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Fabian-Quillama RJ, Cuñat T, Saavedra Y, Ripoll-Romero E, Martin N, Fernández-Valencia JÁ, Tió M. Effects of high-dose dexamethasone on postoperative opioid consumption and perioperative glycaemia in fast-track primary hip arthroplasty: a retrospective cohort study. INTERNATIONAL ORTHOPAEDICS 2025; 49:1403-1410. [PMID: 40178624 PMCID: PMC12075399 DOI: 10.1007/s00264-025-06430-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/25/2024] [Accepted: 01/26/2025] [Indexed: 04/05/2025]
Abstract
BACKGROUND AND PURPOSE Standard recommendations for fast-track hip arthroplasty suggest using 8-10 mg of dexamethasone to reduce opioid consumption, with potential benefits of higher doses but scarce data on glycaemic control and complications. This study compares the effects of higher doses versus the standard doses on postoperative opioid consumption, and secondarily, numerical pain scale, glycaemic control, hospital length of stay and postoperative complications. METHODS Retrospective cohort study of patients scheduled for FAST-TRACK primary hip arthroplasty between 2016 and 2021. Propensity score-matched analyses compared the standard dose group (4-8 mg) versus the high-dose group (16-24 mg). RESULTS 168 patients were included (56 with 4-8 mg, 112 with 16-24 mg). After one-to-one propensity score matching, 52 patients were included in the standard group and 52 in the high-dose group. After matching, the median [IQR] opioid consumption in the low-dose group was 10 [0-12] and in the high-dose group was 0 [0-10], with a 95% CI of -1 to 0 (p = 0.016). In the matched group, there was a median difference of 8 mg/dL (95% CI, -2 to 7, P < 0.05) in the immediate postoperative glycaemia, of 17 mg/dl (95% CI, -2 to 14, P < 0.05) in glycaemia at 24 h and of -1 day (95% CI, -1 to 0, P < 0.05) in hospital stay. No differences in the numerical pain scale and postoperative complications were found. CONCLUSION High-dose dexamethasone slightly increased perioperative glycaemia while reducing opioid consumption and shortening hospital length of stay.
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Affiliation(s)
| | - Tomás Cuñat
- Hospital Clínic of Barcelona, Barcelona, Spain
- Departament de Cirurgia i Especialitats Medicoquirúrgiques. Facultat de Medicina i Ciències de la Salut, Universitat de Barcelona, Barcelona, Spain
| | | | - Elisabet Ripoll-Romero
- Hospital Clínic of Barcelona, Barcelona, Spain
- Departament d'Infermeria de Salut Pública, Salut Mental i Maternoinfantil. Facultat d'Infermeria, Universitat de Barcelona, Barcelona, Spain
| | - Nuria Martin
- Hospital Clínic of Barcelona, Barcelona, Spain
- Departament de Cirurgia i Especialitats Medicoquirúrgiques. Facultat de Medicina i Ciències de la Salut, Universitat de Barcelona, Barcelona, Spain
| | - Jenaro Ángel Fernández-Valencia
- Hospital Clínic of Barcelona, Barcelona, Spain.
- Departament de Cirurgia i Especialitats Medicoquirúrgiques. Facultat de Medicina i Ciències de la Salut, Universitat de Barcelona, Barcelona, Spain.
| | - Montserrat Tió
- Hospital Clínic of Barcelona, Barcelona, Spain
- Departament de Cirurgia i Especialitats Medicoquirúrgiques. Facultat de Medicina i Ciències de la Salut, Universitat de Barcelona, Barcelona, Spain
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Moon SJ, Kim MS, Kim YT, Lee HE, Lee YW, Lee SJ, Chung ES, Park CY. Use of an insulin titration protocol based on continuous glucose monitoring in postoperative cardiac surgery patients with type 2 diabetes and prediabetes: a randomized controlled trial. Cardiovasc Diabetol 2025; 24:210. [PMID: 40369552 PMCID: PMC12079838 DOI: 10.1186/s12933-025-02747-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2024] [Accepted: 04/18/2025] [Indexed: 05/16/2025] Open
Abstract
BACKGROUND Maintaining optimal glucose control is critical for postoperative care cardiac surgery patients. Continuous glucose monitoring (CGM) in this setting remains understudied. We evaluated the efficacy of CGM with a specialized titration protocol in cardiac surgery patients with type 2 diabetes (T2D) and prediabetes. METHODS In this randomized-controlled trial, 54 cardiac surgery patients were randomized one day post-surgery, with 27 CGM and 25 point-of-care (POC) patients completing the study. The CGM group used Dexcom G6 with a CGM-specialized titration protocol, while the POC group used standard monitoring with blinded CGM. The primary outcome was time-in-range (TIR) 100-180 mg/dL for 7 days post-surgery. Secondary outcomes included various glycemic metrics and surgical outcomes. Multiple comparison adjustments were performed using false-discovery-rate (FDR). RESULTS Thirty-one (59.6%) had diabetes and 21 (40.4%) had prediabetes. While TIR 100-180 mg/dL showed no difference (74.7% vs. 71.6%, FDR-adjusted p = 0.376), the CGM group demonstrated improvements in TIR 70-180 mg/dL (83.8% vs. 75.8%, FDR-adjusted p = 0.026), time-in-tight-range (TITR) 100-140 mg/dL (46.3% vs. 36.3%, FDR-adjusted p = 0.018), and TITR 70-140 mg/dL (55.3% vs. 40.5%, FDR-adjusted p = 0.003). Both groups maintained very low rates of time below range (< 70 mg/dL: 0.03% vs. 0.18%, FDR-adjusted p = 0.109). The CGM group showed lower postoperative atrial fibrillation (AF) (18.8% vs. 55.6%, FDR-adjusted p = 0.04999). CONCLUSION While the primary outcome was not achieved, CGM with a specialized titration protocol demonstrated safe glycemic control with improvements in TIR 70-180 mg/dL and TITRs in cardiac surgery patients with T2D and prediabetes. The observed reduction in postoperative AF warrants further investigation. TRIAL REGISTRATION ClinicalTrials.gov NCT06275971.
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Affiliation(s)
- Sun-Joon Moon
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, 29 Saemunan-ro, Jongno-gu, Seoul, 03181, Republic of Korea
| | - Min-Su Kim
- Thoracic and Cardiovascular Surgery, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, 29 Saemunan-ro, Jongno-gu, Seoul, 03181, Republic of Korea
| | - Yun Tae Kim
- Division of Biostatistics, Department of Academic Research, Kangbuk Samsung Hospital, Seoul, Republic of Korea
| | - Ha-Eun Lee
- Thoracic and Cardiovascular Surgery, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, 29 Saemunan-ro, Jongno-gu, Seoul, 03181, Republic of Korea
| | - Young-Woo Lee
- Thoracic and Cardiovascular Surgery, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, 29 Saemunan-ro, Jongno-gu, Seoul, 03181, Republic of Korea
| | - Su-Ji Lee
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, 29 Saemunan-ro, Jongno-gu, Seoul, 03181, Republic of Korea
| | - Euy-Suk Chung
- Thoracic and Cardiovascular Surgery, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, 29 Saemunan-ro, Jongno-gu, Seoul, 03181, Republic of Korea.
| | - Cheol-Young Park
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, 29 Saemunan-ro, Jongno-gu, Seoul, 03181, Republic of Korea.
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Kang J, Chai X, Jia T, Hu H, Fu R, Nie H. Global research trends in perioperative care for diabetic patients: a bibliometric and visualized study. Perioper Med (Lond) 2025; 14:50. [PMID: 40307928 PMCID: PMC12042523 DOI: 10.1186/s13741-025-00532-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2025] [Accepted: 04/19/2025] [Indexed: 05/02/2025] Open
Abstract
Perioperative management in diabetic patients is important since their postoperative mortality and morbidity are higher than that of non-diabetic patients, which will exacerbate the burden on public health. We selected relevant publications from the WoSCC-SCIE between 2007 and 2024, utilizing VOSviewer and CiteSpace to analyze the collected information and generate knowledge maps. A total of 3167 articles from 792 journals and 83 countries/regions were included for analysis. Overall, there has been a continuous increase in publication volume. From the result of academic collaboration between different countries/regions and institutions, the USA occupies a central position in research strength. A total of 18,101 authors participated in research on "perioperative management in diabetic patients" with Dr. Guillermo E. Umpierrez from Emory University School of Medicine being the most productive author. We conclude that perioperative adverse clinical outcomes in diabetic patients and perioperative blood glucose management have consistently been research hotspots in this field. Additionally, continuous glucose monitoring and insulin administration under computer guidance, as well as the use of merging medications are likely to be frontier directions for future research. Research on perioperative care for diabetic patients has been further deepened worldwide, which will be crucial in further improving perioperative care for diabetic patients and enhancing postoperative recovery.
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Affiliation(s)
- Jiangru Kang
- Department of Anesthesiology and Perioperative Medicine, Xijing Hospital, Fourth Military Medical University, 127 West Changle Road, Xi'an, Shaanxi, 710032, China
| | - Xin Chai
- Department of Anesthesiology and Perioperative Medicine, Xijing Hospital, Fourth Military Medical University, 127 West Changle Road, Xi'an, Shaanxi, 710032, China
| | - Tao Jia
- Department of Anesthesiology and Perioperative Medicine, Xijing Hospital, Fourth Military Medical University, 127 West Changle Road, Xi'an, Shaanxi, 710032, China
| | - Huiru Hu
- Department of Anesthesiology and Perioperative Medicine, Xijing Hospital, Fourth Military Medical University, 127 West Changle Road, Xi'an, Shaanxi, 710032, China
| | - Rong Fu
- Department of Anesthesiology and Perioperative Medicine, Xijing Hospital, Fourth Military Medical University, 127 West Changle Road, Xi'an, Shaanxi, 710032, China
| | - Huang Nie
- Department of Anesthesiology and Perioperative Medicine, Xijing Hospital, Fourth Military Medical University, 127 West Changle Road, Xi'an, Shaanxi, 710032, China.
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Ping W, Jingbo Z, Shanshan W, Zihao D, Wanchen Y, Jiayi L, Jiayu W, Hui M. Different regimens of preoperative carbohydrate loading on insulin resistance: A network meta-analysis. Clin Nutr ESPEN 2025; 66:142-150. [PMID: 39842663 DOI: 10.1016/j.clnesp.2025.01.035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2024] [Revised: 11/02/2024] [Accepted: 01/13/2025] [Indexed: 01/24/2025]
Abstract
BACKGROUND & AIMS The effectiveness of preoperative carbohydrate loading(PCL) on postoperative insulin resistance(IR) is controversial. In addition, the effect of different doses of carbohydrates on postoperative IR is also controversial. Therefore, this study aimed to investigate the efficiency of PCL on postoperative IR and the optimal regimen for the effect on postoperative IR. METHODS A systematic search of clinical randomized controlled trials was performed to extract basic information about the included studies, specific regimens of PCL, and preoperative and postoperative IR. Network meta-analysis was performed using frequentist random effects. A total of 7 regimens were identified by categorizing them based on frequency, timing, control groups, and conducting subgroup analysis according to surgical procedure. High (>45 g) and low (≤45 g) doses were divided according to the standard definition of PCL. Dose analysis was performed on studies in the subgroups that met the optimal frequency and timing regimen. Reporting of results based on weighted mean differences(WMD), 95 % confidence intervals(95%CrI), and the surface under the cumulative ranking(SUCRA). RESULTS Carbohydrate loading given only 3 h before surgery is more strongly associated with insulin resistance than fasting(WMD: -4.04,95%CrI: -5.67 to -2.40) and placebo(WMD: -4.00,95%CrI: -5.98 to -2.02). Single-dose preoperative 3 h regimen has the highest probability of being the optimal regimen(SUCRA = 90.9 %). This is also true in open(SUCRA = 93.7 %) and laparoscopic surgery(SUCRA = 99.9 %). Analyzed using a fixed-effects model in open and laparoscopic surgery. In open surgery, high-dose and low-dose carbohydrates are associated with postoperative IR compared with fasting(high-dose: WMD: -1.75,95%CrI: -1.95 to -1.54; low-dose: WMD: -2.46,95%CrI: -3.70 to -1.23) and placebo(high-dose: WMD: -5.37,95%CrI: -6.99 to -3.76; low-dose: WMD: -6.09,95%CrI: -7.29 to -4.90). Low-dose carbohydrates(SUCRA = 95.3 %) have the highest probability of being the best option. In laparoscopic surgery, high-dose and low-dose carbohydrates are also associated with postoperative IR compared with fasting(high-dose (WMD: -5.70,95 %, CrI: -7.63 to -3.77); low-dose (WMD: -3.69,95%CrI: -4.11 to -3.27))and placebo(high-dose (WMD: -5.73,95%CrI: -7.72 to -3.74); low-dose (WMD: -3.72,95%CrI: -4.14 to -3.30)). SUCRA for high-dose carbohydrates is 99.2 %. CONCLUSION Preoperative implementation of carbohydrate loading is more beneficial in alleviating postoperative insulin resistance than fasting and placebo. Conducting PCL on the morning of surgery is more effective in relieving postoperative IR. For both open and laparoscopic surgeries, administering carbohydrate loading 3 h before the surgery may represent the optimal regimen. Further studies are needed to investigate the effect of different doses on postoperative IR.
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Affiliation(s)
- Wu Ping
- School of Graduate, Tianjin University of Traditional Chinese Medicine, No.10 Poyang Lake Road, Tuanbo New City West, Jinghai District, Tianjin, China
| | - Zhai Jingbo
- School of Public Health, Tianjin University of Traditional Chinese Medicine, No.10 Poyang Lake Road, Tuanbo New City West, Jinghai District, Tianjin, China.
| | - Wang Shanshan
- School of Nursing, Tianjin University of Traditional Chinese Medicine, No.10 Poyang Lake Road, Tuanbo New City West, Jinghai District, Tianjin, China.
| | - Deng Zihao
- School of Basic Medical Sciences, Capital Medical University, No.10, West Toujiao, Right Anmenwai, Fengtai District, Beijing, China
| | - Yu Wanchen
- School of Graduate, Tianjin University of Traditional Chinese Medicine, No.10 Poyang Lake Road, Tuanbo New City West, Jinghai District, Tianjin, China
| | - Liu Jiayi
- School of Graduate, Tianjin University of Traditional Chinese Medicine, No.10 Poyang Lake Road, Tuanbo New City West, Jinghai District, Tianjin, China
| | - Wang Jiayu
- School of Graduate, Tianjin University of Traditional Chinese Medicine, No.10 Poyang Lake Road, Tuanbo New City West, Jinghai District, Tianjin, China
| | - Miao Hui
- School of Graduate, Tianjin University of Traditional Chinese Medicine, No.10 Poyang Lake Road, Tuanbo New City West, Jinghai District, Tianjin, China
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Provenzano DA, Hanes M, Hunt C, Benzon HT, Grider JS, Cawcutt K, Doshi TL, Hayek S, Hoelzer B, Johnson RL, Kalagara H, Kopp S, Loftus RW, Macfarlane AJR, Nagpal AS, Neuman SA, Pawa A, Pearson ACS, Pilitsis J, Sivanesan E, Sondekoppam RV, Van Zundert J, Narouze S. ASRA Pain Medicine consensus practice infection control guidelines for regional anesthesia and pain medicine. Reg Anesth Pain Med 2025:rapm-2024-105651. [PMID: 39837579 DOI: 10.1136/rapm-2024-105651] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2024] [Accepted: 08/27/2024] [Indexed: 01/23/2025]
Abstract
BACKGROUND To provide recommendations on risk mitigation, diagnosis and treatment of infectious complications associated with the practice of regional anesthesia, acute and chronic pain management. METHODS Following board approval, in 2020 the American Society of Regional Anesthesia and Pain Medicine (ASRA Pain Medicine) commissioned evidence-based guidelines for best practices for infection control. More than 80 research questions were developed and literature searches undertaken by assigned working groups comprising four to five members. Modified US Preventive Services Task Force criteria were used to determine levels of evidence and certainty. Using a modified Delphi method, >50% agreement was needed to accept a recommendation for author review, and >75% agreement for a recommendation to be accepted. The ASRA Pain Medicine Board of Directors reviewed and approved the final guidelines. RESULTS After documenting the incidence and infectious complications associated with regional anesthesia and interventional pain procedures including implanted devices, we made recommendations regarding the role of the anesthesiologist and pain physician in infection control, preoperative patient risk factors and management, sterile technique, equipment use and maintenance, healthcare setting (office, hospital, operating room), surgical technique, postoperative risk reduction, and infection symptoms, diagnosis, and treatment. Consensus recommendations were based on risks associated with different settings and procedures, and keeping in mind each patient's unique characteristics. CONCLUSIONS The recommendations are intended to be multidisciplinary guidelines for clinical care and clinical decision-making in the regional anesthesia and chronic interventional pain practice. The issues addressed are constantly evolving, therefore, consistent updating will be required.
