348 results match your criteria Perioperative Management of the Diabetic Patient


Perioperative hyperglycaemia in elective arthroplasties. Should we do better?

Acta Anaesthesiol Scand 2020 Jul 2. Epub 2020 Jul 2.

Department of Orthopaedics and Traumatology, Päijät-Häme Central Hospital, Lahti, Finland.

Background: Perioperative dysglycaemia is associated with deleterious outcomes but guidelines to improve glucose management are poorly or inconsistently adhered to. We evaluated glucose management among diabetic and nondiabetic patients undergoing elective hip or knee arthroplasty.

Methods: Capillary plasma glucose (CPG) was measured prospectively four times daily of 209 patients undergoing elective hip or knee surgery. Read More

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http://dx.doi.org/10.1111/aas.13666DOI Listing

Transperitoneal laparoscopic adrenalectomy for the resection of large size pheochromocytoma: Case report and literature review.

Int J Surg Case Rep 2020 23;71:353-359. Epub 2020 May 23.

Fundación Santa Fe de Bogotá Hospital, General Surgery Department, Cra 7 # 117- 15, Bogota, Colombia.

Introduction: Pheochromocytomas are rare neuroendocrine tumors that form in chromaffin cells of the neural crest during the embryological period. In the overall population, incidence rate is 0.1%; lack of early diagnosis or adequate treatment can lead to life-threatening complications. Read More

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http://dx.doi.org/10.1016/j.ijscr.2020.05.027DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7270531PMC

[Properly managing the cataract patients with diabetes mellitus].

Authors:
Z H Li T J Ma Z Ye

Zhonghua Yan Ke Za Zhi 2020 May;56(5):325-329

Department of Ophthalmology, the First Medical Center of Chinese PLA General Hospital, Beijing 100853, China.

The recent years has witnessed the fast growing number of cataract patients with diabetes mellitus (DM). The complexity and diversity of DM-related ocular complications has made the cataract treatment of such patients intractable and easily ignored. Cataract surgery has become an essential part of the comprehensive treatment of diabetic ophthalmopathy. Read More

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http://dx.doi.org/10.3760/cma.j.cn112142-20190402-00194DOI Listing

Evolving Evidence of Diabetic Ketoacidosis in Patients Taking Sodium-Glucose Cotransporter 2 Inhibitors.

J Clin Endocrinol Metab 2020 Aug;105(8)

Department of Medicine, Austin Health, Heidelberg, Victoria, Australia.

Introduction: Sodium glucose cotransporter 2 inhibitors (SGLT2i) have emerged as an important class of blood glucose-lowering medications, due to cardiovascular, metabolic, and renal benefits. However, there is a small but significant risk of diabetic ketoacidosis (DKA) associated with their use.

Methods: A literature search was conducted in Ovid MEDLINE and Embase to July 2019 using variants on the key search terms sodium-glucose cotransporter 2, diabetic ketoacidosis, and type 2 diabetes. Read More

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http://dx.doi.org/10.1210/clinem/dgaa200DOI Listing

Perioperative care of the adult diabetic patient.

Authors:
Helen Lloyd

J Perioper Pract 2020 Apr 17:1750458920915660. Epub 2020 Apr 17.

School of Health and Life Sciences, University of Teesside, Middlesbrough, UK.

The prevalence of diabetes mellitus is rapidly increasing in the UK, presenting greater complexity in its management when in the presence of other comorbidities. In the care of the adult perioperative patient with diabetes mellitus not only can symptoms can be difficult to attribute to one specific cause but also the onset of complications can be rapid. This article discusses the aetiology and key concerns during the perioperative pathway of care for successful management of the adult diabetic patient. Read More

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http://dx.doi.org/10.1177/1750458920915660DOI Listing

Insight Into the Perioperative Management of Type 2 Diabetes.

Cureus 2020 Feb 4;12(2):e6878. Epub 2020 Feb 4.

Internal Medicine, California Institute of Behavioral Neurosciences and Psychology, Fairfield, USA.

Diabetic people are at risk of developing acute complications when exposed to stress. Surgery brings a stressful period when the patient is exposed not only to surgical stress but also the effects of medications used during that particular period. The patient's comorbidities can influence the perioperative management of diabetes. Read More

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http://dx.doi.org/10.7759/cureus.6878DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7058399PMC
February 2020

Tension-free mesh repair of inguinal hernia in patients on continuous ambulatory peritoneal dialysis.

Perit Dial Int 2020 01;40(1):62-66

Department of Surgery, Tung Wah Hospital, Sheung Wan, Hong Kong.

Background: Peritoneal dialysis (PD) is the first-line renal replacement therapy for end-stage renal failure patients in Hong Kong. Abdominal wall hernia is a common mechanical complication of PD, and early surgical repair has been advocated to reduce complications. This study aims to review the outcomes of tension-free mesh repair of inguinal hernia in PD patients. Read More

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http://dx.doi.org/10.1177/0896860819879596DOI Listing
January 2020

Transmetatarsal amputation: A 12 year retrospective case review of outcomes.

