comparing early and long-term outcomes of thoracic endovascular aortic repair (TEVAR) and open surgical repair (OSR) was performed to determine the appropriate treatment option for descending thoracic aortic aneurysm (DTAA). METHODS: Between 2005 and 2014, 438 DTAA patients were treated (TEVAR, 88; OSR, 350). Acute dissection and traumatic injury were excluded. Perioperative and follow-up data were reviewed. Stratified analyses were conducted to identify patients most likely to benefit from TEVAR...
December 21, 2017: Annals of Thoracic Surgery
https://www.readbyqxmd.com/read/29232296/morbid-obesity-does-not-increase-morbidity-or-mortality-in-robotic-cardiac-surgery
#11
Hiroto Kitahara, Brooke Patel, Mackenzie McCrorey, Sarah Nisivaco, Husam H Balkhy
OBJECTIVE: Morbid obesity (body mass index ≥ 35 kg/m) usually confers a higher perioperative risk in cardiac surgery. Robotic cardiac surgery may have many advantages for these high-risk patients. METHODS: We retrospectively reviewed patients undergoing robotic cardiac surgery from July 2013 to April 2017 at our institution. We compared the outcomes of morbidly obese patients versus nonobese patients. RESULTS: A total of 486 patients underwent robotic cardiac surgery (322 men, median age = 65 years)...
November 2017: Innovations: Technology and Techniques in Cardiothoracic and Vascular Surgery
https://www.readbyqxmd.com/read/29223421/a-prospective-multi-institutional-cohort-study-of-mediastinal-infections-after-cardiac-operations
#12
Louis P Perrault, Katherine A Kirkwood, Helena L Chang, John C Mullen, Brian C Gulack, Michael Argenziano, Annetine C Gelijns, Ravi K Ghanta, Bryan A Whitson, Deborah L Williams, Nancy M Sledz-Joyce, Brian Lima, Giampaolo Greco, Nishit Fumakia, Eric A Rose, John D Puskas, Eugene H Blackstone, Richard D Weisel, Michael E Bowdish
BACKGROUND: Mediastinal infections are a potentially devastating complication of cardiac operations. This study analyzed the frequency, risk factors, and perioperative outcomes of mediastinal infections after cardiac operations. METHODS: In 2010, 5,158 patients enrolled in a prospective study evaluating infections after cardiac operations and their effect on readmissions and mortality for up to 65 days after the procedure. Clinical and demographic characteristics, operative variables, management practices, and outcomes were compared for patients with and without mediastinal infections, defined as deep sternal wound infection, myocarditis, pericarditis, or mediastinitis...
December 6, 2017: Annals of Thoracic Surgery
https://www.readbyqxmd.com/read/29186533/surgical-treatment-for-isolated-mitral-valve-endocarditis-a-16-year-single-centre-experience
#13
Sossio Perrotta, Victoria Fröjd, Vincenzo Lepore, Henrik Schersten, Anders Jeppsson, Gunnar Svensson
OBJECTIVES: Despite progress in management, mitral valve endocarditis (MVE) is still a life-threatening disease. We report our experience in surgical treatment of infective isolated MVE. METHODS: A total of 140 operations in 128 patients for MVE performed between January 2000 and December 2015 were included in a retrospective study. There were 109 (78%) operations for native and 31 (22%) operations for prosthetic valve endocarditis. Preoperative and postoperative characteristics and mortality of patients were registered...
November 27, 2017: European Journal of Cardio-thoracic Surgery
https://www.readbyqxmd.com/read/29173965/complications-and-patient-injury-after-ankle-fracture-surgery-a-closed-claim-analysis-with-data-from-the-patient-compensation-association-in-denmark
#14
Naja Bjørslev, Lars Bo Ebskov, Camilla Mersø, Christian Wong
BACKGROUND: The Patient Compensation Association (PCA) receives claims for financial compensation from patients who believe they have sustained damage from their treatment in the Danish health care system. In this study, we have analysed closed claims in which patients suffered injuries due to the surgical treatment of their ankle fracture. We identified causalities contributing to these injuries and malpractices, as well as the economic consequences of these damages. METHODS: Fifty-one approved closed claims from the PCA database from the years 2004-2009 were analysed in a retrospective systematic review...