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Affiliation(s)
| | - Michael Hanes
- Jax Spine and Pain Centers, Jacksonville, Florida, USA
| | - Christine Hunt
- Anesthesiology-Pain Medicine, Mayo Clinic, Jacksonville, Florida, USA
| | - Honorio T Benzon
- Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
- Division of Pain Medicine, Northwestern Memorial Hospital, Chicago, Illinois, USA
| | - Jay S Grider
- Department of Anesthesiology, University of Kentucky, Lexington, Kentucky, USA
| | - Kelly Cawcutt
- Division of Infectious Diseases and Pulmonary & Critical Care Medicine, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Tina L Doshi
- Anesthesiology and Critical Care Medicine, Johns Hopkins University, Baltimore, Maryland, USA
- Division of Pain Medicine, John Hopkins University, Baltimore, Maryland, USA
- Department of Neurosurgery, John Hopkins University, Baltimore, Maryland, USA
| | - Salim Hayek
- Anesthesiology, Case Western Reserve University, Cleveland, Ohio, USA
- University Hospitals of Cleveland, Cleveland, Ohio, USA
| | | | - Rebecca L Johnson
- Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Hari Kalagara
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic in Florida, Jacksonville, Florida, USA
| | - Sandra Kopp
- Anesthesiology, Mayo Clinic Graduate School for Biomedical Sciences, Rochester, Minnesota, USA
| | - Randy W Loftus
- Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | | | - Ameet S Nagpal
- Department of Orthopaedics and Physical Medicine & Rehabilitation, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Stephanie A Neuman
- Department of Pain Medicine, Gundersen Health System, La Crosse, Wisconsin, USA
| | - Amit Pawa
- Department of Theatres, Anaesthesia and Perioperative Medicine, Guy's and St Thomas' Hospitals NHS Trust, London, UK
- King's College London, London, UK
| | - Amy C S Pearson
- Anesthesia, Advocate Aurora Health Inc, Milwaukee, Wisconsin, USA
| | | | - Eellan Sivanesan
- Neuromodulation, Division of Pain Medicine, Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Rakesh V Sondekoppam
- Department of Anesthesia, Pain, and Perioperative Medicine, Stanford University, Palo Alto, California, USA
| | - Jan Van Zundert
- Anesthesiology and Pain Medicine, Maastricht University Medical Centre+, Maastricht, Limburg, The Netherlands
- Anesthesiology, Critical Care and Multidisciplinary Pain Center, Ziekenhuis Oost-Limburg, Genk, Belgium
| | - Samer Narouze
- Division of Pain Management, University Hospitals, Cleveland, Ohio, USA
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Rupprecht B, Dumps C. [Effects of "new" antidiabetic drugs on management of anesthesia]. DIE ANAESTHESIOLOGIE 2025:10.1007/s00101-025-01521-w. [PMID: 40164842 DOI: 10.1007/s00101-025-01521-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Accepted: 02/13/2025] [Indexed: 04/02/2025]
Abstract
Around 9 million people live with diabetes mellitus (DM) in Germany. Around 500,000 new cases are documented every year. In addition, it must be assumed that there are at least 2 million unreported cases. The proportion of patients with type 2 DM is by far the highest and it is currently estimated that around 340,000 adults and 32,000 children are affected by type 1 DM [1]. People with diabetes have an increased mortality rate; however, this has decreased in recent years, particularly due to a reduction in cardiovascular mortality. "New" antidiabetic drugs have certainly played a relevant role in this. Various studies have shown that sodium-glucose Cotransporter 2 inhibitors (SGLT2 inhibitors) in particular but also glucagon-like peptide‑1 receptor agonists (GLP1-RA), have a significant benefit in patients with heart failure [2-5]. Surprisingly, this effect was also detectable in patients without DM [6]. Thus, the group of people who are treated with an SGLT2 inhibitor or a GLP1-RA has been expanded to include people who suffer from heart failure not associated with diabetes. This applies both to patients with reduced left ventricular systolic function (heart failure with reduced ejection fraction, HFrEF) and with preserved or mildly reduced systolic function (heart failure with preserved/mildly reduced ejection fraction, HFpEF/HFmrEF) [7]. In Germany heart failure is the most common diagnosis for hospitalization (40.6 cases/10,000 insurance years) and diseases of the cardiovascular system are the most common cause of death [8]. The increased risk of morbidity and mortality is also reflected in the perioperative setting.In addition to the risks posed by DM itself or associated diseases, the treatment with antidiabetic drugs can also lead to perioperative complications. This article focuses on the drug-related risks of the "new" antidiabetic drugs and draws conclusions regarding the management of anesthesia. The potentially life-threatening euglycemic diabetic ketoacidosis (eDKA) can be a perioperative side effect of SGLT2 inhibitors; however, the diagnosis is associated with hurdles. The GLP1-RAs are also increasingly being prescribed as they reduce cardiovascular risk and make weight loss much easier. GLP1-RAs delay gastric emptying, which potentially results in an increased risk of aspiration. In particular, if other risk factors for aspiration exist, patients should not be considered fasting, if the recommended break in GLP1‑RA intake has not been followed.
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Affiliation(s)
- Bernd Rupprecht
- Klinik für Anästhesiologie und Operative Intensivmedizin, Universitätsklinikum Augsburg, Stenglinstraße 2, 86156, Augsburg, Deutschland.
| | - Christian Dumps
- Klinik für Anästhesiologie und Operative Intensivmedizin, Universitätsklinikum Augsburg, Stenglinstraße 2, 86156, Augsburg, Deutschland
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7
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Armbrust KR, Ailani S, Berkenstock MK. Preoperative Glycemic Control and Acute Endophthalmitis after Cataract Surgery in United States Veterans with Diabetes Mellitus. Ophthalmology 2025:S0161-6420(25)00186-1. [PMID: 40122400 DOI: 10.1016/j.ophtha.2025.03.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2024] [Revised: 03/01/2025] [Accepted: 03/17/2025] [Indexed: 03/25/2025] Open
Abstract
PURPOSE To evaluate whether preoperative glycemic control is predictive of acute endophthalmitis after cataract surgery. DESIGN Retrospective case-control study. PARTICIPANTS Patients with diabetes mellitus (DM) who underwent cataract surgery from 2010 through 2022 in the United States Veterans Affairs (VA) Health Care System. METHODS Data extracted from the VA Corporate Data Warehouse included patient demographics, clinical features, timing of DM diagnosis, and preoperative hemoglobin A1c (HbA1c) levels drawn 0 to 6 months before surgery. Patients with acute postoperative endophthalmitis were identified using Current Procedural Terminology and International Classification of Diseases codes, then confirmed by chart review. Univariable and multivariable analyses were used to test for an association between preoperative HbA1c and the development of postoperative endophthalmitis. MAIN OUTCOME MEASURES Development of postoperative endophthalmitis within 42 days after cataract surgery. RESULTS Of 190 393 patients with a diagnosis of DM at the time of cataract surgery and HbA1c recorded 0 to 6 months before surgery, 157 patients (0.08%) demonstrated acute postoperative endophthalmitis. Mean ± standard deviation preoperative HbA1c was lower in patients with acute postoperative endophthalmitis (7.1 ± 1.4%) than in control participants without endophthalmitis (7.3 ± 1.5%), but this difference was not significant (P = 0.14). Similarly, subanalysis of the cohort with HbA1c levels drawn 0 to 2 months before surgery showed no association between preoperative HbA1c and endophthalmitis (P = 0.31). Multiple logistic regression analysis also showed no association between preoperative glycemic control as measured by HbA1c and postoperative endophthalmitis (adjusted odds ratio, 0.89; 95% confidence interval, 0.79-1.01; P = 0.08). CONCLUSIONS Preoperative HbA1c level was not associated with the development of acute postoperative endophthalmitis in patients with DM undergoing cataract surgery. These findings suggest that preoperative HbA1c guidelines based on infection rates after nonophthalmic surgery may not apply to cataract surgery. FINANCIAL DISCLOSURE(S) Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.
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Affiliation(s)
- Karen R Armbrust
- Department of Ophthalmology, Minneapolis Veterans Affairs Health Care System, Minneapolis, Minnesota; Department of Ophthalmology and Visual Neurosciences, University of Minnesota, Minneapolis, Minnesota.
| | - Sanya Ailani
- Drexel University College of Medicine, Philadelphia, Pennsylvania
| | - Meghan K Berkenstock
- Drexel University College of Medicine, Philadelphia, Pennsylvania; Ocular Immunology Division, Wilmer Eye Institute, Johns Hopkins School of Medicine, Baltimore, Maryland
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Mihailescu AA, Gradinaru S, Kraft A, Blendea CD, Capitanu BS, Neagu SI. Enhanced rehabilitation after surgery: principles in the treatment of emergency complicated colorectal cancers - a narrative review. J Med Life 2025; 18:179-187. [PMID: 40291936 PMCID: PMC12022730 DOI: 10.25122/jml-2025-0049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2025] [Accepted: 03/24/2025] [Indexed: 04/30/2025] Open
Abstract
Enhanced Recovery After Surgery (ERAS) protocols are used in elective colorectal surgeries and have shown improved recovery for many patients. However, using these protocols in emergency colorectal surgery, especially in complicated cases of obstructive colorectal cancer, is still debated. This review examined the ERAS principles that can be adapted for emergencies. We reviewed the literature on applying ERAS principles in emergency colorectal cancer surgery. We analyzed key strategies used before, during, and after surgery. The aim of ERAS in emergency colorectal surgery is to reduce physical stress from urgent surgical conditions. Before surgery, the focus should be on early patient recovery, managing blood sugar levels, and providing patient education when possible. Minimally invasive techniques, careful fluid management, and effective pain relief during surgery are intraoperative key points. After surgery, early feeding, patient mobilization, and minimizing the use of medical devices are encouraged. Studies have shown that using ERAS in emergencies can lower mortality, reduce hospital stays, and influence patient recovery rates, although it may lead to higher initial costs. Still, following ERAS in emergencies is inconsistent due to logistical issues and patient health changes. More people are starting to recognize the benefits of ERAS in obstructive colorectal cancer surgery. Although there is less evidence compared to elective procedures, new studies suggest that organized steps for care can improve patient outcomes. Further research is needed to improve ERAS emergency protocols and identify patients suitable for this approach so that healthcare resources can be used better.
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Key Words
- APACHE II, Acute Physiology and Chronic Health Evaluation
- ASA, American Society of Anesthesiologists
- ELPQuiC, Emergency Laparotomy Pathway Quality Improvement Care
- ERAS, Enhanced Recovery After Surgery
- GDFT, Goal-Directed Fluid Therapy
- MAP, Mean Arterial Pressure
- NGT, Nasogastric Tube
- P-POSSUM, Portsmouth-POSSUM
- PECS, Pectoral Nerve Block
- PONV, Postoperative Nausea and Vomiting
- POSSUM, Physiological and Operative Severity Score for the Enumeration of Mortality
- SIRS, Systemic Inflammatory Response Syndrome
- SSR, Surgical Stress Response
- TAP, Transversus Abdominis Plane
- complicated colorectal cancer
- emergency colorectal surgery
- multimodal rehabilitation
- perioperative care
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Affiliation(s)
- Alexandra-Ana Mihailescu
- Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
- Department of Anesthesiology and Critical Care, Foisor Clinical Hospital of Orthopedics, Traumatology, and Osteoarticular Tuberculosis, Bucharest, Romania
| | - Sebastian Gradinaru
- Faculty of Medicine, Titu Maiorescu University, Bucharest, Romania
- Department of General Surgery, Ilfov County Emergency Clinical Hospital, Bucharest, Romania
| | - Alin Kraft
- Department of General Surgery, General Doctor Aviator Victor Atanasiu National Aviation and Space Medicine Institute, Bucharest, Romania
- Department of Medical-Surgical and Prophylactic Disciplines, Faculty of Medicine, Titu Maiorescu University, Bucharest, Romania
| | - Corneliu-Dan Blendea
- Faculty of Medicine, Titu Maiorescu University, Bucharest, Romania
- Department of Recovery, Physical Medicine and Balneology, Ilfov County Emergency Clinical Hospital, Bucharest, Romania
| | - Bogdan-Sorin Capitanu
- Department of Orthopedics, Foisor Clinical Hospital of Orthopedics, Traumatology and Osteoarticular Tuberculosis, Bucharest, Romania
| | - Stefan Ilie Neagu
- Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
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9
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Aung NL. Random Blood Glucose: Episode 1. Clin Diabetes 2025; 43:317-321. [PMID: 40290826 PMCID: PMC12018998 DOI: 10.2337/cd25-0016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2025] [Accepted: 01/31/2025] [Indexed: 04/30/2025]
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Kurtoglu P, Iyigun E, Sonmez A, Can MF. Effects of Perioperative Glycemic Management Protocol on Glycemic Outcomes of Type 2 Diabetic Patients Undergoing Major Abdominal Surgery: A Prospective Cohort Study. J Perianesth Nurs 2025; 40:35-44. [PMID: 38904600 DOI: 10.1016/j.jopan.2024.02.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2023] [Revised: 02/02/2024] [Accepted: 02/24/2024] [Indexed: 06/22/2024]
Abstract
PURPOSE This study aimed to reveal the effects of a glycemic control protocol directed by nurses during the perioperative period on glycemic outcomes in diabetic patients undergoing major abdominal surgery. DESIGN This was a prospective cohort study METHODS: The study was conducted at the Department of General Surgery of a research and training hospital in Turkey. The study included 47 patients with type 2 diabetes mellitus who underwent elective major abdominal surgery between September 2017 and December 2018. The number of patients in the intervention and the control groups was 22 and 25, respectively. Routine clinical glycemic control was implemented in the control group, whereas a glycemic management protocol developed by a multidisciplinary team was implemented in the intervention group. We collected data on the control group first, followed by the introduction of the glycemic management protocol to clinical staff and glycemia data collection using the new protocol. Blood glucose (BG) levels in patients and the factors that may affect BG were measured in the preoperative, intraoperative, and postoperative periods. Data on glycemic control was also collected. Furthermore, we measured the satisfaction of the nurses implementing the glycemic management protocol. FINDINGS The rate of hyperglycemia in intensive care unit was 21% in the intervention group and 59% in the control group (P < .05). Time spent in the target BG range during insulin infusion was 76% in the intervention group and 35% in the control group (P < .05). The time required to achieve target BG range during insulin infusion was 6 hours for the intervention group and 15 hours for the control group, indicating that less time was required to achieve the target BG range in the intervention group (P < .05). Moreover, the insulin consumption rate in the intensive care unit was lower in the intervention group (P < .05). The satisfaction levels of the nurses that used the glycemic management protocol was 92.61 ± 7.93%. CONCLUSIONS Results of this study showed that the implementation of a glycemic management protocol by nurses for patients undergoing major abdominal surgery decreases the rate of hyperglycemia, insulin consumption rate, and the time required to achieve the targeted BG range during the perioperative period. Therefore, it is recommended to use a glycemia management protocol to control glycemia in patients during the surgical process.
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Affiliation(s)
- Pervin Kurtoglu
- Department of General Surgery, Gulhane Training and Research Hospital, Ankara, Turkey.
| | - Emine Iyigun
- Gulhane Faculty of Nursing, University of Health Sciences, Turkey
| | - Alper Sonmez
- Department of Endocrinology and Metabolism, Ankara Guven Hospital, Ankara, Turkey
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Lepage MA, Lecavalier A, Baldini G, Sun NZ, Bessissow A. Preoperative risk assessment and optimization integrating surgical and anesthetic principles and practices: a national survey for internists. Perioper Med (Lond) 2025; 14:6. [PMID: 39806463 PMCID: PMC11727565 DOI: 10.1186/s13741-024-00489-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2024] [Accepted: 12/28/2024] [Indexed: 01/16/2025] Open
Abstract
BACKGROUND The integration of procedure-specific risks into preoperative patient assessment and optimization are crucial aspects of perioperative care. However, data on internists' knowledge of surgical and anesthetic principles and practices are limited. We thus sought to identify internists' knowledge gaps in terms of surgical- and anesthetic-specific risk factors and characteristics. METHODS An open and voluntary e-survey was conducted via LimeSurvey between April and July 2021 to evaluate Canadian internists' knowledge of surgical and anesthetic principles and practices. The survey included the perceived importance and knowledge of several key surgical and anesthetic aspects, such as surgery duration, procedure-specific cardiac risk, bleeding risk, and thrombotic risk. It also assessed pre- and post-survey self-reported confidence levels in one's knowledge of these characteristics. Finally, we investigated how internists optimize some of the preoperative risks. RESULTS A total of 173 Canadian internists opened the survey link, and 121 completed it (completion rate 70%). While the majority of respondents considered surgical and anesthetic principles and practices as important, most identified knowledge gaps. Participants generally estimated surgery duration and procedure-specific cardiac risk adequately. However, they tended to underestimate procedure-specific bleeding risk for general (58%) and orthopedic (76%) surgeries and to overestimate procedure-specific thrombotic risk for vascular (63%) and genitourinary (60%) surgeries. Furthermore, there is a lack of consensus regarding the appropriate hemoglobin A1c target and 0% of respondents reported using the guideline-suggested hemoglobin threshold for investigation and intervention. CONCLUSIONS Overall, our findings identify significant knowledge gaps among Canadian internists in preoperative assessment of procedure-specific risk factors and can be used to inform both the development of educational initiatives and future research to improve the quality of preoperative patient care.