Foot (Edinb) 2020 Mar 3;42:101637. Epub 2019 Sep 3.

Great Western Hospital, Marlborough Road, Swindon, SN3 6BB, United Kingdom.

Background: Diabetic foot pathology has rapidly increased, presenting a vast economic burden with severe implications for patients. Establishing effective limb salvage techniques such as transmetatarsal amputation is essential to offer viable alternatives to major limb amputation in severe foot infection, where outcomes are variable and mortality rates high.

Methods: A retrospective review of outcomes was performed on patients who underwent TMA at a single United Kingdom hospital between 2005-2017. Read More

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http://dx.doi.org/10.1016/j.foot.2019.08.008DOI Listing

Advances in type 2 diabetes therapy: a focus on cardiovascular and renal outcomes.

Med J Aust 2020 02 7;212(3):133-139. Epub 2020 Jan 7.

Melbourne University, Melbourne, VIC.

Treatment options for type 2 diabetes have expanded. While metformin remains the first line treatment in most cases, choices for second line treatment now extend beyond sulfonylureas and include the sodium-glucose cotransporter 2 (SGLT2) inhibitors, glucagon-like peptide 1 (GLP1) receptor agonists, and dipeptidyl peptidase 4 (DPP4) inhibitors. SGLT2 inhibitors are recommended for people with atherosclerotic cardiovascular disease, heart failure or kidney disease. Read More

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http://dx.doi.org/10.5694/mja2.50472DOI Listing
February 2020

Postoperative Euglycemic Diabetic Ketoacidosis and Encephalopathy Related to SGLT-2 Inhibitors: A Case Report and Discussion of Diabetes Treatment and "Sweet Pee Encephalopathy" in Perioperative Hospital Management.

Neurohospitalist 2020 Jan 7;10(1):51-54. Epub 2019 Mar 7.

Department of Neurology, Mayo Clinic, Jacksonville, FL, USA.

During preanesthesia evaluation, patient medications are reviewed and many are not administered on the day of surgery. Additionally, neurosurgical patients can develop postoperative encephalopathy from a variety of etiologies, including metabolic derangements. We report a case of postoperative neurosurgical euglycemic ketoacidosis which presented as unexplained encephalopathy and was the result of continued action of the patient's serum glucose cotransporter-2 (SGLT-2) inhibitor combined with perioperative fasting. Read More

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http://dx.doi.org/10.1177/1941874419835035DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6900651PMC
January 2020

Glycemic Management in the Operating Room: Screening, Monitoring, Oral Hypoglycemics, and Insulin Therapy.

Curr Diab Rep 2019 11 20;19(11):134. Epub 2019 Nov 20.

Department of Anesthesiology, Emory University School of Medicine, 1364 Clifton Road, Atlanta, GA, 30322, USA.

Purpose Of Review: This review provides a literature update and practical outline for the management of diabetes and stress hyperglycemia for adult surgical patients in the pre- and intraoperative settings.

Recent Findings: Hyperglycemia in surgical patients has been associated with increased risk of complication in both diabetic and non-diabetic patients in the perioperative setting. While current recommended perioperative blood glucose target is < 180 mg/dL (10 mmol/L), optimal outcomes may require different treatment targets for diabetic versus non-diabetic patients. Read More

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http://dx.doi.org/10.1007/s11892-019-1277-4DOI Listing
November 2019

Continuous subcutaneous insulin infusion reduces the risk of postoperative infection.

J Diabetes 2020 May 6;12(5):396-405. Epub 2019 Dec 6.

Division of Endocrinology, Department of Internal Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.

Background: Perioperative hyperglycemia was associated with postoperative infection, and proper management of perioperative glucose has become critical in improving the prognosis of patients.

Methods: A total of 1015 diabetic patients who underwent surgery and received insulin treatment for their hyperglycemia in our hospital were retrospectively reviewed. According to propensity matching, we obtained 253 pairs of patients from the group which received continuous subcutaneous insulin infusion (CSII) therapy (CSII group) and the group which received insulin injection therapy (non-CSII group). Read More

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http://dx.doi.org/10.1111/1753-0407.13008DOI Listing

Management of Diabetes in Patients Undergoing Bariatric Surgery.

Curr Diab Rep 2019 11 4;19(11):112. Epub 2019 Nov 4.

Joslin Diabetes Center, Harvard Medical School, Boston, MA, USA.

Purpose Of Review: The number of bariatric surgeries for patients with type 1 or type 2 diabetes continues to grow. Clinicians are challenged to choose therapies that reach glycemic targets without inducing adverse effects in post-bariatric patients without published guidelines. This review evaluates data supporting the best strategies for diabetes management in patients undergoing bariatric surgery. Read More

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http://dx.doi.org/10.1007/s11892-019-1242-2DOI Listing
November 2019

Point-of-care ultrasound defines gastric content in elective surgical patients with type 2 diabetes mellitus: a prospective cohort study.

