315 results match your criteria Perioperative Management of the Diabetic Patient


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

J Arthroplasty 2019 Jan 29. 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
January 2019
5 Reads

New 5-Factor Modified Frailty Index Predicts Morbidity and Mortality in Geriatric Hip Fractures.

J Orthop Trauma 2019 Jan 30. Epub 2019 Jan 30.

Medical University of South Carolina Department of Orthopaedics 96 Jonathan Lucas Dr CSB 708 Charleston, SC 29425.

Introduction: While 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 aged 60 years and older who underwent surgical management for hip fractures between 2005-2016. Read More

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http://dx.doi.org/10.1097/BOT.0000000000001455DOI Listing
January 2019
1 Read

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
1 Read

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 Jan 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
2 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
1 Read

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
17 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
15 Reads

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

Am J Surg 2018 Oct 16. 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
October 2018
2 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
December 2018
4 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
3 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
4 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
27 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
3 Reads

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

Anesth Analg 2018 Oct;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
9 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
2 Reads

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

J Plast Reconstr Aesthet Surg 2018 Sep 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
1 Read

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
4 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
7 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
3 Reads

When Guidelines Fail: Euglycemic Diabetic Ketoacidosis After Bariatric Surgery in a Patient Taking a Sodium-Glucose Cotransporter-2 Inhibitor: A Case Report.

A A Pract 2018 Jul;11(2):46-48

Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Ontario, Canada.

A 42-year-old woman with diabetes mellitus type 2 treated with the sodium-glucose cotransporter-2 inhibitor canagliflozin underwent elective bariatric gastric bypass. The canagliflozin was held for 24 hours preoperatively. She physiologically decompensated on postoperative day 2. Read More

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http://Insights.ovid.com/crossref?an=02054229-201807150-0000
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http://dx.doi.org/10.1213/XAA.0000000000000734DOI Listing
July 2018
8 Reads

Treatment outcomes in diabetic patients with chronic limb-threatening ischemia.

J Vasc Surg 2018 08 22;68(2):487-494. Epub 2018 Mar 22.

Division of Vascular and Endovascular Surgery, Department of Surgery, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Mass. Electronic address:

Objective: There are conflicting reports about outcomes after infrainguinal bypass for chronic limb-threatening ischemia (CLTI) in patients with diabetes. We compared perioperative outcomes between patients with and patients without diabetes in the current era.

Methods: The National Surgical Quality Improvement Program vascular module, 2011 to 2014, was used to identify patients undergoing infrainguinal revascularization for CLTI. Read More

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http://dx.doi.org/10.1016/j.jvs.2017.11.081DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6057811PMC
August 2018
4 Reads

Perioperative management of adult diabetic patients. Review of hyperglycaemia: definitions and pathophysiology.

Anaesth Crit Care Pain Med 2018 Jun 17;37 Suppl 1:S5-S8. Epub 2018 Mar 17.

Department of surgical anaesthesia and intensive care, South Paris university hospital, hôpital de Bicêtre, AP-HP, 78, rue du Général-Leclerc, 94275 Le Kremlin-Bicêtre, France. Electronic address:

Diabetes mellitus is defined by chronic elevation of blood glucose linked to insulin resistance and/or insulinopaenia. Its diagnosis is based on a fasting blood-glucose level of ≥1.26g/L or, in some countries, a blood glycated haemoglobin (HbA1c) level of >6. Read More

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https://linkinghub.elsevier.com/retrieve/pii/S23525568173029
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http://dx.doi.org/10.1016/j.accpm.2018.02.019DOI Listing
June 2018
5 Reads

Perioperative management of adult diabetic patients. Preoperative period.

Anaesth Crit Care Pain Med 2018 Jun 17;37 Suppl 1:S9-S19. Epub 2018 Mar 17.

Service d'anesthésie - réanimation chirurgicale, hôpitaux universitaires Paris-Sud, AP-HP, 78, rue du Général-Leclerc, 94275 Le Kremlin-Bicêtre, France. Electronic address:

In diabetic patients undergoing surgery, we recommend assessing glycaemic control preoperatively by assessing glycated haemoglobin (HbA1c) levels and recent capillary blood sugar (glucose) levels, and to adjust any treatments accordingly before surgery, paying particular attention to specific complications of diabetes. Gastroparesis creates a risk of stasis and aspiration of gastric content at induction of anaesthesia requiring the use of a rapid sequence induction technique. Cardiac involvement can be divided into several types. Read More

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http://dx.doi.org/10.1016/j.accpm.2018.02.020DOI Listing
June 2018
10 Reads

Perioperative management of adult diabetic patients. Postoperative period.

Anaesth Crit Care Pain Med 2018 Jun 16;37 Suppl 1:S27-S30. Epub 2018 Mar 16.