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Affiliation(s)
- Marc-Antoine Lepage
- Faculty of Medicine and Health Sciences, McGill University, Montreal, Canada
| | - Annie Lecavalier
- Centre Intégré de Santé Et de Services Sociaux de Laval, Laval, Canada
| | - Gabriele Baldini
- Faculty of Medicine and Health Sciences, McGill University, Montreal, Canada
- Department of Anaesthesia, McGill University Health Centre, Montreal, Canada
| | - Ning-Zi Sun
- Faculty of Medicine and Health Sciences, McGill University, Montreal, Canada
- Division of General Internal Medicine, Department of Medicine, McGill University Health Centre, Montreal, Canada
- Institute of Health Sciences Education, McGill University, Montreal, Canada
| | - Amal Bessissow
- Faculty of Medicine and Health Sciences, McGill University, Montreal, Canada.
- Division of General Internal Medicine, Department of Medicine, McGill University Health Centre, Montreal, Canada.
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12
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Cruz P, McKee AM, Chiang HH, McGill JB, Hirsch IB, Ringenberg K, Wildes TS. Perioperative Care of Patients Using Wearable Diabetes Devices. Anesth Analg 2025; 140:2-12. [PMID: 38913575 DOI: 10.1213/ane.0000000000007115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/26/2024]
Abstract
The increasing prevalence of diabetes mellitus has been accompanied by a rapid expansion in wearable continuous glucose monitoring (CGM) devices and insulin pumps. Systems combining these components in a "closed loop," where interstitial glucose measurement guides automated insulin delivery (AID, or closed loop) based on sophisticated algorithms, are increasingly common. While these devices' efficacy in achieving near-normoglycemia is contributing to increasing usage among patients with diabetes, the management of these patients in operative and procedural environments remains understudied with limited published guidance available, particularly regarding AID systems. With their growing prevalence, practical management advice is needed for their utilization, or for the rational temporary substitution of alternative diabetes monitoring and treatments, during surgical care. CGM devices monitor interstitial glucose in real time; however, there are potential limitations to use and accuracy in the perioperative period, and, at the present time, their use should not replace regular point-of-care glucose monitoring. Avoiding perioperative removal of CGMs when possible is important, as removal of these prescribed devices can result in prolonged interruptions in CGM-informed treatments during and after procedures, particularly AID system use. Standalone insulin pumps provide continuous subcutaneous insulin delivery without automated adjustments for glucose concentrations and can be continued during some procedures. The safe intraoperative use of AID devices in their hybrid closed-loop mode (AID mode) requires the CGM component of the system to continue to communicate valid blood glucose data, and thus introduces the additional need to ensure this portion of the system is functioning appropriately to enable intraprocedural use. AID devices revert to non-AID insulin therapy modes when paired CGMs are disconnected or when the closed-loop mode is intentionally disabled. For patients using insulin pumps, we describe procedural factors that may compromise CGM, insulin pump, and AID use, necessitating a proactive transition to an alternative insulin regimen. Procedure duration and invasiveness is an important factor as longer procedures increase the risk of stress hyperglycemia, tissue malperfusion, and device malfunction. Whether insulin pumps should be continued through procedures, or substituted by alternative insulin delivery methods, is a complex decision that requires all parties to understand potential risks and contingency plans relating to patient and procedural factors. Currently available CGMs and insulin pumps are reviewed, and practical recommendations for safe glycemic management during the phases of perioperative care are provided.
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Affiliation(s)
- Paulina Cruz
- From the Division of Endocrinology, Metabolism & Lipid Research, Department of Medicine, Washington University in St Louis School of Medicine, St Louis, Missouri
| | - Alexis M McKee
- From the Division of Endocrinology, Metabolism & Lipid Research, Department of Medicine, Washington University in St Louis School of Medicine, St Louis, Missouri
| | - Hou-Hsien Chiang
- Division of Metabolism, Endocrinology and Nutrition, Department of Medicine, University of Washington School of Medicine, University of Washington, Seattle, Washington
| | - Janet B McGill
- From the Division of Endocrinology, Metabolism & Lipid Research, Department of Medicine, Washington University in St Louis School of Medicine, St Louis, Missouri
| | - Irl B Hirsch
- Division of Metabolism, Endocrinology and Nutrition, Department of Medicine, University of Washington School of Medicine, University of Washington, Seattle, Washington
| | - Kyle Ringenberg
- Department of Anesthesiology, University of Nebraska Medical Center, Omaha, Nebraska
| | - Troy S Wildes
- Department of Anesthesiology, University of Nebraska Medical Center, Omaha, Nebraska
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Taylor JS, Fellman B, Cain KE, Iniesta MD, Earles T, Harris M, James D, Siebel C, Lasala J, Mena G, Raty S, Popovich S, Vu K, Thosani S, Best C, Schmeler KM, Ramirez PT, Meyer LA. Glycemic control to improve post-operative outcomes in patients with type 2 diabetes mellitus: Results of the SUGAR (Surgical Universal euGlycemic Attainment during Recovery) initiative. Int J Gynecol Cancer 2025; 35:100003. [PMID: 39878292 DOI: 10.1016/j.ijgc.2024.100003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2024] [Accepted: 10/30/2024] [Indexed: 01/31/2025] Open
Abstract
OBJECTIVE Hyperglycemia, or glucose values >180 mg/dL, is associated with adverse post-operative outcomes. Our objective was to determine the impact of improving peri-operative glycemic control and evaluate infectious complications among patients with type 2 diabetes mellitus undergoing open gynecologic surgery. METHODS A multidisciplinary team standardized pre-operative screening, referral algorithms, and intra-operative and post-operative hyperglycemia management (Surgical Universal euGlycemic Attainment during Recovery initiative). We compared outcomes between a baseline cohort (March 2016-December 2017) and an intervention cohort (February 2018-August 2022). Patients with type 1 diabetes, and planned minimally invasive, multi-team, or emergency surgery were excluded. Clinical and demographic characteristics were compared using the χ2 test, Fisher exact test, t test, or Wilcoxon rank-sum test, and generalized linear mixed models were used with a logit link function. All statistical analyses were performed using Stata/MP v17.0 (College Station, StataCorp). RESULTS We assessed 103 baseline patients and 167 intervention patients with diabetes. In the baseline cohort, 26 patients (25%) had hemoglobin A1C screened prior to surgery compared with 158 (95%) in the intervention cohort (p < .001). All surgical patients were screened for diabetes to determine eligibility, and we tracked the rate of patients newly diagnosed with type 2 diabetes (18 patients or 11%). The percentages of glucose values ≤180 mg/dL pre-operatively or intra-operatively were similar between cohorts, but the intervention cohort had increased compliance with assessing glucose intra-operatively (84% compared with 55%, p < .001). The percentage of post-operative glucose values ≤180 mg/dL increased from 77% in the baseline cohort to 86% in the intervention cohort (p = .002). The average post-operative glucose value was 10 mg/dL lower in the intervention cohort than in the baseline cohort (p = .005). Rates of surgical site infection, pneumonia, and urinary tract infection were similar between cohorts. CONCLUSION Our initiative improved compliance with pre-operative glycemic screening and decreased hyperglycemia among diabetic patients. We did not identify the correlation between glycemic control and infectious complications.
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Affiliation(s)
- Jolyn S Taylor
- The University of Texas MD Anderson Cancer Center, Department of Gynecologic Oncology and Reproductive Medicine, Houston, TX, USA.
| | - Bryan Fellman
- The University of Texas MD Anderson Cancer Center, Department of Biostatistics, Houston, TX, USA
| | - Katherine E Cain
- The University of Texas MD Anderson Cancer Center, Department of Pharmacy Clinical Programs, Houston, TX, USA
| | - Maria D Iniesta
- The University of Texas MD Anderson Cancer Center, Department of Gynecologic Oncology and Reproductive Medicine, Houston, TX, USA
| | - Terri Earles
- The University of Texas MD Anderson Cancer Center, Department of Gynecologic Oncology and Reproductive Medicine, Houston, TX, USA
| | - Melinda Harris
- The University of Texas MD Anderson Cancer Center, Department of Gynecologic Oncology and Reproductive Medicine, Houston, TX, USA
| | - Deepthi James
- The University of Texas MD Anderson Cancer Center, Department of Gynecologic Oncology and Reproductive Medicine, Houston, TX, USA
| | - Christine Siebel
- The University of Texas MD Anderson Cancer Center, Department of Clinical Nutrition, Houston, TX, USA
| | - Javier Lasala
- The University of Texas MD Anderson Cancer Center, Department of Anesthesiology and Peri-operative Medicine, Houston, TX, USA
| | - Gabriel Mena
- The University of Texas MD Anderson Cancer Center, Department of Anesthesiology and Peri-operative Medicine, Houston, TX, USA
| | - Sally Raty
- The University of Texas MD Anderson Cancer Center, Department of Anesthesiology and Peri-operative Medicine, Houston, TX, USA
| | - Shannon Popovich
- The University of Texas MD Anderson Cancer Center, Department of Anesthesiology and Peri-operative Medicine, Houston, TX, USA
| | - Khanh Vu
- The University of Texas MD Anderson Cancer Center, Department of General Internal Medicine, Houston, TX, USA
| | - Sonali Thosani
- The University of Texas MD Anderson Cancer Center, Department of Endocrinology, Houston, TX, USA
| | - Conor Best
- The University of Texas MD Anderson Cancer Center, Department of Endocrinology, Houston, TX, USA
| | - Kathleen M Schmeler
- The University of Texas MD Anderson Cancer Center, Department of Gynecologic Oncology and Reproductive Medicine, Houston, TX, USA
| | - Pedro T Ramirez
- Houston Methodist Hospital Neal Cancer Center, Department of Obstetrics and Gynecology, Houston, TX, USA
| | - Larissa A Meyer
- The University of Texas MD Anderson Cancer Center, Department of Gynecologic Oncology and Reproductive Medicine, Houston, TX, USA
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14
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Gohel P, Lavadi RS, Jawad-Makki MAH, Kumar RP, Waheed AA, Elkaim LM, Jaikumar V, Alan N, Buell TJ, Pennicooke B, Hamilton DK, Agarwal N. Comprehensive guidelines for prehabilitation in spine surgery. JOURNAL OF CRANIOVERTEBRAL JUNCTION AND SPINE 2025; 16:5-15. [PMID: 40292172 PMCID: PMC12029390 DOI: 10.4103/jcvjs.jcvjs_209_24] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2024] [Accepted: 01/24/2025] [Indexed: 04/30/2025] Open
Abstract
Study Design Literature review. Objectives Review prehabilitation techniques used for elective spine surgery to create a comprehensive list of recommendations. Methods A systematic review was performed using the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines by searching three electronic databases from 1997 to 2021. Pertinent literature reporting information on prehabilitation, applicable to spine surgery, was identified. Seventy studies were selected for further analysis. Findings from the literature were reinforced by practices employed by the authors. Results Preoperative smoking cessation should be achieved 3-4 weeks before elective spine surgery. Preoperative weight loss programs to reach a goal BMI <35 kg/m2 may be a viable solution to minimize wound complications and surgical site infections. To minimize the negative impact of cardiopulmonary comorbidities, patients can enroll in an exercise program prior to surgery. Patients should abstain from alcohol before elective spine surgery. Patients with osteoporosis may benefit from supplementation with Vitamin D, calcium, and parathyroid hormone. Opioids should be weaned to complete cessation 6-8 weeks before surgery. Preoperative cognitive behavioral therapy (CBT) and education seem to be the most beneficial in reducing complications associated with psychiatric comorbidities. Patients should engage in a comprehensive prehabilitation regimen. Conclusion Targeting patient risk factors with personalized interventions can improve postoperative outcomes in patients undergoing elective spine surgery.
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Affiliation(s)
- Paulomi Gohel
- Department of Neurosurgery, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Raj Swaroop Lavadi
- Department of Neurosurgery, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | | | - Rohit Prem Kumar
- Department of Neurosurgery, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Ayesha Akbar Waheed
- Department of Neurosurgery, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Lior M. Elkaim
- Department of Neurology and Neurosurgery, McGill University, Montreal, Quebec, Canada
| | - Vinay Jaikumar
- Department of Neurosurgery, University at Buffalo, Buffalo, NY, USA
| | - Nima Alan
- Department of Neurosurgery, University of California, San Francisco, CA, USA
| | - Thomas J. Buell
- Department of Neurosurgery, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Brenton Pennicooke
- Department of Neurosurgery, Washington University School of Medicine, St. Louis, MO, USA
| | - D. Kojo Hamilton
- Department of Neurosurgery, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Nitin Agarwal
- Department of Neurosurgery, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
- Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
- Department of Neurological Surgery, Veterans Affairs Pittsburgh Healthcare System, Pittsburgh, PA, USA
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15
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American Diabetes Association Professional Practice Committee, ElSayed NA, McCoy RG, Aleppo G, Balapattabi K, Beverly EA, Briggs Early K, Bruemmer D, Echouffo-Tcheugui JB, Ekhlaspour L, Galindo RJ, Garg R, Khunti K, Lal R, Lingvay I, Matfin G, Pandya N, Pekas EJ, Pilla SJ, Polsky S, Segal AR, Seley JJ, Stanton RC, Bannuru RR. 16. Diabetes Care in the Hospital: Standards of Care in Diabetes-2025. Diabetes Care 2025; 48:S321-S334. [PMID: 39651972 PMCID: PMC11635037 DOI: 10.2337/dc25-s016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2024]
Abstract
The American Diabetes Association (ADA) "Standards of Care in Diabetes" includes the ADA's current clinical practice recommendations and is intended to provide the components of diabetes care, general treatment goals and guidelines, and tools to evaluate quality of care. Members of the ADA Professional Practice Committee, an interprofessional expert committee, are responsible for updating the Standards of Care annually, or more frequently as warranted. For a detailed description of ADA standards, statements, and reports, as well as the evidence-grading system for ADA's clinical practice recommendations and a full list of Professional Practice Committee members, please refer to Introduction and Methodology. Readers who wish to comment on the Standards of Care are invited to do so at professional.diabetes.org/SOC.
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16
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Gianchandani R, Wei M, Demidowich A. Management of Hyperglycemia in Hospitalized Patients. Ann Intern Med 2024; 177:ITC177-ITC192. [PMID: 39652876 DOI: 10.7326/annals-24-02754] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2024] Open
Abstract
People with diabetes account for 25% of hospitalizations, or 8 million admissions annually. Poor glycemic control in the hospital is associated with increased morbidity, mortality, length of stay, and readmissions. Key considerations of inpatient diabetes management include initiation of appropriate insulin or medication regimens and frequent dose adjustments based on patient-specific factors. Inpatient diabetes management teams and new technologies are increasingly prevalent and can assist in achieving glycemic targets in the hospital. At discharge, standardized checklists should be used to ensure successful transitions of care.
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Affiliation(s)
- Roma Gianchandani
- Division of Endocrinology, Diabetes, and Metabolism, Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, California (R.G., M.W.)
| | - Margaret Wei
- Division of Endocrinology, Diabetes, and Metabolism, Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, California (R.G., M.W.)
| | - Andrew Demidowich
- Division of Endocrinology, Diabetes, and Metabolism, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland (A.D.)
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Rea A, Salenger R, Grant MC, Yeh J, Damas B, Crisalfi C, Arora R, Gregory AJ, Morton-Bailey V, Engelman DT. Preoperative medication management turnkey order set for nonemergent adult cardiac surgery. JTCVS OPEN 2024; 22:1-13. [PMID: 39780789 PMCID: PMC11704528 DOI: 10.1016/j.xjon.2024.06.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/05/2024] [Revised: 05/25/2024] [Accepted: 06/10/2024] [Indexed: 01/11/2025]
Abstract
Objective The management of preoperative medications is an essential component of perioperative care for the cardiac surgical patient. This turnkey order set is part of a series created by the Enhanced Recovery After Surgery Cardiac Society, first presented at the Annual Meeting of The American Association for Thoracic Surgery in 2023. Numerous guidelines and expert consensus documents have been published to provide guidance in preoperative medication management. Our objective is to integrate these documents into an evidence-based order set that will facilitate standardized implementation of best practices for preoperative medication management for nonemergent adult cardiac surgery. Methods Subject matter experts were consulted to translate existing guidelines and peer reviewed literature into a sample turnkey order set for the preoperative management of patients' medications. Orders derived from consistent Class I, IIA, or equivalent recommendations across referenced guidelines and consensus manuscripts appear in the order set in bold type. Selected orders that were inconsistently Class I or IIA, Class IIB, or supported by published evidence, were also included in italicized type. Results Holding antiplatelet and anticoagulant medications before nonemergent cardiac surgical procedures may reduce the risk of bleeding. Sodium-glucose co-transporter-2 inhibitors and glucagon-like peptide-1 agonists should also be discontinued to prevent acidosis and aspiration, respectively. Specific guidance for frequently used medications are complied within the manuscript, less frequently used medications are listed seperately. Conclusions Despite strong recommendations from major guidelines and consensus manuscripts, variation exists in preoperative medication orders, with limited availability of succinct implementation tools. This turnkey order set may facilitate standardized comprehensive preoperative medication management before nonemergent cardiac surgery.