BMC Anesthesiol 2019 10 10;19(1):179. Epub 2019 Oct 10.

Faculty of Anaesthesiology, Changhai Hospital, Naval Medical University, Shanghai, 200433, China.

Background: Delayed gastric emptying and the resultant "full stomach" is the most important risk factor for perioperative pulmonary aspiration. Using point-of-care gastric sonography, we aimed to investigate the prevalence of full stomach and its risk factors in elective surgical patients with type 2 diabetes.

Methods: Type 2 diabetic and non-diabetic elective surgical patients were included from July 2017 to April 2018 in a 1:1 ratio. Read More

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http://dx.doi.org/10.1186/s12871-019-0848-xDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6785890PMC
October 2019
1 Read
1.333 Impact Factor

Persistent Postoperative Hyperglycemia as a Risk Factor for Operative Treatment of Deep Wound Infection After Spine Surgery.

Neurosurgery 2019 Sep 25. Epub 2019 Sep 25.

Department of Neurosurgery, School of Medicine, Johns Hopkins University, Baltimore, Maryland.

Background: Surgical site infections (SSIs) affect 1% to 9% of all spine surgeries. Though previous work has found diabetes mellitus type 2 (DM2) to increase the risk for wound infection, the influence of perioperative hyperglycemia is poorly described.

Objective: To investigate perioperative hyperglycemia as an independent risk factor for surgical site infection. Read More

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http://dx.doi.org/10.1093/neuros/nyz405DOI Listing
September 2019
3 Reads

From the ICU to the operating room: how to manage the patient?

Curr Opin Anaesthesiol 2020 Apr;33(2):139-145

Hebrew University Faculty of Medicine and General ICU, Jerusalem, Israel.

Purpose Of Review: To outline key points for perioperative ICU optimization of nutrition, airway management, blood product preparation and transfusion, antibiotic prophylaxis and transport.

Recent Findings: Optimization entails glycemic control for all, with specific attention to type-1 diabetic patients. Transport-related adverse events may be averted with surgery in the ICU. Read More

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http://Insights.ovid.com/crossref?an=00001503-900000000-9882
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http://dx.doi.org/10.1097/ACO.0000000000000785DOI Listing
April 2020
5 Reads

Prognostic factors for cesarean section outcome of pregnant women with gestational diabetes mellitus: a systematic review and meta-analysis.

Diabetes Metab Syndr Obes 2019 21;12:913-929. Epub 2019 Jun 21.

Department of Endocrinology, Chinese PLA General Hospital, Beijing 100853, People's Republic of China.

To evaluate the prognostic factors for cesarean section outcome of pregnant women with diabetes mellitus. MEDLINE, EMBASE, Cochrane Library, CBM, CNKI and Wanfang database were searched. Two researchers independently screened the literature, extracted data, and evaluated the risk of bias of included studies. Read More

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http://dx.doi.org/10.2147/DMSO.S188293DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6596347PMC
June 2019
7 Reads

[Emphasizing the overall management of cataract surgery in patients with diabetes].

Authors:
K Yao C X Yan

Zhonghua Yan Ke Za Zhi 2019 Jul;55(7):481-484

Eye Center, Second Affiliated Hospital of Zhejiang University School of Medicine, Zhejiang Provincial Key Laboratory of Ophthalmology, Hangzhou 310009, China.

Cataract is one of the common cause of vision decrease in diabetic patients, which occurs earlier and develops faster than in common patients, and often requires surgery for treatment. However, diabetic patients are more likely to have fundus lesions, and are more prone to have complications, such as infection, posterior capsular opacity, cystoid macular edema, etc. Diabetic patients have a higher risk of cataract surgery than ordinary cataract patients. Read More

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http://dx.doi.org/10.3760/cma.j.issn.0412-4081.2019.07.001DOI Listing
July 2019
5 Reads

Short and sweet. Perioperative management of the diabetic pediatric patient (The Paediatric Anaesthetic Trainee Research Network [PATRN] Swift Survey 2018).

Paediatr Anaesth 2019 09;29(9):964-965

Department of Anaesthesia, Royal Aberdeen Children's Hospital, Aberdeen, UK.

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http://dx.doi.org/10.1111/pan.13698DOI Listing
September 2019
7 Reads

Diabetic Control Predicts Surgical Site Infection Risk in Orthopaedic Trauma Patients.

J Orthop Trauma 2019 Oct;33(10):514-517

Department of Orthopaedic Surgery and Rehabilitation, Texas Tech University Health Sciences Center, El Paso, TX.

Objectives: (1) To determine the incidence of surgical site infections (SSIs) in diabetic orthopaedic trauma patients and (2) to establish a protocol for managing diabetes mellitus (DM) in orthopaedic trauma patients.

Design: Retrospective cohort study.

Setting: Level 1 Trauma Center. Read More

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http://dx.doi.org/10.1097/BOT.0000000000001512DOI Listing
October 2019
16 Reads

Intravenous lidocaine in the management of chronic peripheral neuropathic pain: a randomized-controlled trial.