Service d'anesthésie - réanimation chirurgicale, hôpitaux universitaires Paris-Sud, AP-HP, 78, rue du Général-Leclerc, 94275 Le Kremlin-Bicêtre, France. Electronic address:

Follow on from continuous intravenous administration of insulin with an electronic syringe (IVES) is an important element in the postoperative management of a diabetic patient. The basal-bolus scheme is the most suitable taking into account the nutritional supply and variable needs for insulin, reproducing the physiology of a normal pancreas: (i) slow (long-acting) insulin (=basal) which should immediately take over from IVES insulin simulating basal secretion; (ii) ultra-rapid insulin to simulate prandial secretion (=bolus for the meal); and (iii) correction of possible hyperglycaemia with an additional ultra-rapid insulin bolus dose. A number of schemes are proposed to help calculate the dosages for the change from IV insulin to subcutaneous insulin and for the basal-bolus scheme. Read More

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http://dx.doi.org/10.1016/j.accpm.2018.02.023DOI Listing
June 2018
11 Reads

Perioperative management of adult diabetic patients. Intraoperative period.

Anaesth Crit Care Pain Med 2018 Jun 16;37 Suppl 1:S21-S25. Epub 2018 Mar 16.

Department of surgical anaesthesia and intensive care, South Paris university hospital, hôpital de Bicêtre, AP-HP, 78, rue du Général-Leclerc, 94275 Le Kremlin-Bicêtre, France. Electronic address:

Perioperative hyperglycaemia (>1.80g/L or 10mmol/L) increases morbidity (particularly due to infection) and mortality. Hypoglycaemia can be managed in the perioperative period by decreasing blood sugar levels with insulin between 0. Read More

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http://dx.doi.org/10.1016/j.accpm.2018.02.018DOI Listing
June 2018
47 Reads

Perioperative management of adult diabetic patients. Specific situations.

Anaesth Crit Care Pain Med 2018 Jun 16;37 Suppl 1:S31-S35. Epub 2018 Mar 16.

Department of surgical anaesthesia and intensive care, South Paris university hospital, hôpital de Bicêtre, AP-HP, 78, rue du Général-Leclerc, 94275 Le Kremlin-Bicêtre, France. Electronic address:

Ambulatory surgery can be carried out in diabetic patients. By using a strict organisational and technical approach, the risk of glycaemic imbalance is minimised, allowing the patients to return to their previous way of life more quickly. Taking into account the context of ambulatory surgery, with a same day discharge, the aims are to minimise the changes to antidiabetic treatment, to maintain adequate blood sugar control and to resume oral feeding as quickly as possible. Read More

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http://dx.doi.org/10.1016/j.accpm.2018.02.022DOI Listing
June 2018
9 Reads

Management Strategies for Noncardiac Surgery Following a Coronary Artery Event.

Curr Cardiol Rep 2018 01 20;20(1). Epub 2018 Jan 20.

Gill Heart and Vascular Institute, University of Kentucky, 326 Wethington Building, 900 South Limestone Street, Lexington, KY, 40536-0200, USA.

Purpose Of Review: Coronary artery event includes acute coronary syndrome (ACS), percutaneous coronary intervention (PCI), and coronary artery bypass graft (CABG) surgery. Following such an event, risk of noncardiac surgery is increased. Of major concern is what can make this surgery safer?

Recent Findings: High functional capacity improves cardiovascular (CV) risk; at least 4. Read More

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http://dx.doi.org/10.1007/s11886-018-0948-0DOI Listing
January 2018
6 Reads

Operating department practitioners care of the patient with diabetes in the perioperative period.

Authors:
Nicola Morley

J Perioper Pract 2017 Apr;27(4):71-76

BSc ODP Student, UK.

Diabetes mellitus (DM) is a of group metabolic diseases which are defined by hyperglycaemia affecting multiple organs. The condition is found in people of all ages and ethnicities. Diabetes mellitus affects 180 million people worldwide and increasing numbers of patients are presenting with diabetic complications and the need for surgical intervention. Read More

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http://dx.doi.org/10.1177/175045891702700402DOI Listing
April 2017
9 Reads

Perioperative management of adult diabetic patients. The role of the diabetologist.

Anaesth Crit Care Pain Med 2018 Jun 6;37 Suppl 1:S37-S38. Epub 2018 Jan 6.