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Affiliation(s)
- Amanda Rea
- Division of Cardiac Surgery, University of Maryland St Joseph Medical Center, Towson, Md
| | - Rawn Salenger
- Division of Cardiac Surgery, University of Maryland St Joseph Medical Center, Towson, Md
- Department of Surgery, University of Maryland School of Medicine, Baltimore, Md
| | - Michael C. Grant
- Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University, School of Medicine, Baltimore, Md
| | - Jennifer Yeh
- Division of Cardiac Surgery, University of Maryland St Joseph Medical Center, Towson, Md
| | - Barbara Damas
- Heart & Vascular Program, Baystate Health, University of Massachusetts Chan Medical School-Baystate, Springfield, Mass
| | - Cheryl Crisalfi
- Heart & Vascular Program, Baystate Health, University of Massachusetts Chan Medical School-Baystate, Springfield, Mass
| | - Rakesh Arora
- Department of Surgery, Division of Cardiac Surgery, Harrington Heart and Vascular, Institute, University Hospitals, Case Western Reserve University, Cleveland, Ohio
| | - Alexander J. Gregory
- Department of Anesthesiology, Cumming School of Medicine & Libin Cardiovascular Institute, University of Calgary, Calgary, Alberta, Canada
| | | | - Daniel T. Engelman
- Heart & Vascular Program, Baystate Health, University of Massachusetts Chan Medical School-Baystate, Springfield, Mass
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Komurcu O, Genc C, Kurt BC, Demir O, Akbaş A, Akyurt D, Kuşderci HS, Tulgar S, Süren M. Preoperative evaluation: Impact on early perioperative hemodynamic and respiratory complications. BMC Anesthesiol 2024; 24:435. [PMID: 39604844 PMCID: PMC11600558 DOI: 10.1186/s12871-024-02821-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2024] [Accepted: 11/18/2024] [Indexed: 11/29/2024] Open
Abstract
BACKGROUND The impact of routine preoperative anesthesia evaluations on potential perioperative complications remains unclear. This study aimed to investigate the effect of preoperative evaluation on early perioperative hemodynamic and respiratory complications. METHODS This prospective observational study analyzed data from patients aged 18 to 80 who underwent elective surgery between October 15, 2023, and February 15, 2024. The study evaluated the effect of preoperative anesthesia evaluation on hemodynamic and respiratory complications occurring during surgery and within the first 24 h postoperatively, as well as its impact on the length of hospital stay. RESULTS The analysis included 1117 patients for whom complete data was available. Hemodynamic and respiratory complications were observed in 545 patients (48.7%), occurring within the first 24 h intraoperatively and postoperatively. Because no additional examinations beyond routine blood tests, radiological imaging, and electrocardiograms were performed in the preoperative period, the impact of these tests on the development of hemodynamic and respiratory complications could not be determined. There was no statistically significant association between the presence or absence of preoperative consultation and the occurrence of early perioperative hemodynamic and respiratory complications [OR (95% CI): 0.879 (0.646-1.195); P = 0.411], nor did it affect the length of hospital stay [median (IQR); 2 (3) vs. 2 (3); P = 0.245]. CONCLUSION While the impact of routinely requested laboratory and imaging methods before surgery could not be assessed in this study, consultations that were requested did not affect hemodynamic and respiratory complications in the early perioperative period or on the duration of hospital stay. TRIAL REGISTRATION NUMBER Samsun University Samsun Training and Research Hospital, following ethics committee approval (Samsun University clinical research ethics committee (KAEK) 2.12.2023) and Clinical Trials (NCT06203171 / 04.18.2024) registration.
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Affiliation(s)
- Ozgür Komurcu
- Faculty of Medicine, Department of Anesthesiology and Reanimation, Samsun University, Samsun, Turkey
| | - Caner Genc
- Faculty of Medicine, Department of Anesthesiology and Reanimation, Samsun University, Samsun, Turkey
| | - Betül Ciftci Kurt
- Faculty of Medicine, Department of Anesthesiology and Reanimation, Samsun University, Samsun, Turkey
| | - Olcay Demir
- Faculty of Medicine, Department of Anesthesiology and Reanimation, Samsun University, Samsun, Turkey
| | - Asuman Akbaş
- Faculty of Medicine, Department of Anesthesiology and Reanimation, Samsun University, Samsun, Turkey
| | - Dilan Akyurt
- Faculty of Medicine, Department of Anesthesiology and Reanimation, Samsun University, Samsun, Turkey
| | - Hatice Selçuk Kuşderci
- Faculty of Medicine, Department of Anesthesiology and Reanimation, Samsun University, Samsun, Turkey
| | - Serkan Tulgar
- Faculty of Medicine, Department of Anesthesiology and Reanimation, Samsun University, Samsun, Turkey
| | - Mustafa Süren
- Faculty of Medicine, Department of Anesthesiology and Reanimation, Samsun University, Samsun, Turkey.
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19
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Thompson A, Fleischmann KE, Smilowitz NR, de Las Fuentes L, Mukherjee D, Aggarwal NR, Ahmad FS, Allen RB, Altin SE, Auerbach A, Berger JS, Chow B, Dakik HA, Eisenstein EL, Gerhard-Herman M, Ghadimi K, Kachulis B, Leclerc J, Lee CS, Macaulay TE, Mates G, Merli GJ, Parwani P, Poole JE, Rich MW, Ruetzler K, Stain SC, Sweitzer B, Talbot AW, Vallabhajosyula S, Whittle J, Williams KA. 2024 AHA/ACC/ACS/ASNC/HRS/SCA/SCCT/SCMR/SVM Guideline for Perioperative Cardiovascular Management for Noncardiac Surgery: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. Circulation 2024; 150:e351-e442. [PMID: 39316661 DOI: 10.1161/cir.0000000000001285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/26/2024]
Abstract
AIM The "2024 AHA/ACC/ACS/ASNC/HRS/SCA/SCCT/SCMR/SVM Guideline for Perioperative Cardiovascular Management for Noncardiac Surgery" provides recommendations to guide clinicians in the perioperative cardiovascular evaluation and management of adult patients undergoing noncardiac surgery. METHODS A comprehensive literature search was conducted from August 2022 to March 2023 to identify clinical studies, reviews, and other evidence conducted on human subjects that were published in English from MEDLINE (through PubMed), EMBASE, the Cochrane Library, the Agency for Healthcare Research and Quality, and other selected databases relevant to this guideline. STRUCTURE Recommendations from the "2014 ACC/AHA Guideline on Perioperative Cardiovascular Evaluation and Management of Patients Undergoing Noncardiac Surgery" have been updated with new evidence consolidated to guide clinicians; clinicians should be advised this guideline supersedes the previously published 2014 guideline. In addition, evidence-based management strategies, including pharmacological therapies, perioperative monitoring, and devices, for cardiovascular disease and associated medical conditions, have been developed.
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Affiliation(s)
| | | | | | - Lisa de Las Fuentes
- Former ACC/AHA Joint Committee on Clinical Practice Guidelines member; current member during the writing effort
| | | | | | | | | | | | | | | | - Benjamin Chow
- Society of Cardiovascular Computed Tomography representative
| | | | | | | | | | | | | | | | | | | | | | - Purvi Parwani
- Society for Cardiovascular Magnetic Resonance representative
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20
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Thompson A, Fleischmann KE, Smilowitz NR, de Las Fuentes L, Mukherjee D, Aggarwal NR, Ahmad FS, Allen RB, Altin SE, Auerbach A, Berger JS, Chow B, Dakik HA, Eisenstein EL, Gerhard-Herman M, Ghadimi K, Kachulis B, Leclerc J, Lee CS, Macaulay TE, Mates G, Merli GJ, Parwani P, Poole JE, Rich MW, Ruetzler K, Stain SC, Sweitzer B, Talbot AW, Vallabhajosyula S, Whittle J, Williams KA. 2024 AHA/ACC/ACS/ASNC/HRS/SCA/SCCT/SCMR/SVM Guideline for Perioperative Cardiovascular Management for Noncardiac Surgery: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. J Am Coll Cardiol 2024; 84:1869-1969. [PMID: 39320289 DOI: 10.1016/j.jacc.2024.06.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/26/2024]
Abstract
AIM The "2024 AHA/ACC/ACS/ASNC/HRS/SCA/SCCT/SCMR/SVM Guideline for Perioperative Cardiovascular Management for Noncardiac Surgery" provides recommendations to guide clinicians in the perioperative cardiovascular evaluation and management of adult patients undergoing noncardiac surgery. METHODS A comprehensive literature search was conducted from August 2022 to March 2023 to identify clinical studies, reviews, and other evidence conducted on human subjects that were published in English from MEDLINE (through PubMed), EMBASE, the Cochrane Library, the Agency for Healthcare Research and Quality, and other selected databases relevant to this guideline. STRUCTURE Recommendations from the "2014 ACC/AHA Guideline on Perioperative Cardiovascular Evaluation and Management of Patients Undergoing Noncardiac Surgery" have been updated with new evidence consolidated to guide clinicians; clinicians should be advised this guideline supersedes the previously published 2014 guideline. In addition, evidence-based management strategies, including pharmacological therapies, perioperative monitoring, and devices, for cardiovascular disease and associated medical conditions, have been developed.
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21
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Alzghoul H, Weimer J, Antigua A, Maule G, Ismail MF, Althunibat W, Reddy R, Khan AA, Sher N, Meadows R, Khan A. Optimizing Postoperative Glucose Management in CABG Patients: Exploring Early Transition to Subcutaneous Insulin. J Cardiovasc Dev Dis 2024; 11:348. [PMID: 39590191 PMCID: PMC11594893 DOI: 10.3390/jcdd11110348] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2024] [Revised: 10/11/2024] [Accepted: 10/22/2024] [Indexed: 11/28/2024] Open
Abstract
INTRODUCTION Tight glycemic control is essential for optimal outcomes after coronary artery bypass graft (CABG) surgery, regardless of pre-operative diabetes status. The ideal timing for transitioning from intravenous (IV) to subcutaneous (SC) insulin remains unclear. This study addresses this knowledge gap by comparing the effects of early transition (postoperative day 1, POD1) versus delayed transition on glycemic control and patient outcomes after CABG surgery. METHODS We analyzed data from a single tertiary medical center focusing on patients receiving insulin during their CABG hospitalization between 1 and 31 October 2022. We divided patients into two groups based on their transition timing: (1) Delayed Transition Group, patients transitioned from IV insulin infusion to SC insulin after POD1; and (2) Early Transition Group, patients transitioned on POD1. The primary outcome was the incidence of euglycemia on POD1. Secondary outcomes included rates of maintaining euglycemia from POD1 until POD10 or hospital discharge, hospital length of stay (LOS), ICU LOS, mean glucose levels, rates of hyperglycemia (blood glucose > 180 mg/dL) and hypoglycemia (blood glucose < 70 mg/dL), and rate of restarting IV insulin. Statistical analysis adjusted for BMI and diabetes diagnosis. RESULTS A total of 394 patients were enrolled, with 68 patients (17.3%) in the delayed-transition group and 326 patients (82.7%) in the early-transition group. Majority of the patients were males (74%), with an average age of 67 ± 9 years. Mean HbA1C and creatinine levels were comparable between the two groups. Patients in the early-transition group experienced a shorter ICU and hospital length of stay compared to the delayed-transition group, without a higher risk of restarting IV insulin. CONCLUSIONS Early transition from IV insulin drip to SC insulin on POD1 of CABG surgery reduces ICU and hospital LOS without increasing the risk of transitioning back to IV insulin.
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Affiliation(s)
- Hamza Alzghoul
- Graduate Medical Education, University of Central Florida College of Medicine, Orlando, FL 32816, USA; (H.A.); (G.M.); (M.F.I.); (W.A.)
| | - Joel Weimer
- Department of Pharmacy, HCA Florida North Florida Hospital, Gainesville, FL 32605, USA; (J.W.); (A.A.)
| | - Abigail Antigua
- Department of Pharmacy, HCA Florida North Florida Hospital, Gainesville, FL 32605, USA; (J.W.); (A.A.)
| | - Geran Maule
- Graduate Medical Education, University of Central Florida College of Medicine, Orlando, FL 32816, USA; (H.A.); (G.M.); (M.F.I.); (W.A.)
| | - Mohamed F. Ismail
- Graduate Medical Education, University of Central Florida College of Medicine, Orlando, FL 32816, USA; (H.A.); (G.M.); (M.F.I.); (W.A.)
| | - Ward Althunibat
- Graduate Medical Education, University of Central Florida College of Medicine, Orlando, FL 32816, USA; (H.A.); (G.M.); (M.F.I.); (W.A.)
| | - Raju Reddy
- Division of Pulmonary and Critical Care, Department of Medicine, University of Texas, Austin, TX 78712, USA;
| | - Abdul Ahad Khan
- Division of Pulmonary, Critical Care and Sleep Medicine, University of Arizona College of Medicine-Phoenix, Banner University Medical Center, Phoenix, AZ 85006, USA; (A.A.K.); (N.S.)
| | - Nehan Sher
- Division of Pulmonary, Critical Care and Sleep Medicine, University of Arizona College of Medicine-Phoenix, Banner University Medical Center, Phoenix, AZ 85006, USA; (A.A.K.); (N.S.)
| | - Robyn Meadows
- Graduate Medical Education, HCA Healthcare, Brentwood, TN 37027, USA;
| | - Akram Khan
- Division of Pulmonary, Allergy and Critical Care Medicine, Department of Medicine, Oregon Health and Science University, Portland, OR 97239, USA
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22
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Mendez CE, Shiffermiller JF, Razzeto A, Hannoush Z. Endocrine Care for the Surgical Patient: Diabetes Mellitus, Thyroid and Adrenal Conditions. Med Clin North Am 2024; 108:1185-1200. [PMID: 39341621 DOI: 10.1016/j.mcna.2024.04.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/01/2024]
Abstract
Patients with hyperglycemia, thyroid dysfunction, and adrenal insufficiency face increased perioperative risk, which may be mitigated by appropriate management. This review addresses preoperative glycemic control, makes evidence-based recommendations for the increasingly complex perioperative management of noninsulin diabetes medications, and provides guideline-supported strategies for the perioperative management of insulin, including suggested indications for continuous intravenous insulin. The authors propose a strategy for determining when surgery should be delayed in patients with thyroid dysfunction and present a matrix for managing perioperative stress dose corticosteroids based on the limited evidence available.
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Affiliation(s)
- Carlos E Mendez
- Division of General Internal Medicine, Medical College of Wisconsin, 8701 West Watertown Plank Road, Milwaukee, WI 53226, USA.
| | - Jason F Shiffermiller
- Division of Hospital Medicine, Department of Internal Medicine, University of Nebraska Medical Center, 986435 Nebraska Medical Center, Omaha, NE 68198-6435, USA
| | - Alejandra Razzeto
- Division of Endocrinology, Diabetes and Metabolism, Department of Internal Medicine, University of Miami, Miller School of Medicine, FL 33136, USA
| | - Zeina Hannoush
- Division of Endocrinology, Diabetes and Metabolism, Department of Internal Medicine, University of Miami, Miller School of Medicine, FL 33136, USA
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23
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Razak A, Baburyan S, Lee E, Costa A, Bergese SD. Role of Point-of-Care Gastric Ultrasound in Advancing Perioperative Fasting Guidelines. Diagnostics (Basel) 2024; 14:2366. [PMID: 39518332 PMCID: PMC11545054 DOI: 10.3390/diagnostics14212366] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2024] [Revised: 10/19/2024] [Accepted: 10/21/2024] [Indexed: 11/16/2024] Open
Abstract
Pulmonary aspiration in the perioperative period carries the risk of significant morbidity and mortality. As such, guidelines have been developed with the hopes of minimizing this risk by recommending fasting from solids and liquids over a specified amount of time. Point-of-care ultrasound has altered the landscape of perioperative medicine; specifically, gastric ultrasound plays a pivotal role in perioperative assessment. Further, the advent of glucagon-like-peptide-1 receptor agonists, the widespread use of cannabis, and Enhanced Recovery program carbohydrate beverage presents new challenges when attempting to standardize fasting guidelines. This review synthesizes the literature surrounding perioperative fasting guidelines specifically with regard to the use of point-of-care ultrasound in assessing for gastric contents and minimizing the risk of aspiration.