Can J Anaesth 2019 07 16;66(7):820-827. Epub 2019 May 16.

Statistical Services, London, ON, Canada.

Purpose: Neuropathic pain, resulting from injury to the peripheral or central nervous system, is due to upregulation of aberrant sodium channels with neuronal hyperexcitability. Lidocaine blocks these channels and several studies show that intravenous (IV) lidocaine infusion provides significant relief in patients with chronic peripheral neuropathic pain in the short term (for up to six hours). Our objective was to determine if IV lidocaine provides significant pain relief and overall improvement in quality of life in the longer term (for up to four weeks). Read More

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http://dx.doi.org/10.1007/s12630-019-01395-8DOI Listing
July 2019
13 Reads

Trauma in the Diabetic Limb.

Clin Podiatr Med Surg 2019 Jul 8;36(3):499-523. Epub 2019 Apr 8.

Orthopaedic Surgery, University of Texas Southwestern Medical Center, 1801 Inwood Road, Dallas, TX 75390-8883, USA; Foot and Ankle Service, Orthopaedic Surgery, Parkland Memorial Hospital, Level 1 Trauma Center, 5200 Harry Hines Boulevard, Dallas, TX 75235, USA.

Poorly controlled diabetes with comorbid manifestations negatively affects outcomes in lower extremity trauma, increasing the risk of short-term and long-term complications. Management strategies of patients with diabetes that experience lower extremity trauma should also include perioperative management of hyperglycemia to reduce adverse and serious adverse events. Read More

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https://linkinghub.elsevier.com/retrieve/pii/S08918422193002
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http://dx.doi.org/10.1016/j.cpm.2019.02.012DOI Listing
July 2019
17 Reads

Perioperative diabetic ketoacidosis associated with sodium-glucose co-transporter-2 inhibitors: a systematic review.

Br J Anaesth 2019 Jul 3;123(1):27-36. Epub 2019 May 3.

Department of Endocrinology and Metabolic Unit, Royal Adelaide Hospital, Adelaide, Australia; Discipline of Medicine, University of Adelaide, Adelaide, Australia; Department of Endocrinology and Diabetes, The Metabolic Unit, The Queen Elizabeth Hospital, Adelaide, Australia.

Background: Perioperative diabetic ketoacidosis (DKA) with near-normal blood glucose concentrations, termed euglycaemic ketoacidosis (EDKA), is an adverse effect associated with sodium-glucose co-transporter-2 inhibitors (SGLT2i). Guidelines are still evolving concerning the perioperative management of patients on SGLT2i. We performed a systematic review of published reports of DKA from SGLT2i in the surgical setting to understand better the clinical presentation and characteristics of SGLT2i-associated DKA. Read More

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http://dx.doi.org/10.1016/j.bja.2019.03.028DOI Listing
July 2019
23 Reads

Protective effect of intraoperative re-dose of prophylactic antibiotics on surgical site infection in diabetic patients: a retrospective cohort study.

Ann Transl Med 2019 Mar;7(5):96

Department of Social Medicine and Health Management, China Medical University, Shenyang 110122, China.

Background: Surgical site infection (SSI) has a high incidence in diabetic surgical patients. Preoperative antibiotic prophylaxis followed by an intraoperative re-dose was a common strategy in diabetic prolonged procedures. However, there were lacking studies on the relative benefits of this strategy on SSI. Read More

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http://dx.doi.org/10.21037/atm.2019.01.35DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6462642PMC
March 2019
9 Reads

Comparison of outcomes after carotid endarterectomy between type 2 diabetic and non-diabetic patients with significant carotid stenosis.

Cardiovasc Diabetol 2019 03 25;18(1):41. Epub 2019 Mar 25.

Department of Surgery, University of Ulsan College of Medicine and Asan Medical Center, Asanbyeongwon-gil 86, Songpa-gu, Seoul, 05505, Republic of Korea.

Background: We aimed to compare early and late outcomes after carotid endarterectomy (CEA) between Korean type 2 diabetic and non-diabetic patients and to investigate the impact of diabetes on the overall incidence of cardiovascular events after CEA.

Methods: We retrospectively analyzed 675 CEAs, which were performed on 613 patients with significant carotid stenosis between January 2007 and December 2014. The CEAs were divided into a type 2 diabetes mellitus (DM) group (n = 265, 39. Read More

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http://dx.doi.org/10.1186/s12933-019-0848-7DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6432752PMC
March 2019
6 Reads

Scrotoplasty at Time of Penile Implant is at High Risk for Dehiscence in Diabetics.

J Sex Med 2019 04 7;16(4):602-608. Epub 2019 Mar 7.

Mayo Clinic, Department of Urology, Rochester, MN, USA. Electronic address:

Introduction: Scrotoplasty has become a common practice during insertion of penile prosthesis, improving patient perception of penile length. Previous reports on scrotoplasty outcomes have only focused on the perceived benefits. The risk of wound complications after scrotoplasty is unknown. Read More

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http://dx.doi.org/10.1016/j.jsxm.2019.02.001DOI Listing
April 2019
14 Reads
3.151 Impact Factor

Preoperative hemoglobin A1c levels and increased risk of adverse limb events in diabetic patients undergoing infrainguinal lower extremity bypass surgery in the Vascular Quality Initiative.