November 21, 2017: Injury
https://www.readbyqxmd.com/read/29168157/perioperative-implications-of-sodium-glucose-cotransporter-2-inhibitors-a-case-series-of-euglycemic-diabetic-ketoacidosis-in-three-patients-after-cardiac-surgery
#15
Aaron Lau, Simon Bruce, Erica Wang, Ron Ree, Kevin Rondi, Anthony Chau
PURPOSE: Sodium-glucose cotransporter-2 inhibitors (SGLT2i) comprise the newest class of oral hypoglycemic agents approved for treating type II diabetes mellitus (DM-II). Their use, however, has been associated with the rare development of euglycemic diabetic ketoacidosis (euDKA). We present three cases of euDKA that occurred following elective coronary artery bypass grafting surgery. The role of the anesthesiologist in the prevention, diagnosis, and management of this complication is also discussed...
November 22, 2017: Canadian Journal of Anaesthesia, Journal Canadien D'anesthésie
https://www.readbyqxmd.com/read/29162977/perioperative-management-of-patients-with-diabetes
#16
REVIEW
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
https://www.readbyqxmd.com/read/29160727/a-review-of-perioperative-complications-of-outpatient-total-ankle-arthroplasty
#17
Todd R Borenstein, Kapil Anand, Quanlin Li, Timothy P Charlton, David B Thordarson
BACKGROUND: Total ankle arthroplasty (TAA) is commonly pursued for patients with painful arthritis. Outpatient TAA are increasingly common and have been shown to decrease costs compared to inpatient surgery. However, there are very few studies examining the safety of outpatient TAA. In this study, we retrospectively reviewed 65 consecutive patients who received outpatient TAA to identify complication rates. METHODS: The medical records of 65 consecutive outpatient TAA from October 2012 to May 2016 with a minimum 6-month follow-up were reviewed...
November 1, 2017: Foot & Ankle International
https://www.readbyqxmd.com/read/29124870/defining-a-hba1c-value-that-predicts-increased-risk-of-penile-implant-infection
#18
Mohamad Habous, Raanan Tal, Tarek Soliman, Alaa Tealab, Mohammed Nassar, Zenhom Mekawi, Saad Mahmoud, Osama Abdelwahab, Mohamed Elkhouly, Hatem Kamr, Abdallah Remeah, Saleh Binsaleh, David Ralph, John Mulhall
OBJECTIVES: To explore the association between HbA1C level and penile implant infection rates and to define a cut-off value that predicted implant infection. PATIENTS AND METHODS: A multi center prospective study included all patients undergoing penile implant surgery between 2009-15. Preoperative, perioperative and postoperative management were identical for the entire cohort. Univariate analysis was performed to define predictors of implant infection. HbA1c levels were analyzed as a continuous variable and sequential analysis was conducted utilizing 0...
November 10, 2017: BJU International
https://www.readbyqxmd.com/read/29049074/physiology-and-role-of-intraocular-pressure-in-contemporary-anesthesia
#19
Dermot J Kelly, Sinéad M Farrell
More than 26 million Americans suffer with cataracts, and with 3.6 million cataract extractions performed annually in the United States, it is the most common surgical procedure. The integrity of the delicate structures of the eye that mediate vision is dependent on the intraocular pressure (IOP). Yet, IOP acts to compress the vessels within the globe-akin to a Starling resistor-and is a key component that determines the ocular perfusion pressure, defined as the difference between arterial pressure and IOP...
October 17, 2017: Anesthesia and Analgesia
https://www.readbyqxmd.com/read/28921676/perioperative-passport-empowering-people-with-diabetes-along-their-surgical-journey
#20
E Page, F Akiboye, S Jackson, C Kerry, R Round, G Rayman
AIM: To determine whether a handheld 'perioperative passport' could improve the experience of perioperative care for people with diabetes and overcome some of the communication issues commonly identified in inpatient extracts. METHODS: Individuals with diabetes undergoing elective surgery requiring at least an overnight stay were identified via a customized information technology system. Those allocated to the passport group were given the perioperative passport before their hospital admission...
September 18, 2017: Diabetic Medicine: a Journal of the British Diabetic Association
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