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Affiliation(s)
- Alina Razak
- Department of Anesthesiology, Stony Brook University Health Science Center, Stony Brook, NY 11794, USA; (A.R.); (A.C.)
| | - Silva Baburyan
- Renaissance School of Medicine, Stony Brook University, Stony Brook, NY 11794, USA; (S.B.); (E.L.)
| | - Esther Lee
- Renaissance School of Medicine, Stony Brook University, Stony Brook, NY 11794, USA; (S.B.); (E.L.)
| | - Ana Costa
- Department of Anesthesiology, Stony Brook University Health Science Center, Stony Brook, NY 11794, USA; (A.R.); (A.C.)
| | - Sergio D. Bergese
- Department of Anesthesiology, Stony Brook University Health Science Center, Stony Brook, NY 11794, USA; (A.R.); (A.C.)
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24
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Goron AR, Connolly C, Valdez-Sinon AN, Hesson A, Helou C, Kirschen GW. Anti-Hyperglycemic Medication Management in the Perioperative Setting: A Review and Illustrative Case of an Adverse Effect of GLP-1 Receptor Agonist. J Clin Med 2024; 13:6259. [PMID: 39458209 PMCID: PMC11509032 DOI: 10.3390/jcm13206259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2024] [Revised: 10/14/2024] [Accepted: 10/18/2024] [Indexed: 10/28/2024] Open
Abstract
A host of anti-hyperglycemic agents are currently available and widely prescribed for diabetes and weight loss management. In patients undergoing surgery, use of these agents poses a clinical challenge to surgeons, anesthesiologists, and other perioperative care providers with regard to optimal timing of discontinuation and resumption of use, as well as possible effects of these agents on physiology and risk of postoperative complications. Here, we provide a comprehensive review of anti-hyperglycemic medications' effects on physiology, risks/benefits, and best practice management in the perioperative setting. Additionally, we report an illustrative case of small bowel obstruction in a patient taking semaglutide for 6 months prior to an otherwise uncomplicated laparoscopic hysterectomy and bilateral salpingo-oophorectomy. This review is meant to serve not as a replacement of, but rather as a consolidated complement to, various society guidelines regarding perioperative anti-hyperglycemic agent management.
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Affiliation(s)
- Abby R. Goron
- Department of Obstetrics and Gynecology, Vanderbilt University Medical Center, Nashville, TN 37232, USA;
| | - Courtney Connolly
- Department of Gynecology and Obstetrics, Johns Hopkins Hospital, Baltimore, MD 21287, USA; (C.C.); (A.N.V.-S.)
| | - Arielle N. Valdez-Sinon
- Department of Gynecology and Obstetrics, Johns Hopkins Hospital, Baltimore, MD 21287, USA; (C.C.); (A.N.V.-S.)
| | - Ashley Hesson
- Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, MI 48109, USA;
| | - Christine Helou
- Department of Obstetrics and Gynecology, Greater Baltimore Medical Center, Towson, MD 21204, USA;
| | - Gregory W. Kirschen
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Pennsylvania, Philadelphia, PA 19104, USA
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Lim HA, Kim M, Kim NJ, Huh J, Jeong JO, Hwang W, Choi H. The Performance of Continuous Glucose Monitoring During the Intraoperative Period: A Scoping Review. J Clin Med 2024; 13:6169. [PMID: 39458119 PMCID: PMC11508367 DOI: 10.3390/jcm13206169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2024] [Revised: 10/12/2024] [Accepted: 10/14/2024] [Indexed: 10/28/2024] Open
Abstract
Introduction: Perioperative dysglycemia is associated with negative surgical outcomes, including increased risk of infections and longer hospital stays. Continuous glucose monitoring (CGM) provides real-time glucose data, potentially improving glycemic control during surgery. However, the performance of CGM in the intraoperative environment has not been well established. This scoping review aimed to evaluate the performance of CGM systems during the intraoperative period, focusing on their technical reliability, accuracy, adverse device effects, and efficacy. Inclusion criteria: Studies that assessed intraoperative CGM performance, focusing on technical reliability, accuracy, adverse effects, or efficacy, were included. No restrictions were placed on the study design, surgical type, participant demographics, or publication date. Methods: A comprehensive literature search was performed using PubMed, EMBASE, and the Cochrane Library, covering publications up to 12 June 2024. Two independent reviewers screened and selected the studies for inclusion based on predefined eligibility criteria. Data extraction focused on the study characteristics, CGM performance, and outcomes. Results: Twenty-two studies were included, the majority of which were prospective cohort studies. CGM systems demonstrated a high technical reliability, with sensor survival rates above 80%. However, the accuracy varied, with some studies reporting mean or median absolute relative differences of over 15%. The adverse effects were minimal and mainly involved minor skin irritation. One randomized trial found no significant difference between CGM and point-of-care glucose monitoring for glycemic control. Conclusions: Although CGM has the potential to improve intraoperative glycemic management, its accuracy remains inconsistent. Future research should explore newer CGM technologies and assess their impact on surgical outcomes.
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Affiliation(s)
- Hyun Ah Lim
- Department of Thoracic and Cardiovascular Surgery, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul 06591, Republic of Korea;
| | - Minjoo Kim
- Department of Anesthesiology and Pain Medicine, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul 06591, Republic of Korea; (M.K.); (J.H.)
| | - Na Jin Kim
- Medical Library, The Catholic University of Korea, Seoul 06591, Republic of Korea;
| | - Jaewon Huh
- Department of Anesthesiology and Pain Medicine, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul 06591, Republic of Korea; (M.K.); (J.H.)
| | - Jin-Oh Jeong
- Wake Forest Institute for Regenerative Medicine (WFIRM), Wake Forest School of Medicine, Winson-Salem, NC 27157, USA;
| | - Wonjung Hwang
- Department of Anesthesiology and Pain Medicine, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul 06591, Republic of Korea; (M.K.); (J.H.)
| | - Hoon Choi
- Department of Anesthesiology and Pain Medicine, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul 06591, Republic of Korea; (M.K.); (J.H.)
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Kumar SM, Anandhi A, Sureshkumar S, Keerthi AR, Raja K, Jha AK, Bobby Z, Kate V. Effect of preoperative oral carbohydrate loading on postoperative insulin resistance, patient-perceived well-being, and surgical outcomes in elective colorectal surgery: a randomized controlled trial. J Gastrointest Surg 2024; 28:1654-1660. [PMID: 39142436 DOI: 10.1016/j.gassur.2024.07.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2024] [Revised: 07/03/2024] [Accepted: 07/27/2024] [Indexed: 08/16/2024]
Abstract
BACKGROUND Insulin resistance (IR) is one of the independent determinants influencing the length of hospital stay (LOHS) and postoperative complications in colorectal procedures. Preoperative oral carbohydrate loading (OCL) has emerged as a prospective countermeasure for IR. This study aimed to investigate the effects of preoperative carbohydrate loading on postoperative IR, inflammatory parameters, and clinical outcomes in patients undergoing elective colorectal surgery. METHODS This was an open-label, parallel arm, superiority randomized controlled trial conducted over 2 years. Participants were assigned to conventional fasting and oral OCL groups. IR, insulin sensitivity, Glasgow Prognostic Score (GPS), and interleukin 6 levels were analyzed on the day of surgery and on the first postoperative day (POD-1) and third POD (POD-3). Clinical parameters, such as thirst, hunger, dry mouth, anxiety, weakness, pain, nausea, and vomiting, were compared in the perioperative period. In addition, surgical clinical outcomes, such as intestinal recovery, time to independent ambulation, postoperative morbidity, and LOHS, were studied. RESULTS A total of 72 participants were included, with 36 in each group. In the OCL group, there was a statistically significant decrease in postoperative IR on the day of surgery, POD-1, and POD-3 (P = .0336). Similarly, inflammatory parameters and the GPS were found to be significantly lower in the OCL group (P < .001). Clinical parameters, such as thirst, hunger, and dry mouth, were significantly lower in the intervention group (P =.00), with a shortened LOHS. CONCLUSION This study demonstrated that preoperative carbohydrate loading is associated with reduced IR and inflammatory markers, shortened hospital stays, and improved overall clinical outcomes in elective colorectal surgery.
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Affiliation(s)
- Shanmugam Mannoj Kumar
- Department of Surgery, Jawaharlal Institute of Postgraduate Medical Education and Research, Pondicherry, India
| | - Amaranathan Anandhi
- Department of Surgery, Jawaharlal Institute of Postgraduate Medical Education and Research, Pondicherry, India.
| | - Sathasivam Sureshkumar
- Department of Surgery, Jawaharlal Institute of Postgraduate Medical Education and Research, Pondicherry, India
| | - Andi Rajendharan Keerthi
- Department of Surgery, Jawaharlal Institute of Postgraduate Medical Education and Research, Pondicherry, India
| | - Kalayarasan Raja
- Department of Surgical Gastroenterology, Jawaharlal Institute of Postgraduate Medical Education and Research, Pondicherry, India
| | - Ajay Kumar Jha
- Department of Anesthesia, Jawaharlal Institute of Postgraduate Medical Education and Research, Pondicherry, India
| | - Zachariah Bobby
- Department of Biochemistry, Jawaharlal Institute of Postgraduate Medical Education and Research, Pondicherry, India
| | - Vikram Kate
- Department of Surgery, Jawaharlal Institute of Postgraduate Medical Education and Research, Pondicherry, India
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27
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Singh S, Chandan S, Dahiya DS, Aswath G, Ramai D, Maida M, Anderloni A, Muscatiello N, Facciorusso A. Impact of GLP-1 Receptor Agonists in Gastrointestinal Endoscopy: An Updated Review. J Clin Med 2024; 13:5627. [PMID: 39337114 PMCID: PMC11432656 DOI: 10.3390/jcm13185627] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2024] [Revised: 09/17/2024] [Accepted: 09/21/2024] [Indexed: 09/30/2024] Open
Abstract
Glucagon-like peptide-1 receptor agonists (GLP-1 RAs) have become one of the most popular medications for patients with diabetes and obesity. Due to their effects on gut motility via central or parasympathetic pathways, there have been concerns about an increased incidence of retained gastric contents and risk of aspiration in the perioperative period. Hence, the American Society of Anesthesiologists (ASA) recommends holding GLP-1 RAs on the procedure day or a week before the elective procedure based on the respective daily or weekly formulations, regardless of the dose, indication (obesity or diabetes), or procedure type. On the contrary, the American Gastroenterological Association (AGA) advises an individualized approach, stating that more data are needed to decide if and when the GLP-1 RAs should be held prior to elective endoscopy. Several retrospective and prospective studies, along with meta-analyses, have been published since then evaluating the role of GLP-1 RAs in patients scheduled for endoscopic procedures. In this review, we discuss the current clinical guidelines and available studies regarding the effect of GLP-1 RAs on GI endoscopies.
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Affiliation(s)
- Sahib Singh
- Internal Medicine, Sinai Hospital of Baltimore, Baltimore, MD 21215, USA;
| | - Saurabh Chandan
- Center for Interventional Endoscopy (CIE), Advent Health, Orlando, FL 32803, USA;
| | - Dushyant Singh Dahiya
- Gastroenterology & Hepatology, The University of Kansas School of Medicine, Kansas City, KS 66160, USA
| | - Ganesh Aswath
- Gastroenterology & Hepatology, State University of New York Upstate Medical University, Syracuse, NY 13210, USA;
| | - Daryl Ramai
- Brigham and Women’s Hospital, Harvard Medical School, Boston, MA 02115, USA;
| | - Marcello Maida
- Department of Medicine and Surgery, School of Medicine and Surgery, University of Enna “Kore”, 94100 Enna, Italy;
| | - Andrea Anderloni
- Gastroenterology and Digestive Endoscopy Unit, Fondazione IRCCS Policlinico San Matteo, 27100 Pavia, Italy;
| | - Nicola Muscatiello
- Gastroenterology Unit, Department of Medical and Surgical Sciences, University of Foggia, 71122 Foggia, Italy;
| | - Antonio Facciorusso
- Gastroenterology Unit, Department of Medical and Surgical Sciences, University of Foggia, 71122 Foggia, Italy;
- Clinical Effectiveness Research Group, Faculty of Medicine, Institute of Health and Society, University of Oslo, 0372 Oslo, Norway
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28
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Bartoszko J, van Klei W. Aspiration under anesthesia: what happens after we sound the glucagon-like peptide-1 receptor agonist alarm? Can J Anaesth 2024; 71:1203-1208. [PMID: 39187640 DOI: 10.1007/s12630-024-02809-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2024] [Revised: 05/09/2024] [Accepted: 05/26/2024] [Indexed: 08/28/2024] Open
Affiliation(s)
- Justyna Bartoszko
- Department of Anesthesia and Pain Management, Toronto General Hospital - University Health Network, 200 Elizabeth Street, 3EN-464, Toronto, ON, M5G 2C4, Canada.
- Department of Anesthesiology & Pain Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada.
- Toronto General Hospital Research Institute, University Health Network, Toronto, ON, Canada.
| | - Wilton van Klei
- Department of Anesthesiology and Intensive Care Medicine, University Medical Center Utrecht, Utrecht, The Netherlands
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Rajan N, Duggan EW, Abdelmalak BB, Butz S, Rodriguez LV, Vann MA, Joshi GP. Society for Ambulatory Anesthesia Updated Consensus Statement on Perioperative Blood Glucose Management in Adult Patients With Diabetes Mellitus Undergoing Ambulatory Surgery. Anesth Analg 2024; 139:459-477. [PMID: 38517760 DOI: 10.1213/ane.0000000000006791] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/24/2024]
Abstract
This consensus statement is a comprehensive update of the 2010 Society for Ambulatory Anesthesia (SAMBA) Consensus Statement on perioperative blood glucose management in patients with diabetes mellitus (DM) undergoing ambulatory surgery. Since the original consensus guidelines in 2010, several novel therapeutic interventions have been introduced to treat DM, including new hypoglycemic agents and increasing prevalence of insulin pumps and continuous glucose monitors. The updated recommendations were developed by an expert task force under the provision of SAMBA and are based on a comprehensive review of the literature from 1980 to 2022. The task force included SAMBA members with expertise on this topic and those contributing to the primary literature regarding the management of DM in the perioperative period. The recommendations encompass preoperative evaluation of patients with DM presenting for ambulatory surgery, management of preoperative oral hypoglycemic agents and home insulins, intraoperative testing and treatment modalities, and blood glucose management in the postanesthesia care unit and transition to home after surgery. High-quality evidence pertaining to perioperative blood glucose management in patients with DM undergoing ambulatory surgery remains sparse. Recommendations are therefore based on recent guidelines and available literature, including general glucose management in patients with DM, data from inpatient surgical populations, drug pharmacology, and emerging treatment data. Areas in need of further research are also identified. Importantly, the benefits and risks of interventions and clinical practice information were considered to ensure that the recommendations maintain patient safety and are clinically valid and useful in the ambulatory setting. What Other Guidelines Are Available on This Topic? Since the publication of the SAMBA Consensus Statement for perioperative blood glucose management in the ambulatory setting in 2010, several recent guidelines have been issued by the American Diabetes Association (ADA), the American Association of Clinical Endocrinologists (AACE), the Endocrine Society, the Centre for Perioperative Care (CPOC), and the Association of Anaesthetists of Great Britain and Ireland (AAGBI) on DM care in hospitalized patients; however, none are specific to ambulatory surgery. How Does This Guideline Differ From the Previous Guidelines? Previously posed clinical questions that were outdated were revised to reflect current clinical practice. Additional questions were developed relating to the perioperative management of patients with DM to include the newer therapeutic interventions.