Anaesthesia and intensive care department, hôpitaux universitaires Paris-Sud, AP-HP, hôpital de Bicêtre, 78, rue du Général-Leclerc, 94275 Le Kremlin-Bicêtre, France. Electronic address:

A patient should be referred to a diabetologist perioperatively in several circumstances: preoperative recognition of a previously unknown diabetes or detection of glycaemic imbalance (HbA1c <5% or >8%); during hospitalisation, recognition of a previously unknown diabetes, persisting glycaemic imbalance despite treatment or difficulty resuming previously used chronic treatment; postoperatively and after discharge from hospital, for all diabetic patients in whom HbA1c is >8%. Read More

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https://linkinghub.elsevier.com/retrieve/pii/S23525568173029
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http://dx.doi.org/10.1016/j.accpm.2017.10.009DOI Listing
June 2018
17 Reads

Perioperative implications of sodium-glucose cotransporter-2 inhibitors: a case series of euglycemic diabetic ketoacidosis in three patients after cardiac surgery.

Can J Anaesth 2018 02 22;65(2):188-193. Epub 2017 Nov 22.

Department of Anesthesiology, Pharmacology & Therapeutics, University of British Columbia, Vancouver, BC, Canada.

Purpose: Sodium-glucose cotransporter-2 inhibitors (SGLT2i) comprise the newest class of oral hypoglycemic agents approved for treating type II diabetes mellitus (DM-II). Their use, however, has been associated with the rare development of euglycemic diabetic ketoacidosis (euDKA). We present three cases of euDKA that occurred following elective coronary artery bypass grafting surgery. Read More

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http://link.springer.com/10.1007/s12630-017-1018-6
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http://dx.doi.org/10.1007/s12630-017-1018-6DOI Listing
February 2018
25 Reads

Does Site Matter? Comparing Accuracy and Patient Comfort of Blood Glucose Samples Taken From the Finger and Palm of the Perioperative Patient.

J Perianesth Nurs 2017 Dec 22;32(6):573-577. Epub 2017 Mar 22.

Purpose: This study compared two blood glucose (BG) point of care sampling methods to determine which is least painful yet accurate.

Design: The two-period, two-treatment crossover trial compared the traditional fingertip sampling method to a form of alternative site testing (AST), palm of the hand.

Methods: Subjects received both methods of BG sampling to compare comfort and accuracy. Read More

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http://dx.doi.org/10.1016/j.jopan.2016.10.006DOI Listing
December 2017
37 Reads

High hemoglobin A associated with increased adverse limb events in peripheral arterial disease patients undergoing revascularization.

J Vasc Surg 2018 01 31;67(1):217-228.e1. Epub 2017 Aug 31.

Division of Vascular Surgery and Endovascular Therapy, Department of Surgery, Emory University School of Medicine, Atlanta, Ga.

Objective: Diabetes and peripheral arterial disease (PAD) are independently associated with increased risk of amputation. However, the effect of poor glycemic control on adverse limb events has not been studied. We examined the effects of poor glycemic control (high hemoglobin A level) on the risk of amputation and modified major adverse limb events (mMALEs) after lower extremity revascularization. Read More

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http://dx.doi.org/10.1016/j.jvs.2017.06.101DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5741490PMC
January 2018
27 Reads

Pharmacology and Perioperative Considerations for Diabetes Mellitus Medications.

Curr Clin Pharmacol 2017 ;12(3):157-163

Division of General Internal Medicine, Mayo Clinic, Jacksonville, FL 32224, United States.

Background: Given the prevalence of diabetes mellitus in modern society, health care providers are frequently tasked with managing glucose control in the perioperative period. When determining perioperative diabetes management, the clinician must balance the need to maintain relative euglycemia at the time of surgery with preventing hypoglycemia or hyperglycemia in a fasting surgical patient. This balance requires an understanding of the pharmacology of these medications, the type of surgery, and the patient's degree of diabetic control. Read More

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http://dx.doi.org/10.2174/1574884712666170810115847DOI Listing
January 2017
38 Reads

Anesthesia for Kidney and Pancreas Transplantation.

Anesthesiol Clin 2017 Sep 10;35(3):439-452. Epub 2017 Jul 10.

Department of Anesthesiology, Columbia University Medical Center, College of Physicians & Surgeons, Columbia University, PH 527-B, 630 West 168th Street, New York, NY 10032, USA. Electronic address:

Kidney transplants are the most common solid organ abdominal transplant and are occasionally performed simultaneously with pancreas transplants in diabetic patients. Preoperative evaluation of potential transplant recipients should focus on the potential for occult cardiovascular disease while also screening for other signs of end-organ dysfunction. Intraoperatively, it is of utmost importance to ensure adequate graft perfusion to limit the risk of postoperative graft dysfunction or rejection. Read More

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http://dx.doi.org/10.1016/j.anclin.2017.04.005DOI Listing
September 2017
11 Reads

Perioperative antibiotic use in diabetic patients: A retrospective review of 670 surgeries.