J Vasc Surg 2019 10 7;70(4):1225-1234.e1. Epub 2019 Mar 7.

Division of Cardiology, University of Southern California Keck School of Medicine, Los Angeles, Calif. Electronic address:

Background: The impact of preoperative glycemic control on the risk of adverse perioperative outcomes in diabetic patients undergoing lower extremity bypass (LEB) surgery is not well-understood. We determined whether higher preoperative hemoglobin A1c (HbA1c) levels are associated with an increased risk of major adverse limb events, major adverse cardiovascular events, and mortality in diabetic patients undergoing infrainguinal LEB.

Methods: A retrospective review of all infrainguinal LEB surgeries in the Vascular Quality Initiative registry from January 2012 to February 2017 was performed. Read More

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http://dx.doi.org/10.1016/j.jvs.2018.12.041DOI Listing
October 2019
4 Reads
3.021 Impact Factor

Association between statin use and perioperative mortality after aortobifemoral bypass in patients with aortoiliac occlusive disease.

J Vasc Surg 2019 Aug 2;70(2):509-515. Epub 2019 Mar 2.

Division of Vascular and Endovascular Surgery, University of California San Diego, La Jolla, Calif. Electronic address:

Objective: The benefit of statins in reducing perioperative cardiovascular events in patients undergoing suprainguinal bypass is still controversial. The purpose of this study was to evaluate the association between statin use and perioperative mortality in patients undergoing aortobifemoral bypass (ABFB) for aortoiliac occlusive disease.

Methods: We retrospectively analyzed all patients who had ABFB in the American College of Surgeons National Surgical Quality Improvement Program data set from 2011 to 2016. Read More

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http://dx.doi.org/10.1016/j.jvs.2018.10.120DOI Listing
August 2019
10 Reads

Perioperative Dietary Restriction of Carbohydrates in the Management of Blood Glucose Levels in Patients Undergoing Total Knee Replacement.

J Arthroplasty 2019 06 29;34(6):1105-1109. Epub 2019 Jan 29.

Department of Orthopaedic Surgery, Brigham and Women's Hospital, Boston, MA; Department of Orthopaedic Surgery, Harvard Medical School, Boston, MA.

Background: Approximately 75% of the US population over 65 years has prediabetes or diabetes. Despite current evidence for the efficacy of carbohydrate restriction in managing blood glucose, this practice has not been implemented as part of routine perioperative blood sugar management. We hypothesize that a carbohydrate reduced hospital diet (CRD) of 135 g/d may improve blood sugar levels following total knee arthroplasty (TKA) compared to a non-carbohydrate reduced hospital diet (NCRD). Read More

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https://linkinghub.elsevier.com/retrieve/pii/S08835403193009
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http://dx.doi.org/10.1016/j.arth.2019.01.049DOI Listing
June 2019
16 Reads

New Five-Factor Modified Frailty Index Predicts Morbidity and Mortality in Geriatric Hip Fractures.

J Orthop Trauma 2019 Jul;33(7):319-323

Department of Orthopaedics, Medical University of South Carolina, Charleston, SC.

Introduction: Although the 11-factor modified frailty index (mFI-11) has been shown to predict adverse outcomes in elderly patients undergoing surgery for hip fractures, the newer 5-factor index has not been evaluated in this population. The goal of this study is to evaluate the mFI-5 as a predictor of morbidity and mortality in elderly patients undergoing surgical management for hip fractures.

Methods: The NSQIP database was queried for patients 60 years of age and older who underwent surgical management for hip fractures between 2005 and 2016. Read More

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http://dx.doi.org/10.1097/BOT.0000000000001455DOI Listing
July 2019
13 Reads

Development of Diabetes after Pancreaticoduodenectomy: Results of a 10-Year Series Using Prospective Endocrine Evaluation.

J Am Coll Surg 2019 04 26;228(4):400-412.e2. Epub 2019 Jan 26.

Department of Surgery, Emory University, Atlanta, GA; Winship Cancer Institute, Emory University, Atlanta, GA. Electronic address:

Background: Limited literature is available on the development of impaired glucose tolerance and diabetes mellitus after pancreaticoduodenectomy. The primary aim was to define the diabetic phenotype and correlate preoperative glycemic laboratory results to new-onset diabetes after pancreaticoduodenectomy.

Study Design: In this prospective study, perioperative fasting and postprandial (oral glucose tolerance test) plasma glucose, glycated hemoglobin, insulin, and c-peptide were measured in consecutive patients undergoing pancreaticoduodenectomy by the senior author from 2006 to 2017. Read More

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https://linkinghub.elsevier.com/retrieve/pii/S10727515193007
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http://dx.doi.org/10.1016/j.jamcollsurg.2018.12.042DOI Listing
April 2019
28 Reads

Perioperative Management of the Diabetic Patient Referred to Cardiac Surgery.