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Affiliation(s)
- Niraja Rajan
- From the Department of Anesthesiology and Perioperative Medicine, Penn State Health, Hershey Outpatient Surgery Center, Hershey, Pennsylvania
| | - Elizabeth W Duggan
- Department of Anesthesiology and Perioperative Medicine, University of Alabama Birmingham, Birmingham, Alabama
| | - Basem B Abdelmalak
- Departments of General Anesthesiology and Outcomes Research, Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Anesthesia for Bronchoscopic Surgery, Anesthesiology Institute, Cleveland Clinic, Cleveland, Ohio
| | - Steven Butz
- Department of Anesthesiology, Division of Pediatric Anesthesiology, Medical College of Wisconsin, Children's Wisconsin Surgicenter, Milwaukee, Wisconsin
| | - Leopoldo V Rodriguez
- Department of Anesthesiology and Perioperative Medicine, Boulder Valley Anesthesiology PLLC, UCHealth Longs Peak Hospital and Surgery Center, Boulder Community Health, Foothills Hospital, Boulder, Colorado
| | - Mary Ann Vann
- Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Girish P Joshi
- Department of Anesthesiology and Pain Management, University of Texas Southwestern Medical School, Dallas, Texas
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K S, J O, N M, I T, A F, AR E. Perioperative Blood Glucose Optimization in Orthopaedic Trauma Patients. OPERATIVE TECHNIQUES IN ORTHOPAEDICS 2024; 34:101128. [DOI: 10.1016/j.oto.2024.101128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/03/2025]
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Katerenchuk V, Ribeiro EM, Batista AC. Impact of Intraoperative Dexamethasone on Perioperative Blood Glucose Levels: Systematic Review and Meta-Analysis of Randomized Trials. Anesth Analg 2024; 139:490-508. [PMID: 39151135 DOI: 10.1213/ane.0000000000006933] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/18/2024]
Abstract
BACKGROUND Dexamethasone is associated with increased blood glucose levels that could impact patient outcomes or management. This study aimed to synthesize the available evidence regarding the impact of an intraoperative single dose of dexamethasone on blood glucose levels. METHODS We searched CENTRAL, MEDLINE, and clinicaltrials.gov for randomized controlled trials (RCTs) comparing a single intraoperative dose of dexamethasone to control in adult patients who underwent noncardiac surgery. We followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and the review was registered in PROSPERO (CRD42023420562). Data were pooled using a random-effects model. We reported pooled dichotomous data using odds ratios (OR) and continuous data using the mean difference (MD), reporting 95% confidence intervals (95% CIs), and corresponding P-values for both. Confidence in the evidence was appraised using the Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) approach. As primary outcomes we assessed maximum blood glucose levels measurement and variation from baseline within 24 hours of surgery; blood glucose levels measurement and variation from baseline at 2, 4, 8, 12, and 24 hours after dexamethasone administration. As secondary outcomes, we evaluated insulin requirements and hyperglycemic events. RESULTS We included 23 RCTs, enrolling 11,154 participants overall. Dexamethasone was associated with a significant increment in blood glucose levels compared to control at all timepoints. The results showed an increase compared to control of 0.37 mmol L-1 (6.7 mg dL-1) at 2 hours (95% CI, 0.16-0.58 mmol L-1 or 2.9-10.5 mg dL-1), 0.97 mmol L-1 (17.5 mg dL-1) at 4 hours (95% CI, 0.67-1.25 mmol L-1 or 12.1-22.5 mg dL-1), 0.96 mmol L-1 (17.3 mg dL-1) at 8 hours (95% CI, 0.55-1.36 mmol L-1 or 9.9-24.5 mg dL-1), 0.90 mmol L-1 (16.2 mg dL-1) at 12 hours (95% CI, 0.62-1.19 mmol L-1 or 11.2-21.4 mg dL-1) and 0.59 mmol L-1 (10.6 mg dL-1) at 24 hours (95% CI, 0.22-0.96 mmol L-1 or 4.0-17.3 mg dL-1). No difference was found between subgroups regarding diabetic status (patients with diabetes versus patients without diabetes) in all the outcomes except 2 (maximum blood glucose levels variation within 24 hours and variation at 4 hours) and dexamethasone dose (4-5 mg vs 8-10 mg) in all the outcomes except 2 (blood glucose levels at 24 hours and hyperglycemic events). CONCLUSIONS Mean blood glucose levels rise between 0.37 and 1.63 mmol L-1 (6.7 and 29.4 mg dL-1) within 24 hours after a single dose of dexamethasone administered at induction of anesthesia compared to control, but in most patients this difference will not be clinically relevant.
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Affiliation(s)
- Vasyl Katerenchuk
- From the Department of Anesthesiology, Centro Hospitalar de Setúbal E.P.E., Setúbal, Portugal
| | - Eduardo Matos Ribeiro
- Department of Anesthesiology, Centro Hospitalar de Lisboa Ocidental E.P.E., Lisboa, Portugal
| | - Ana Correia Batista
- From the Department of Anesthesiology, Centro Hospitalar de Setúbal E.P.E., Setúbal, Portugal
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Greer CL, Neumiller JJ. Multidisciplinary Diabetes Management and Education Strategies in the Inpatient Rehabilitation Setting. Diabetes Spectr 2024; 37:227-233. [PMID: 39157780 PMCID: PMC11327166 DOI: 10.2337/dsi24-0012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/20/2024]
Abstract
People with diabetes receiving inpatient rehabilitation have multiple unique care needs. Although the condition, event, or disability resulting in admission to an inpatient rehabilitation facility (IRF) may not have a causal relationship with chronic conditions such as diabetes, the condition precipitating referral to IRF care may increase a person's risk for worsening cardiometabolic disease. Furthermore, diabetes management in the IRF setting may be complicated by stress hyperglycemia from illness and/or drug-induced hyperglycemia from the use of glucocorticoids or other offending medications. The availability of a multidisciplinary team of clinicians and therapists in the IRF setting holds great opportunity for development of robust diabetes care and education programs to optimize therapy, teach or reinforce diabetes self-management survival skills, and facilitate safe transitions of care to individuals' next setting of care.
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Affiliation(s)
| | - Joshua J. Neumiller
- College of Pharmacy and Pharmaceutical Sciences, Washington State University, Spokane, WA
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Kieruzel N, Sethi S, Nair V, Wolf JM, Strelzow JA. Do preoperative glucose levels predict risk of complications in orthopaedic surgery? EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY & TRAUMATOLOGY : ORTHOPEDIE TRAUMATOLOGIE 2024; 34:2941-2947. [PMID: 38816627 DOI: 10.1007/s00590-024-04008-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/18/2024] [Accepted: 05/22/2024] [Indexed: 06/01/2024]
Abstract
PURPOSE Post-operative hyperglycemia is a known risk factor for post-surgical complications. The predictive value of pre-operative blood glucose levels, however, is less understood. This study aimed to determine if pre-operative screening blood glucose levels affect the rate of post-operative infection or wound complications. We also investigated if case urgency or anatomic location alters this relationship. METHODS A single-institution retrospective chart review was performed to evaluate patients treated between 2018 and 2021. Subjects ≥ 18 years with closed, non-infected orthopaedic diagnoses requiring surgery were included. Case urgency, demographics, comorbidities, blood glucose level within twelve h prior to surgery, and hemoglobin A1c level within 3 months of surgery, were collected. Infections and wound complications were recorded as outcomes. RESULTS A total of 775 subjects with a mean age of 61 (range 18-96) were identified, including 543 elective and 232 trauma patients, with a mean pre-operative fasting glucose value of 127.7 mg/dL (range, 49-388 mg/dL) and average HbA1c of 6.9%. The odds of infectious complications were increased by a factor of 1.01 for every 1-point increase in blood glucose (95% CI 1.01-1.02; p < 0.01). CONCLUSIONS Pre-operative blood glucose levels greater than 137 mg/dL were associated with an increase in wound complications, but not deep infections. Infection rates stratified by anatomic site and case urgency were not impacted by pre-operative glucose levels. The increased risk of poor wound healing in patients with pre-operative hyperglycemia demonstrates that day of surgery point-of-care blood glucose screening can be a useful risk stratification tool.
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Affiliation(s)
- Natalie Kieruzel
- Chicago Medical School, Rosalind Franklin University of Medicine and Science, 3333 Green Bay Rd, North Chicago, IL, 60064, USA
| | - Sahil Sethi
- The University of Chicago Pritzker School of Medicine, Chicago, IL, 60637, USA
| | - Vivek Nair
- The University of Chicago Pritzker School of Medicine, Chicago, IL, 60637, USA
| | - Jennifer Moriatis Wolf
- Department of Orthopaedic Surgery and Rehabilitation Medicine, The University of Chicago Medical Center, 5841 S. Maryland Ave. | Rm. S-341A, MC3079, Chicago, IL, 60637, USA
| | - Jason Alexander Strelzow
- Department of Orthopaedic Surgery and Rehabilitation Medicine, The University of Chicago Medical Center, 5841 S. Maryland Ave. | Rm. S-341A, MC3079, Chicago, IL, 60637, USA.
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Xiong Q, Huang F, Xu Y, Wei K, Cheng B, Dan Liu MD, Wang Q, Deng Y. Association Between the Blood Glucose Value at PACU Discharge and Postoperative Hypoglycemia in Nondiabetic Patients With Hyperglycemia After Hysteroscopic Surgery: A Retrospective Cohort Study. J Perianesth Nurs 2024; 39:552-557.e1. [PMID: 38219082 DOI: 10.1016/j.jopan.2023.10.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2023] [Revised: 06/16/2023] [Accepted: 10/13/2023] [Indexed: 01/15/2024]
Abstract
PURPOSE The target glycemic control for nondiabetic patients in the postanesthesia care unit (PACU) after hysteroscopic surgery remains unclear. Our goal is to determine the optimal level of glycemic control by finding the relationship between blood glucose level (BGL) leaving the PACU and postoperative hypoglycemia in nondiabetic patients. DESIGN This retrospective cohort study was conducted at a comprehensive tertiary hospital in Chongqing, China between June 2018 and December 2020. METHODS The target independent and dependent variables were BGL leaving the PACU and postoperative hypoglycemia, respectively. The primary outcome was the incidence of hypoglycemia. Logistic regression was used to explore the association between discharge BGL and hypoglycemia. The optimal glycemic control range was determined by using the receiver operating characteristic (ROC) curve. FINDINGS Prior to insulin use, BGL in the insulin-using subgroup might be as high as 20 mmol/L. Hypoglycemia was related to the BGL while leaving the PACU (odds ratio (OR) 0.37 [95% confidence interval (CI) 0.22 to 0.65]). The best cut-off value (12.95 mmol/L) was determined by fitting the ROC curve. CONCLUSIONS If severe hyperglycemia develops during hysteroscopic surgery in individuals with 5% glucose as the mediator of uterine distention, the recommendation is to maintain blood glucose above 12.95 mmol/L when treated with insulin.
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Affiliation(s)
- Qiuju Xiong
- Department of Anesthesiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Fusen Huang
- Department of Anesthesiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China.
| | - Yi Xu
- Department of Anesthesiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Ke Wei
- Department of Anesthesiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Bo Cheng
- Department of Anesthesiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - M D Dan Liu
- Department of Anesthesiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Qunying Wang
- Department of Anesthesiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Youlin Deng
- Department of Gynecology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
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Polderman J, Hermanides J, Hulst A. Update on the perioperative management of diabetes mellitus. BJA Educ 2024; 24:261-269. [PMID: 39099754 PMCID: PMC11293569 DOI: 10.1016/j.bjae.2024.04.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/23/2024] [Indexed: 08/06/2024] Open
Affiliation(s)
- J.A.W. Polderman
- Amsterdam University Medical Centres, Amsterdam, The Netherlands
| | - J. Hermanides
- Amsterdam University Medical Centres, Amsterdam, The Netherlands
| | - A.H. Hulst
- Amsterdam University Medical Centres, Amsterdam, The Netherlands
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Cardiovascular Subcommittee of Chinese International Exchange and Promotion Association for Medical and Healthcare, JI LN, CHEN YD. Consensus on glycemic management for patients with coronary heart disease and type 2 diabetes. J Geriatr Cardiol 2024; 21:689-702. [PMID: 39183955 PMCID: PMC11341531 DOI: 10.26599/1671-5411.2024.07.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/27/2024] Open
Abstract
The prevalence of patients with coronary heart disease (CHD) and diabetes mellitus is notably high, posing significant residual cardiovascular risks even after routine interventions such as antihypertensive, lipid-lowering, and antithrombotic treatments. Recent studies have demonstrated that certain glucose-lowering medications confer cardiovascular benefits for patients with type 2 diabetes. However, a survey indicates that cardiologists may not be fully acquainted with the optimal screening timing, indicators, and diagnostic criteria for type 2 diabetes, and there is insufficient awareness and a low rate of prescription of novel glucose-lowering medications with proven cardiovascular efficacy, such as glucagon-like peptide-1 receptor agonists (GLP-1 RAs) and sodium-glucose co-transporter-2 inhibitors (SGLT-2i). In this context, based on domestic and international guidelines or consensus and the latest evidence-based evidence, this consensus aims to standardize the glycemic management for patients with acute coronary syndrome, chronic coronary syndrome, and perioperative management for percutaneous coronary intervention. It highlights the key points of screening and diagnosis of type 2 diabetes, and the comprehensive management of cardiovascular risk in patients with CHD. The consensus elaborates on the principles and algorithms of glycemic management for CHD patients, without involving acute complications of diabetes, clarifies the clinical practice of glucose-lowering medications with cardiovascular benefits, and promotes the standardized use of these medications in cardiovascular and other related specialty fields. Additionally, it addresses the glucose-lowering treatment to comprehensively reduce cardiovascular risks.
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de Castro RCC, Costa PN, Rocha EAV, Ribeiro IVDCP, Parreira MP. Lymphocyte Levels and Morbidity and Mortality in Cardiovascular Surgery With Cardiopulmonary Bypass. Braz J Cardiovasc Surg 2024; 39:e20230136. [PMID: 39038070 PMCID: PMC11259249 DOI: 10.21470/1678-9741-2023-0136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Accepted: 10/24/2023] [Indexed: 07/24/2024] Open
Abstract
INTRODUCTION A year ago, in a sample of 113 patients, our research group found that a high number of lymphocytes in the immediate postoperative period was correlated to a poor prognosis in cardiovascular surgeries. This study is an expansion of the initial study in order to confirm this finding. METHODS We analyzed the data of 338 consecutive patients submitted to cardiovascular surgeries with cardiopulmonary bypass performed at Hospital Universitário Ciências Médicas (Belo Horizonte/Brazil) from 2015 to 2017. We analyzed 39 variables with the outcomes death, hospital stay, and intensive care unit stay. RESULTS The value of lymphocytes in the immediate postoperative period > 2175.0/mm³ was an indicator of poor prognosis in this sample (P<0.001). The variables female sex, age, high level of European System for Cardiac Operative Risk Evaluation II, increased stay in the intensive care unit and in the ward, elevation of creatinine in the preoperative period and at intensive care unit discharge, elevation of the percentage of immediate postoperative period segmented neutrophils, high immediate postoperative period neutrophil/lymphocyte ratio, fasting hyperglycemia, preoperative critical condition, reintubation, mild or transient acute renal failure, surgical infection, cardiopulmonary bypass, and aortic cross-clamping and mechanical ventilation durations also had an impact on the mortality outcome. CONCLUSION The value of lymphocytes in the immediate postoperative period > 2175.0/mm3 was an indicator of poor prognosis in cardiovascular surgery with cardiopulmonary bypass.
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Affiliation(s)
| | | | | | | | - Maria Paula Parreira
- Faculdade Ciências Médicas de Minas Gerais, Belo
Horizonte, Minas Gerais, Brazil
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Panidapu N, Babu S, Gadhinglajkar SV, Thomas D, Aspari AM, Sen B. Effects of Dexmedetomidine on Perioperative Glycemic Control in Adult Diabetic Patients Undergoing Cardiac Surgery. Ann Card Anaesth 2024; 27:228-234. [PMID: 38963357 PMCID: PMC11315263 DOI: 10.4103/aca.aca_209_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Revised: 03/01/2024] [Accepted: 03/11/2024] [Indexed: 07/05/2024] Open
Abstract
BACKGROUND AND OBJECTIVE To study the effects of dexmedetomidine (DEX) on perioperative blood glucose levels in adult diabetes mellitus (DM) patients undergoing cardiac surgery. METHODS AND MATERIAL A prospective, observational study was conducted on 100 adult diabetic patients aged between 18 and 75 years undergoing cardiac surgery with cardiopulmonary bypass (CPB). The patients were divided into two groups (group D and group C) of 50 each. Group D patients received DEX infusion, whereas the group C patients received 0.9% normal saline infusion. RESULTS The blood glucose levels, heart rate, mean arterial pressure, and serum potassium levels at different time points were comparable between the two groups (P > 0.05). The mean dose of insulin required in the combined population as well as in both controlled and uncontrolled DM patients was significantly less in group D than in group C (combined population - 36.03 ± 22.71 vs 47.82 ± 30.19 IU, P = 0.0297; uncontrolled DM - 37.36 ± 23.9 IU vs 48.16 ± 25.15 IU, P = 0.0301; controlled DM - 34.7 ± 21.5 IU vs 47.63 ± 35.25 IU, P = 0.0291). Duration of mechanical ventilation and VIS were comparable between the two groups. The incidence of arrhythmias (20% vs 46%, P = 0.0059) and delirium (6% vs 20%, P = 0.0384) was significantly less in group D than in group C. None of the patients in either group had stroke, myocardial ischemia, and mortality. CONCLUSION The results suggested that DEX infusion during the intraoperative period was very effective for perioperative glycemic control and reduction of insulin requirement in DM patients undergoing cardiac surgery.
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Affiliation(s)
- Nagarjuna Panidapu
- Department of Cardiac Anesthesia, Amrita Institute of Medical Sciences, Kochi, Kerala, India
| | - Saravana Babu
- Division of Cardiothoracic and Vascular Anesthesia, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, Kerala, India
| | - Shrinivas V Gadhinglajkar
- Division of Cardiothoracic and Vascular Anesthesia, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, Kerala, India
| | - Diana Thomas
- Division of Cardiothoracic and Vascular Anesthesia, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, Kerala, India
| | - Azeez Mahammad Aspari
- Division of Cardiothoracic and Vascular Anesthesia, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, Kerala, India
| | - Barsha Sen
- Department of Cardiac Anesthesia, Amrita Institute of Medical Sciences, Kochi, Kerala, India
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Chiari P, Fellahi JL. Myocardial protection in cardiac surgery: a comprehensive review of current therapies and future cardioprotective strategies. Front Med (Lausanne) 2024; 11:1424188. [PMID: 38962735 PMCID: PMC11220133 DOI: 10.3389/fmed.2024.1424188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2024] [Accepted: 05/23/2024] [Indexed: 07/05/2024] Open
Abstract
Cardiac surgery with cardiopulmonary bypass results in global myocardial ischemia-reperfusion injury, leading to significant postoperative morbidity and mortality. Although cardioplegia is the cornerstone of intraoperative cardioprotection, a number of additional strategies have been identified. The concept of preconditioning and postconditioning, despite its limited direct clinical application, provided an essential contribution to the understanding of myocardial injury and organ protection. Therefore, physicians can use different tools to limit perioperative myocardial injury. These include the choice of anesthetic agents, remote ischemic preconditioning, tight glycemic control, optimization of respiratory parameters during the aortic unclamping phase to limit reperfusion injury, appropriate choice of monitoring to optimize hemodynamic parameters and limit perioperative use of catecholamines, and early reintroduction of cardioprotective agents in the postoperative period. Appropriate management before, during, and after cardiopulmonary bypass will help to decrease myocardial damage. This review aimed to highlight the current advancements in cardioprotection and their potential applications during cardiac surgery.
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Affiliation(s)
- Pascal Chiari
- Service d’Anesthésie Réanimation, Hôpital Universitaire Louis Pradel, Hospices Civils de Lyon, Lyon, France
- Laboratoire CarMeN, Inserm UMR 1060, Université Claude Bernard Lyon 1, Lyon, France
| | - Jean-Luc Fellahi
- Service d’Anesthésie Réanimation, Hôpital Universitaire Louis Pradel, Hospices Civils de Lyon, Lyon, France
- Laboratoire CarMeN, Inserm UMR 1060, Université Claude Bernard Lyon 1, Lyon, France
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Singh S, Suresh Kumar VC, Aswath G. Impact of glucagon-like peptide receptor agonists on endoscopy and its preoperative management: Guidelines, challenges, and future directions. World J Gastrointest Endosc 2024; 16:292-296. [PMID: 38946857 PMCID: PMC11212520 DOI: 10.4253/wjge.v16.i6.292] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2024] [Revised: 04/28/2024] [Accepted: 05/13/2024] [Indexed: 06/13/2024] Open
Abstract
Glucagon-like peptide receptor agonists (GLP-1RA) are used to treat type 2 diabetes mellitus and, more recently, have garnered attention for their effectiveness in promoting weight loss. They have been associated with several gastrointestinal adverse effects, including nausea and vomiting. These side effects are presumed to be due to increased residual gastric contents. Given the potential risk of aspiration and based on limited data, the American Society of Anesthesiologists updated the guidelines concerning the preoperative management of patients on GLP-1RA in 2023. They included the duration of mandated cessation of GLP-1RA before sedation and usage of "full stomach" precautions if these medications were not appropriately held before the procedure. This has led to additional challenges, such as extended waiting time, higher costs, and increased risk for patients. In this editorial, we review the current societal guidelines, clinical practice, and future directions regarding the usage of GLP-1RA in patients undergoing an endoscopic procedure.
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Affiliation(s)
- Sahib Singh
- Department of Internal Medicine, Sinai Hospital, Baltimore, MD 21215, United States
| | - Vishnu Charan Suresh Kumar
- Division of Gastroenterology and Hepatology, State University of New York Upstate Medical University, Syracuse, NY 13210, United States
| | - Ganesh Aswath
- Division of Gastroenterology and Hepatology, State University of New York Upstate Medical University, Syracuse, NY 13210, United States
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Fiorindi C, Giudici F, Testa GD, Foti L, Romanazzo S, Tognozzi C, Mansueto G, Scaringi S, Cuffaro F, Nannoni A, Soop M, Baldini G. Multimodal Prehabilitation for Patients with Crohn's Disease Scheduled for Major Surgery: A Narrative Review. Nutrients 2024; 16:1783. [PMID: 38892714 PMCID: PMC11174506 DOI: 10.3390/nu16111783] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2024] [Revised: 05/25/2024] [Accepted: 06/05/2024] [Indexed: 06/21/2024] Open
Abstract
Approximately 15-50% of patients with Crohn's disease (CD) will require surgery within ten years following the diagnosis. The management of modifiable risk factors before surgery is essential to reduce postoperative complications and to promote a better postoperative recovery. Preoperative malnutrition reduced functional capacity, sarcopenia, immunosuppressive medications, anemia, and psychological distress are frequently present in CD patients. Multimodal prehabilitation consists of nutritional, functional, medical, and psychological interventions implemented before surgery, aiming at optimizing preoperative status and improve postoperative recovery. Currently, studies evaluating the effect of multimodal prehabilitation on postoperative outcomes specifically in CD are lacking. Some studies have investigated the effect of a single prehabilitation intervention, of which nutritional optimization is the most investigated. The aim of this narrative review is to present the physiologic rationale supporting multimodal surgical prehabilitation in CD patients waiting for surgery, and to describe its main components to facilitate their adoption in the preoperative standard of care.
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Affiliation(s)
- Camilla Fiorindi
- Department of Health Science, University of Firenze, Azienda Ospedaliero Universitaria Careggi, Largo Brambilla 3, 50139 Florence, Italy; (S.R.); (C.T.); (G.M.); (F.C.); (A.N.); (G.B.)
- Multimodal Prehabilitation Center, Azienda Ospedaliera Universitaria Careggi, Largo Brambilla 6, 50135 Florence, Italy; (G.D.T.); (L.F.)
| | - Francesco Giudici
- Department of Experimental and Clinical Medicine, University of Florence, Largo Brambilla 6, 50135 Florence, Italy; (F.G.); (S.S.)
| | - Giuseppe Dario Testa
- Multimodal Prehabilitation Center, Azienda Ospedaliera Universitaria Careggi, Largo Brambilla 6, 50135 Florence, Italy; (G.D.T.); (L.F.)
- Division of Geriatric and Intensive Care Medicine, University of Florence, Azienda Ospedaliero Universitaria Careggi, Largo Brambilla 3, 50139 Florence, Italy
| | - Lorenzo Foti
- Multimodal Prehabilitation Center, Azienda Ospedaliera Universitaria Careggi, Largo Brambilla 6, 50135 Florence, Italy; (G.D.T.); (L.F.)
- Section of Anesthesiology and Intensive Care, University of Florence, Largo Brambilla 3, 50139 Florence, Italy
| | - Sara Romanazzo
- Department of Health Science, University of Firenze, Azienda Ospedaliero Universitaria Careggi, Largo Brambilla 3, 50139 Florence, Italy; (S.R.); (C.T.); (G.M.); (F.C.); (A.N.); (G.B.)
- Multimodal Prehabilitation Center, Azienda Ospedaliera Universitaria Careggi, Largo Brambilla 6, 50135 Florence, Italy; (G.D.T.); (L.F.)
| | - Cristina Tognozzi
- Department of Health Science, University of Firenze, Azienda Ospedaliero Universitaria Careggi, Largo Brambilla 3, 50139 Florence, Italy; (S.R.); (C.T.); (G.M.); (F.C.); (A.N.); (G.B.)
- Multimodal Prehabilitation Center, Azienda Ospedaliera Universitaria Careggi, Largo Brambilla 6, 50135 Florence, Italy; (G.D.T.); (L.F.)
| | - Giovanni Mansueto
- Department of Health Science, University of Firenze, Azienda Ospedaliero Universitaria Careggi, Largo Brambilla 3, 50139 Florence, Italy; (S.R.); (C.T.); (G.M.); (F.C.); (A.N.); (G.B.)
- Multimodal Prehabilitation Center, Azienda Ospedaliera Universitaria Careggi, Largo Brambilla 6, 50135 Florence, Italy; (G.D.T.); (L.F.)
| | - Stefano Scaringi
- Department of Experimental and Clinical Medicine, University of Florence, Largo Brambilla 6, 50135 Florence, Italy; (F.G.); (S.S.)
| | - Francesca Cuffaro
- Department of Health Science, University of Firenze, Azienda Ospedaliero Universitaria Careggi, Largo Brambilla 3, 50139 Florence, Italy; (S.R.); (C.T.); (G.M.); (F.C.); (A.N.); (G.B.)
| | - Anita Nannoni
- Department of Health Science, University of Firenze, Azienda Ospedaliero Universitaria Careggi, Largo Brambilla 3, 50139 Florence, Italy; (S.R.); (C.T.); (G.M.); (F.C.); (A.N.); (G.B.)
| | - Mattias Soop
- Department for IBD and Intestinal Failure Surgery, Karolinska University Hospital, SE 177 76 Stockholm, Sweden;
| | - Gabriele Baldini
- Department of Health Science, University of Firenze, Azienda Ospedaliero Universitaria Careggi, Largo Brambilla 3, 50139 Florence, Italy; (S.R.); (C.T.); (G.M.); (F.C.); (A.N.); (G.B.)
- Multimodal Prehabilitation Center, Azienda Ospedaliera Universitaria Careggi, Largo Brambilla 6, 50135 Florence, Italy; (G.D.T.); (L.F.)
- Section of Anesthesiology and Intensive Care, University of Florence, Largo Brambilla 3, 50139 Florence, Italy
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Kulikov A, Gruenbaum SE, Quinones-Hinojosa A, Pugnaloni PP, Lubnin A, Bilotta F. Preoperative Risk Assessment Before Elective Craniotomy: Are Aspirin, Arrhythmias, Deep Venous Thromboses, and Hyperglycemia Contraindications to Surgery? World Neurosurg 2024; 186:68-77. [PMID: 38479642 DOI: 10.1016/j.wneu.2024.03.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2024] [Accepted: 03/05/2024] [Indexed: 04/18/2024]
Abstract
OBJECTIVE Perioperative risk assessment and stratification before craniotomy is necessary to identify and optimize modifiable risk factors. Due to the high costs of diagnostic testing and concerns for delaying surgery, some have questioned whether and when surgery delays are warranted and supported by the current body of literature. The objective of this scoping review was to evaluate the available evidence on the prognostic value of preoperative risk assessment before anesthesia for elective craniotomy. METHODS In this scoping review, we reviewed 156 papers that assess preoperative risk assessment before elective craniotomy, of which 27 papers were included in the final analysis. RESULTS There is little high-quality evidence to suggest significant risk reduction when 4 common preexisting abnormalities are present: preoperative chronic aspirin therapy, cardiac arrhythmias, deep vein thrombosis, or hyperglycemia. CONCLUSIONS The risk of delaying craniotomy should ultimately be weighed against the perceived risks associated the patient's comorbid conditions and should be considered on an individualized basis.
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Affiliation(s)
- Alexander Kulikov
- Department of Anesthesiology, Burdenko National Medical Research Center of Neurosurgery, Moscow, Russia
| | - Shaun E Gruenbaum
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic Florida, Jacksonville, Florida.
| | | | - Pier Paolo Pugnaloni
- Department of Anesthesiology, Critical Care and Pain Medicine, Sapienza University of Rome, Rome, Italy
| | - Andrey Lubnin
- Department of Anesthesiology, Burdenko National Medical Research Center of Neurosurgery, Moscow, Russia
| | - Federico Bilotta
- Department of Anesthesiology, Critical Care and Pain Medicine, Sapienza University of Rome, Rome, Italy
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Kulikov A, Krovko Y, Zagidullin T, Bilotta F. Implementation of perioperative blood glucose monitoring and insulin infusion protocol can decrease postoperative infection rate in diabetic patients undergoing elective craniotomy: An observational study. J Clin Neurosci 2024; 124:137-141. [PMID: 38705025 DOI: 10.1016/j.jocn.2024.04.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2024] [Revised: 04/26/2024] [Accepted: 04/30/2024] [Indexed: 05/07/2024]
Abstract
BACKGROUND Severe perioperative hyperglycemia (SH) is a proven risk factor for postoperative complications after craniotomy. To reduce this risk, it has been proposed to implement the standardized clinical protocol for scheduled perioperative blood glucose concentration (BGC) monitoring. This would be followed by intravenous (IV) insulin infusion to keep BGC below 180 mg/dl in the perioperative period. The aim of this prospective observational study was to assess the impact of this type of protocol on the postoperative infection rate in patients undergoing elective craniotomy. METHODS A total of 42 patients were prospectively enrolled in the study. Protocol included scheduled BGC monitoring in the perioperative period and rapid-acting insulin IV infusion when intraoperative SH was detected. The diagnosis of infection (wound, pulmonary, blood stream, urinary tract infection or central nervous system infection) was established according to CDC criteria within the first postoperative week. A previously enrolled group of patients with sporadic BGC monitoring and subcutaneous insulin injections for SH management was used as a control group. RESULTS An infectious complication (i.e., pneumonia) was diagnosed only in one patient (2 %) in the prospective group. In comparison with the control group, a decrease in the risk of postoperative infection was statistically significant with OR = 0.08 [0.009 - 0.72] (p = 0.02). Implementation of the perioperative BGC monitoring and the correction protocol prevented both severe hyperglycemia and hypoglycemia with BGC < 70 mg/dl. CONCLUSION Scheduled BGC monitoring and the use of low-dose insulin infusion protocol can decrease the postoperative infection rate in patients undergoing elective craniotomy. Future studies are needed to prove the causality of the implementation of such a protocol with an improved outcome.
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Affiliation(s)
- Alexander Kulikov
- Burdenko National Medical Research Center of Neurosurgery, Moscow, Russia.
| | - Yulia Krovko
- Burdenko National Medical Research Center of Neurosurgery, Moscow, Russia
| | - Timur Zagidullin
- Burdenko National Medical Research Center of Neurosurgery, Moscow, Russia
| | - Federico Bilotta
- Department of Anesthesiology, Critical Care and Pain Medicine, Sapienza University of Rome, Italy
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Patham B, Kansara A, Sadhu AR. Real-time Continuous Glucose Monitoring in the Intensive Care Unit: The Fifth Vital Sign. Diabetes Care 2024; 47:924-926. [PMID: 38768336 DOI: 10.2337/dci24-0020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2024] [Accepted: 03/27/2024] [Indexed: 05/22/2024]
Affiliation(s)
- Bhargavi Patham
- Houston Methodist Academic Institute, Houston, TX
- Weill Cornell Medical College, New York, NY
- School of Engineering Medicine, Texas A&M University, College Station, TX
- Division of Endocrinology, Diabetes, and Metabolism, Houston Methodist Hospital, Houston, TX
- Health Science Center, Texas A&M University, College Station, TX
| | - Abhishek Kansara
- Houston Methodist Academic Institute, Houston, TX
- Weill Cornell Medical College, New York, NY
- Division of Endocrinology, Diabetes, and Metabolism, Houston Methodist Hospital, Houston, TX
- Health Science Center, Texas A&M University, College Station, TX
| | - Archana R Sadhu
- Houston Methodist Academic Institute, Houston, TX
- Weill Cornell Medical College, New York, NY
- Division of Endocrinology, Diabetes, and Metabolism, Houston Methodist Hospital, Houston, TX
- Health Science Center, Texas A&M University, College Station, TX
- Pancreas Transplantation and Transplant Endocrinology, Houston Methodist J.C. Walter Jr. Transplant Center, Houston Methodist Hospital, Houston, TX
- Houston Methodist Research Institute, Houston, TX
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Tharwat M, Al-Sobayil F, Ali H. Changes in the hematobiochemical, acid-base and blood gas elements as well as biomarkers of inflammation and bone metabolism in donkeys ( Equus asinus) with acute bleeding. Open Vet J 2024; 14:1146-1153. [PMID: 38938441 PMCID: PMC11199747 DOI: 10.5455/ovj.2024.v14.i5.8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2024] [Accepted: 04/21/2024] [Indexed: 06/29/2024] Open
Abstract
Background Acute hemorrhage is fatal in equines with a complication of severe hypovolemic shock that causes a sudden death in such cases. Aim This study was designed to report the influences of acute bleeding in conscious non-sedated donkeys (Equus asinus) on the hematobiochemical variables, acid-base, blood gas elements, and markers of inflammation and bone metabolism. Methods Eight healthy donkeys were used where a total of 900 ml of whole blood was collected. Five blood samples were collected from each animal: just before collection of blood (T0); (2) 30 (T1), 60 (T2), 120 (T3), and 240 minutes (T4) later. The blood panels including total white blood cells, lymphocytes, neutrophils, red blood cell counts (RBCs), HCT, hemoglobin (Hg), and RBCs indices were measured. Biochemical parameters and electrolytes were evaluated. The activity of aspartate aminotransferase (AST), creatine kinase (CK), and γ-glutamyl transferase (GGT) were also determined. Complete acid-base and blood gas panels were assessed. Serum amyloid A (SAA), haptoglobin (Hp), osteocalcin (OC), bone alkaline phosphatase (b-ALP), and pyridinoline cross-links (PYD) were measured. Results The RBCs, Hg, and HCT increased significantly at points T1, T2, and T3 compared to T0. The concentrations of total proteins and albumin decreased significantly at points T3 and T4. The blood urea nitrogen concentrations increased significantly at T4. Creatinine concentrations increased significantly at T2 and T3. The AST, GGT, and CK decreased significantly. On the other hand, glucose increased significantly at T3 and T4. The pH decreased significantly at points T1, T2, T3, and T4. The PCO2 increased significantly at T3 and T4. The BE, HCO3, and TCO2 values decreased significantly at T2, T3, and T4. Contrary, the AG increased significantly at points T3 and T4. The potassium increased significantly at T1-T4 and chloride decreased significantly at T3 and T4. Lactate showed significant increases at T1-T4. The SAA, Hp, OC, b-ALP, and PYD did not differ significantly at T1-T4. Conclusion In conscious non-sedated donkeys, induced bleeding resulted in significant changes in the hematobiochemical elements, the acid-base status, and blood gas and electrolyte parameters. However, it did not change the markers of inflammation and bone metabolism.