Braz J Cardiovasc Surg 2018 Nov-Dec;33(6):618-625

Cardiovascular Surgery Division, Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (InCor-HCFMUSP), São Paulo, SP, Brazil.

Currently there is a progressive increase in the prevalence of diabetes in a referred for cardiovascular surgery. Benefits of glycemic management (< 180 mg/dL) in diabetic patients compared to patients without diabetes in perioperative cardiac surgery. The purpose of this study is to present recommendations based on international evidence and adapted to our clinical practice for the perioperative management of hyperglycemia in adult patients with and without diabetes undergoing cardiovascular surgery. Read More

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http://dx.doi.org/10.21470/1678-9741-2018-0147DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6326452PMC
March 2019
6 Reads

Amputation rates of the lower limb by amputation level - observational study using German national hospital discharge data from 2005 to 2015.

BMC Health Serv Res 2019 01 6;19(1). Epub 2019 Jan 6.

Department of Structural Advancement and Quality Management in Health Care, Technische Universität Berlin, Berlin, Germany.

Background: In international comparisons, rates of amputations of the lower limb are relatively high in Germany. This study aims to analyze trends in lower limb amputations over time, as well as outcomes of care concerning in-hospital mortality and reamputation rates during the same hospital stay which might indicate the quality of surgical and perioperative health care processes.

Methods: This work is an observational population-based study using complete national hospital discharge data (Diagnosis-Related Group Statistics (DRG Statistics)) from 2005 to 2015. Read More

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http://dx.doi.org/10.1186/s12913-018-3759-5DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6322244PMC
January 2019
8 Reads

Sodium-glucose cotransporter-2 inhibitors: an overview and perioperative implications.

Curr Opin Anaesthesiol 2019 Feb;32(1):80-85

Department of Anesthesiology, Yale School of Medicine.

Purpose Of Review: Sodium-glucose cotransporter 2 (SGLT-2) inhibitors are a relatively new class of drugs used in the management of diabetes mellitus. This review will highlight key pharmacologic characteristics of this class of drugs; discuss their potential role in management of patients with cardiac disease; and raise several perioperative concerns for anesthesiologists caring for patients on SGLT-2 inhibitors.

Recent Findings: Recent trials have shown a strong mortality benefit in diabetic patients on SGLT 2 inhibitors especially in patients with a high cardiovascular burden. Read More

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http://dx.doi.org/10.1097/ACO.0000000000000674DOI Listing
February 2019
10 Reads

Evaluation and Perioperative Management of the Diabetic Patient.

Clin Podiatr Med Surg 2019 Jan 25;36(1):83-102. Epub 2018 Oct 25.

Department of Psychiatry, Rutgers New Jersey Medical School, 185 South Orange Avenue, Newark, NJ 07103, USA.

Diabetes mellitus is a devastating disease that has reached epidemic proportions. The surgical patient with diabetes is at increased risk for developing complications when compared with patients without diabetes. A comprehensive preoperative work-up must be performed, including ancillary studies, with optimization of the patient's glucose levels during the perioperative period to decrease the chance of developing surgical complications. Read More

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https://linkinghub.elsevier.com/retrieve/pii/S08918422183005
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http://dx.doi.org/10.1016/j.cpm.2018.08.004DOI Listing
January 2019
45 Reads

Preoperative Anesthetic Considerations in the Podiatric Surgical Candidate.

Clin Podiatr Med Surg 2019 Jan 25;36(1):1-19. Epub 2018 Oct 25.

General Anesthesiology and Critical Care, Cleveland Clinic Lerner College of Medicine, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195, USA.

There are multiple challenges the podiatric surgeon faces while attempting to treat patients in the perioperative setting. Given the aging and increasingly complex surgical population, preoperative evaluation is of utmost importance to mitigate unnecessary risks and to optimize patient outcomes. This article reviews key preoperative considerations, patient evaluation, and factors affecting selection of anesthetic technique. Read More

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http://dx.doi.org/10.1016/j.cpm.2018.08.001DOI Listing
January 2019
38 Reads

Association between acute phase perioperative glucose parameters and postoperative outcomes in diabetic and non-diabetic patients undergoing non-cardiac surgery.

Am J Surg 2019 08 16;218(2):302-310. Epub 2018 Oct 16.

Department of Anesthesiology, VA Puget Sound Health Care System, Seattle, WA, USA. Electronic address:

Background: The relationship between acute phase perioperative hyperglycemia and postoperative outcome is poorly understood.

Methods: Retrospective cohort study of diabetic and non-diabetic adult patients undergoing non-cardiac surgery. Mean glucose and glycemic variability during the intraoperative and immediate postoperative periods were compared to length of stay, 30-day mortality, and postoperative complications. Read More

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http://dx.doi.org/10.1016/j.amjsurg.2018.10.024DOI Listing
August 2019
10 Reads

PROACTIVE PROTOCOL-BASED MANAGEMENT OF HYPERGLYCEMIA AND DIABETES IN COLORECTAL SURGERY PATIENTS.

Endocr Pract 2018 Dec 5;24(12):1073-1085. Epub 2018 Oct 5.

Objective: The management of diabetic patients undergoing elective abdominal surgery continues to be unsystematic, despite evidence that standardized perioperative glycemic control is associated with fewer postoperative surgical complications. We examined the efficacy of a pre-operative diabetes optimization protocol implemented at a single institution in improving perioperative glycemic control with a target blood glucose of 80 to 180 mg/dL.

Methods: Patients with established and newly diagnosed diabetes who underwent elective colorectal surgery were included. Read More

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http://journals.aace.com/doi/10.4158/EP-2018-0379
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http://dx.doi.org/10.4158/EP-2018-0379DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6485257PMC
December 2018
29 Reads

Mexiletine Usage in a Chronic Pain Clinic: Indications, Tolerability, and Side Effects.

Pain Physician 2018 09;21(5):E573-E579

Department of Anesthesiology, Pain Management & Perioperative Medicine; Henry Ford Health System; Detroit, MI.

Background: Intravenous lidocaine has multiple applications in the management of acute and chronic pain. Mexiletine, an oral lidocaine analogue, has been used in a number of chronic pain conditions although its use is not well characterized.

Objectives: To report our experience using mexiletine in a chronic pain population, specifically looking at tolerability, side effects, and EKG changes. Read More

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September 2018
10 Reads

Cataract surgery in diabetes mellitus: A systematic review.

Indian J Ophthalmol 2018 Oct;66(10):1401-1410

Department of Ophthalmology, Nottingham University Hospitals NHS Trust, University of Nottingham, Nott Inghamshire, UK.

India is considered the diabetes capital of the world, and a significant proportion of patients undergoing cataract surgery are diabetic. Considering this, we reviewed the principles and guidelines of managing cataract in patients with diabetes. The preoperative, intraoperative, and postoperative factors are of paramount importance in the management of diabetic cataract patients. Read More

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http://dx.doi.org/10.4103/ijo.IJO_1158_17DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6173035PMC
October 2018
13 Reads

Autonomic disturbances in diabetes: Assessment and anaesthetic implications.

Indian J Anaesth 2018 Aug;62(8):575-583

Department of Anaesthesia and Intensive Care, Nizam's Institute of Medical Sciences, Hyderabad, Telangana, India.

Diabetes mellitus is the most common medical condition and with increased awareness of heath and related issues, several patients are getting diagnosed with diabetes. The poor control of sugar and long-standing status of disease affects the autonomic system of body. The autonomic nervous system innervates cardiovascular, gastrointestinal, and genitourinary system, thus affecting important functions of the body. Read More

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http://dx.doi.org/10.4103/ija.IJA_224_18DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6100274PMC
August 2018
33 Reads

Gastric Ultrasound for the Regional Anesthesiologist and Pain Specialist.

Reg Anesth Pain Med 2018 Oct;43(7):689-698

Department of Anesthesiology, University of Toronto, Toronto, Ontario, Canada.

This article in our series on point-of-care ultrasound (US) for the regional anesthesiologist and pain management specialist describes the emerging role of gastric ultrasonography. Although gastric US is a relatively new point-of-care US application in the perioperative setting, its relevance for the regional anesthesiologist and pain specialist is significant as our clinical practice often involves providing deep sedation without a secured airway. Given that pulmonary aspiration is a well-known cause of perioperative morbidity and mortality, the ability to evaluate for NPO (nil per os) status and risk stratify patients scheduled for anesthesia is a powerful skill set. Read More

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http://dx.doi.org/10.1097/AAP.0000000000000846DOI Listing
October 2018
25 Reads

Preoperative Continuation Versus Interruption of Oral Hypoglycemics in Type 2 Diabetic Patients Undergoing Ambulatory Surgery: A Randomized Controlled Trial.

Anesth Analg 2018 10;127(4):e54-e56

From the Departments of Anesthesiology and Pain Management.

Patients with type 2 diabetes mellitus receiving oral hypoglycemic drugs (OHDs) are usually instructed to stop them before surgery. We hypothesize that continuing OHD preoperatively should result in lower perioperative blood glucose (BG) levels. Ambulatory surgery patients with type 2 diabetes mellitus on OHDs were randomized to continue (n = 69) or withhold (n = 73) OHDs preoperatively. Read More

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http://dx.doi.org/10.1213/ANE.0000000000003675DOI Listing
October 2018
28 Reads

Comparable clinical and structural outcomes after arthroscopic rotator cuff repair in diabetic and non-diabetic patients.

Knee Surg Sports Traumatol Arthrosc 2018 Dec 17;26(12):3810-3817. Epub 2018 Jul 17.

Department of Orthopaedic Surgery, Tokushima Red Cross Hospital, 103 Irinokuchi, Komatsushima-cho, Komatsushima, Tokushima, 773-8502, Japan.