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Affiliation(s)
- Mohamed Tharwat
- Department of Clinical Sciences, College of Veterinary Medicine, Qassim University, Buraidah, Saudi Arabia
- Department of Animal Medicine, Faculty of Veterinary Medicine, Zagazig University, Zagazig, Egypt
| | - Fahd Al-Sobayil
- Department of Clinical Sciences, College of Veterinary Medicine, Qassim University, Buraidah, Saudi Arabia
| | - Haytham Ali
- Department of Animal and Veterinary Sciences, College of Agricultural and Marine Sciences, Sultan Qaboos University, Muscat, Sultanate of Oman
- Department of Pathology, Faculty of Veterinary Medicine, Zagazig University, Zagazig, Egypt
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Park SJ, Oh AR, Lee JH, Yang K, Park J. Association of preoperative blood glucose level with delirium after non-cardiac surgery in diabetic patients. Korean J Anesthesiol 2024; 77:226-235. [PMID: 38171594 PMCID: PMC10982528 DOI: 10.4097/kja.23301] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Revised: 12/15/2023] [Accepted: 01/03/2024] [Indexed: 01/05/2024] Open
Abstract
BACKGROUND Hyperglycemia has shown a negative association with cognitive dysfunction. We analyzed patients with high preoperative blood glucose level and hemoglobin A1c (HbA1c) level to determine the prevalence of postoperative delirium. METHODS We reviewed a database of 23,532 patients with diabetes who underwent non-cardiac surgery. Acute hyperglycemia was defined as fasting blood glucose > 140 mg/dl or random glucose > 180 mg/dl within 24 h before surgery. Chronic hyperglycemia was defined as HbA1c level above 6.5% within three months before surgery. The incidence of delirium was compared according to the presence of acute and chronic hyperglycemia. RESULTS Of the 23,532 diabetic patients, 21,585 had available preoperative blood glucose level within 24 h before surgery, and 18,452 patients reported levels indicating acute hyperglycemia. Of the 8,927 patients with available HbA1c level within three months before surgery, 5,522 had levels indicating chronic hyperglycemia. After adjustment with inverse probability weighting, acute hyperglycemia was related to higher incidence of delirium (hazard ratio: 1.33, 95% CI [1.10,1.62], P = 0.004 for delirium) compared with controls without acute hyperglycemia. On the other hand, chronic hyperglycemia did not correlate with postoperative delirium. CONCLUSIONS Preoperative acute hyperglycemia was associated with postoperative delirium, whereas chronic hyperglycemia was not significantly associated with postoperative delirium. Irrespective of chronic hyperglycemia, acute glycemic control in surgical patients could be crucial for preventing postoperative delirium.
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Affiliation(s)
- Soo Jung Park
- Department of Anesthesiology and Pain Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
- Department of Anesthesiology and Pain Medicine, Ajou University School of Medicine, Suwon, Korea
| | - Ah Ran Oh
- Department of Anesthesiology and Pain Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
- Department of Anesthesiology and Pain Medicine, Kangwon National University Hospital, Chuncheon, Korea
| | - Jong-Hwan Lee
- Department of Anesthesiology and Pain Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Kwangmo Yang
- Center for Health Promotion, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jungchan Park
- Department of Anesthesiology and Pain Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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Gribnau A, van Zuylen ML, Coles JP, Plummer MP, Hermanns H, Hermanides J. Cerebral Glucose Metabolism following TBI: Changes in Plasma Glucose, Glucose Transport and Alternative Pathways of Glycolysis-A Translational Narrative Review. Int J Mol Sci 2024; 25:2513. [PMID: 38473761 DOI: 10.3390/ijms25052513] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2023] [Revised: 02/05/2024] [Accepted: 02/14/2024] [Indexed: 03/14/2024] Open
Abstract
Traumatic brain injury (TBI) is a major public health concern with significant consequences across various domains. Following the primary event, secondary injuries compound the outcome after TBI, with disrupted glucose metabolism emerging as a relevant factor. This narrative review summarises the existing literature on post-TBI alterations in glucose metabolism. After TBI, the brain undergoes dynamic changes in brain glucose transport, including alterations in glucose transporters and kinetics, and disruptions in the blood-brain barrier (BBB). In addition, cerebral glucose metabolism transitions from a phase of hyperglycolysis to hypometabolism, with upregulation of alternative pathways of glycolysis. Future research should further explore optimal, and possibly personalised, glycaemic control targets in TBI patients, with GLP-1 analogues as promising therapeutic candidates. Furthermore, a more fundamental understanding of alterations in the activation of various pathways, such as the polyol and lactate pathway, could hold the key to improving outcomes following TBI.
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Affiliation(s)
- Annerixt Gribnau
- Department of Anaesthesiology, Amsterdam UMC Location University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
| | - Mark L van Zuylen
- Department of Anaesthesiology, Amsterdam UMC Location University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
- Department of Paediatric Intensive Care, Amsterdam UMC Location University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
| | - Jonathan P Coles
- Division of Anaesthesia, Department of Medicine, University of Cambridge, Addenbrooke's Hospital, Hills Road, Cambridge CB2 0QQ, UK
| | - Mark P Plummer
- Intensive Care Unit, Royal Melbourne Hospital, 300 Grattan Street, Parkville, VIC 3050, Australia
| | - Henning Hermanns
- Department of Anaesthesiology, Amsterdam UMC Location University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
| | - Jeroen Hermanides
- Department of Anaesthesiology, Amsterdam UMC Location University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
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Sun Y, Zhang X, Zhang M, Guo Y, Sun T, Liu M, Gao X, Liu Y, Gao Z, Chen L, Du X, Wang Y. Preliminary investigation of the effect of non-cardiac surgery on intraoperative islet and renal function: a single-center prospective cohort study. Front Med (Lausanne) 2024; 11:1235335. [PMID: 38414619 PMCID: PMC10897010 DOI: 10.3389/fmed.2024.1235335] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Accepted: 01/22/2024] [Indexed: 02/29/2024] Open
Abstract
Background The effect of different non-cardiac surgical methods on islet and renal function remains unclear. We conducted a preliminary investigation to determine whether different surgical methods affect islet function or cause further damage to renal function. Methods In this prospective cohort study, the clinical data of 63 adult patients who underwent non-cardiac surgery under general anesthesia were evaluated from February 2019 to January 2020. Patients were divided into the abdominal surgery group, the laparoscopic surgery group, and the breast cancer surgery group. The primary outcome was the difference between the effects of different surgical methods on renal function. Results Islet and renal function were not significantly different between the groups. The correlation analysis showed that hematocrit (HCT) and hemoglobin (HB) were negatively correlated with fasting plasma glucose (FPG) (p < 0.05), MAP was positively correlated with C-peptide (p < 0.05), and HCT and Hb were positively correlated with serum creatinine (SCr) (p < 0.05). Fasting insulin (FINS) and C-peptide were negatively correlated with SCr (p < 0.05), and the homeostatic model assessment of insulin resistance (HOMA-IR) was positively correlated with SCr (p < 0.05). FINS, C-peptide, HOMA-IR, and the homeostatic model assessment of β-cell function (HOMA-β) were positively correlated with cystatin C (Cys C) (p < 0.05). Conclusion FINS, C-peptide, and HOMA-IR had positive effects on beta-2-microglobulin (β2-MG). FINS, C-peptide, and HOMA-IR were positively correlated with Cys C and β2-Mg. While FINS and C-peptide were negatively correlated with SCr, HOMA-IR was positively correlated with SCr.
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Affiliation(s)
- Yongtao Sun
- Department of Anesthesiology, The First Affiliated Hospital of Shandong First Medical University and Shandong Provincial Qianfoshan Hospital, Shandong Institute of Anesthesia and Respiratory Critical Medicine, Jinan, China
| | - Xiaoning Zhang
- Department of Anesthesiology, The First Affiliated Hospital of Shandong First Medical University and Shandong Provincial Qianfoshan Hospital, Shandong Institute of Anesthesia and Respiratory Critical Medicine, Jinan, China
| | - Min Zhang
- Department of Anesthesiology, The First Affiliated Hospital of Shandong First Medical University and Shandong Provincial Qianfoshan Hospital, Shandong Institute of Anesthesia and Respiratory Critical Medicine, Jinan, China
| | - Yongle Guo
- Department of Anesthesiology, The First Affiliated Hospital of Shandong First Medical University and Shandong Provincial Qianfoshan Hospital, Shandong Institute of Anesthesia and Respiratory Critical Medicine, Jinan, China
- Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, China
| | - Tao Sun
- Department of Clinical Laboratory Medicine, The First Affiliated Hospital of Shandong First Medical University and Shandong Provincial Qianfoshan Hospital, Jinan, China
| | - Mengjie Liu
- Department of Anesthesiology, The First Affiliated Hospital of Shandong First Medical University and Shandong Provincial Qianfoshan Hospital, Shandong Institute of Anesthesia and Respiratory Critical Medicine, Jinan, China
| | - Xiaojun Gao
- Department of Anesthesiology, The First Affiliated Hospital of Shandong First Medical University and Shandong Provincial Qianfoshan Hospital, Shandong Institute of Anesthesia and Respiratory Critical Medicine, Jinan, China
| | - Yang Liu
- Department of Anesthesiology, The First Affiliated Hospital of Shandong First Medical University and Shandong Provincial Qianfoshan Hospital, Shandong Institute of Anesthesia and Respiratory Critical Medicine, Jinan, China
| | - Zhongquan Gao
- Department of Anesthesiology, The First Affiliated Hospital of Shandong First Medical University and Shandong Provincial Qianfoshan Hospital, Shandong Institute of Anesthesia and Respiratory Critical Medicine, Jinan, China
- Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, China
| | - Lina Chen
- Department of Anesthesiology, The First Affiliated Hospital of Shandong First Medical University and Shandong Provincial Qianfoshan Hospital, Shandong Institute of Anesthesia and Respiratory Critical Medicine, Jinan, China
| | - Xiaoyan Du
- Yidu Cloud (Beijing) Technology Co. Ltd., Beijing, China
| | - Yuelan Wang
- Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, China
- Department of Anesthesiology, Shandong Provincial Hospital Affiliated to Shandong First Medical University (Shandong Provincial Hospital), Jinan, China
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Baesso GMM, Venâncio AV, Barca LCV, Peppi PF, Faria CA, Machado JPC, Murgas LDS, Bicudo ÁJDA, Lima EMMD, Barreto-Vianna ARDC. Exploring the effects of eugenol, menthol, and lidocaine as anesthetics on zebrafish glucose homeostasis. Comp Biochem Physiol C Toxicol Pharmacol 2024; 276:109784. [PMID: 37935341 DOI: 10.1016/j.cbpc.2023.109784] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Revised: 10/06/2023] [Accepted: 10/30/2023] [Indexed: 11/09/2023]
Abstract
Zebrafish (Danio rerio) are widely employed as an experimental model in various scientific fields. The investigation of glucose metabolism dysfunctions has gained recent significant prominence. Considering that certain anesthetics may impact glycemic levels, it is imperative to carefully select an anesthetic that does not induce such side effects, thereby mitigating potential adverse influences on research outcomes. In this sense, this study aimed to evaluate potential glucose alterations and induction and recovery times resulting from the use of eugenol, menthol and lidocaine as anesthetics in zebrafish. A total of 150 adult male and female zebrafish were divided into ten groups, comprising a control group euthanized by rapid chilling, and three groups anesthetized with low (40 mg/L eugenol, 60 mg/L menthol, 100 mg/L lidocaine), intermediate (60 mg/L eugenol, 90 mg/L menthol, 225 mg/L lidocaine), and high (80 mg/L eugenol, 120 mg/L menthol, 350 mg/L lidocaine) anesthetic concentrations. Glucose levels and induction and recovery times were assessed. The findings reveal that eugenol and menthol did not cause glucose level alterations at any of the investigated concentrations, while lidocaine caused a non-concentration-dependent hyperglycemia. Eugenol and menthol also exhibited similar recovery times at different concentrations, while lidocaine recovery times were concentration-dependent. This study, therefore, concludes that eugenol and menthol are safe and satisfactory anesthetics for use in zebrafish research involving glucose analyses, while lidocaine use can cause biases due to altered glucose levels and safety concerns. Researchers should, therefore, carefully consider anesthetic selection to ensure reliable results in zebrafish assessments.
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Kukanti C, Agrawal N, Karim HMR, Sinha M. Effect of Sevoflurane, Isoflurane, and Desflurane on the Random Blood Glucose Levels in Non-diabetic Patients Undergoing General Anesthesia: A Randomized, Single-Blind Study. Cureus 2024; 16:e54216. [PMID: 38496133 PMCID: PMC10944314 DOI: 10.7759/cureus.54216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/14/2024] [Indexed: 03/19/2024] Open
Abstract
BACKGROUND Volatile anesthetic agents like sevoflurane, isoflurane, and desflurane are widely used for maintaining general anesthesia (GA). Their effect on the autonomic system is different and can impact the blood sugar homeostasis. This study compares the intraoperative blood glucose levels in non-diabetic patients undergoing non-cardiac surgery under GA with the three volatile agents. METHODS A randomized, single-blind, parallel-arm study recruited 105 non-diabetic patients into three groups. GA induction and maintenance were standardized except for the volatile agent. Capillary blood sugar levels were measured at different time points and compared between and within the groups. A p-value of <0.05 was considered significant. RESULTS Entire participants completed the study, and their baseline characteristics were statistically indifferent. Intraoperative blood glucose rise and variation were the highest in the desflurane group and the lowest in the isoflurane group; the differences were statistically significant at 15, 30, and 45 minutes. The highest blood sugar level was noted at 60 minutes in all groups; after that, the level started falling. However, none of the raises were beyond 140 mg% to categorize them as hyperglycemia. CONCLUSION Intraoperative glycemic variation was evident with isoflurane, sevoflurane, and desflurane. The maximum increase from the pre-induction level was noted at 60 minutes. However, none of the readings reached the hyperglycemia level. The rise was significantly higher in desflurane-based anesthesia than in isoflurane. This study was, however, conducted in non-diabetic patients; hence, results might not be extrapolated to diabetic patients.
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Affiliation(s)
- Chandini Kukanti
- Anaesthesiology, Critical Care, and Pain Medicine, All India Institute of Medical Sciences, Raipur, Raipur, IND
| | - Nandkishore Agrawal
- Anaesthesiology, Critical Care, and Pain Medicine, All India Institute of Medical Sciences, Raipur, Raipur, IND
| | - Habib Md R Karim
- Anaesthesiology, Critical Care, and Pain Medicine, All India Institute of Medical Sciences, Deoghar, Deoghar, IND
| | - Mamta Sinha
- Anaesthesiology, Critical Care, and Pain Medicine, All India Institute of Medical Sciences, Raipur, Raipur, IND
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