Purpose: To compare clinical outcome and rotator cuff integrity after arthroscopic rotator cuff repair (ARCR) in patients with and without diabetes mellitus.

Methods: This retrospective study involved 264 consecutive patients who underwent ARCR from 2012 to 2015. Inclusion criteria were a medium or large-sized tear and a minimum of 1-year follow-up. Read More

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http://dx.doi.org/10.1007/s00167-018-4994-3DOI Listing
December 2018
39 Reads

Incidence of heparin-induced thrombocytopenia in lower-extremity free flap reconstruction correlates with the overall surgical population.

J Plast Reconstr Aesthet Surg 2018 09 8;71(9):1252-1259. Epub 2018 Jun 8.

Department of Plastic Surgery, MedStar Georgetown University Hospital, 3800 Reservoir Rd NW, Washington DC 20007, United States. Electronic address:

Background: Lower-extremity free flap reconstruction is a growing trend in the management of lower extremity wounds. Heparin-induced thrombocytopenia (HIT) is a significant risk to free flap reconstruction. The purpose of this study was to investigate the incidence of HIT in patients receiving lower-extremity free flap surgery. Read More

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http://dx.doi.org/10.1016/j.bjps.2018.05.034DOI Listing
September 2018
6 Reads

Clinical significance of perioperative changes in ankle-brachial index with regard to extremity-related outcome in non-diabetic patients with critical limb ischemia.

Langenbecks Arch Surg 2018 Sep 17;403(6):741-748. Epub 2018 Jun 17.

Department of Vascular and Endovascular Surgery, Heidelberg University Hospital, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany.

Purpose: To evaluate the significance of perioperative changes in ankle-brachial index (ABI) with regard to extremity-related outcome in non-diabetic patients with critical limb ischemia (CLI) following revascularization.

Methods: The study represents a subanalysis of the multicentric Registry of First-line Treatment in Patients with CLI (CRITISCH). After exclusion of diabetic patients, conservative cases, and primary major amputation, 563 of 1200 CRITISCH patients (mean age 74 ± 10. Read More

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http://dx.doi.org/10.1007/s00423-018-1689-7DOI Listing
September 2018
44 Reads

Functional Connectivity Alterations: Novel Therapy and Future Implications in Chronic Pain Management.

Pain Physician 2018 05;21(3):E207-E214

Department of Anesthesiology, Perioperative, and Pain Medicine, Brigham and Women's Hospital/Harvard, Boston, MA; Department of Anesthesiology, LSU School of Medicine, New Orleans, LA.

Background: Chronic pain is a major public health problem resulting in physical and emotional pain for individuals and families, loss of productivity, and an annual cost of billions of dollars. The lack of objective measures available to aid in diagnosis and evaluation of therapies for chronic pain continues to be a challenge for the clinician.

Objectives: Functional magnetic resonance imaging (fMRI) is an imaging technique that can establish regional areas of interest and examine synchronous neuronal activity in functionally related but anatomically distinct regions of the brain, known as functional connectivity. Read More

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May 2018
11 Reads

Accurate pain reporting training diminishes the placebo response: Results from a randomised, double-blind, crossover trial.

PLoS One 2018 24;13(5):e0197844. Epub 2018 May 24.

Analgesic Solutions, Natick, Massachusetts, United States of America.

Analgesic trials frequently fail to demonstrate efficacy of drugs known to be efficacious. Poor pain reporting accuracy is a possible source for this low essay-sensitivity. We report the effects of Accurate-Pain-Reporting-Training (APRT) on the placebo response in a trial of Pregabalin for painful-diabetic-neuropathy. Read More

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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0197844PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5993117PMC
December 2018
24 Reads

Association Between Ethnicity and Postoperative Hyperglycemia in a Southeast Asian Population Undergoing Cardiac Surgery.

J Cardiothorac Vasc Anesth 2019 02 7;33(2):388-393. Epub 2018 Mar 7.

Singapore General Hospital, Department of Anaesthesia, Singapore. Electronic address:

Objective: Postoperative hyperglycemia is a known risk factor for adverse outcomes following cardiac surgery. Therefore, the authors investigated the association between ethnicity and postoperative hyperglycemia in a Southeast Asian multiethnic population undergoing cardiac surgery.

Design: Perioperative data were analyzed prospectively. Read More

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http://dx.doi.org/10.1053/j.jvca.2018.03.010DOI Listing
February 2019
16 Reads

Tanezumab: Therapy targeting nerve growth factor in pain pathogenesis.

J Anaesthesiol Clin Pharmacol 2018 Jan-Mar;34(1):111-116

Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, USA.

In recent years, nerve growth factor (NGF) and the NGF receptor have become potential therapeutic targets in the treatment of acute and chronic pain states. NGF is a neurotrophin involved in regulating the function of sensory and sympathetic neurons during development. Numerous pain states have been linked to elevated levels of NGF and its role in increasing the perception of pain. Read More

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http://dx.doi.org/10.4103/joacp.JOACP_389_15DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5885425PMC
April 2018
13 Reads