J Plast Reconstr Aesthet Surg 2017 Nov 8;70(11):1629-1634. Epub 2017 Jul 8.

Department of Plastic Surgery, Louis Stokes VA Medical Center, 10701 East Boulevard, Cleveland, OH, 44106, USA. Electronic address:

Purpose: Carpal tunnel syndrome (CTS) has a high incidence in diabetic patients, with a reported incidence up to 21%. In severe cases of CTS, patients may undergo carpal tunnel release (CTR) surgery, which involves the risk of infection and other complications. To decrease the risk of infection, some physicians provide prophylactic antibiotics. Read More

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http://dx.doi.org/10.1016/j.bjps.2017.06.042DOI Listing
November 2017
10 Reads

Update in perioperative medicine: practice changing evidence published in 2016.

Hosp Pract (1995) 2017 Oct 28;45(4):158-164. Epub 2017 Jul 28.

a General Internal Medicine , Mayo Clinic , Rochester , MN , USA.

This summary reviews 18 key articles published in 2016 which have significant practice implications for the perioperative medical care of surgical patients. Due to the multi-disciplinary nature of the practice of perioperative medicine, important new evidence is published in journals representing a variety of medical and surgical specialties. Keeping current with the evidence that drives best practice in perioperative medicine is therefore challenging. Read More

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http://dx.doi.org/10.1080/21548331.2017.1359060DOI Listing
October 2017
9 Reads

Sarcopenia is a Predictor of Surgical Morbidity in Inflammatory Bowel Disease.

Inflamm Bowel Dis 2017 10;23(10):1867-1872

The University of Iowa Hospitals and Clinics, Iowa City, Iowa.

Background: Sarcopenia is associated with an increased risk of operative morbidity and mortality. The impact of sarcopenia in inflammatory bowel disease (IBD) has not been evaluated. This study assessed the role of sarcopenia on operative outcomes in IBD. Read More

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http://dx.doi.org/10.1097/MIB.0000000000001166DOI Listing
October 2017
42 Reads

Effect of Preoperative Diabetes Management on Glycemic Control and Clinical Outcomes After Elective Surgery.

Ann Surg 2018 May;267(5):858-862

Division of Endocrinology, Diabetes, and Hypertension, Brigham and Women's Hospital, Harvard Medical School, Boston, MA.

Objective: The aim of this study was to evaluate whether preoperative diabetes management can improve glycemic control and clinical outcomes after elective surgery.

Background: There is lack of data on the importance of diabetes treatment before elective surgery. Diabetes is often ignored before surgery and aggressively treated afterwards. Read More

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http://dx.doi.org/10.1097/SLA.0000000000002323DOI Listing
May 2018
77 Reads

[Nutrition management in obese patients with type 2 diabetes mellitus after laparoscopic sleeve gastrectomy].

Zhonghua Wei Chang Wai Ke Za Zhi 2017 Apr;20(4):411-416

Center of Metabolic and Bariatric Surgery, Fudan University Pudong Medical Center, Shanghai 201399, China.

Objective: To explore the value of nutrition management in obese patients with type 2 diabetes mellitus(T2DM) after laparoscopic sleeve gastrectomy(LSG).

Methods: Clinical data of 22 obese T2DM patients undergoing LSG from March 2013 to July 2015 in Fudan University Pudong Medical Center were collected. All the patients strictly followed the specialized instruction by nutritionists: diabetic and low calorie diet 3347. Read More

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April 2017
15 Reads

A Meta-analysis of Long-term Mortality and Associated Risk Factors following Lower Extremity Amputation.

Ann Vasc Surg 2017 Jul 5;42:322-327. Epub 2017 Apr 5.

Department of Surgery, Division of Vascular Surgery and Endovascular Interventions, Columbia University Medical Center, New York, NY.

Background: A majority of patients undergoing lower limb amputations have diabetes or peripheral artery disease. Despite improvements in care, there remains a substantial perioperative mortality associated with these procedures. Less well-defined is the mortality risk to these patients going forward, once outside the perioperative period. Read More

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http://dx.doi.org/10.1016/j.avsg.2016.12.015DOI Listing
July 2017
13 Reads

Diabetes Mellitus and Hyperglycemia and the Risk of Aseptic Loosening in Total Joint Arthroplasty.

J Arthroplasty 2017 09 2;32(9S):S251-S253. Epub 2017 Mar 2.

Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota.

Background: It is unknown to what extent diabetes mellitus modifies the long-term risk of aseptic loosening in total hip arthroplasty (THA) and total knee arthroplasty (TKA). We examined the association between diabetes mellitus, perioperative hyperglycemia, and the likelihood of revisions for aseptic loosening.

Methods: We studied 16,085 primary THA and TKA procedures performed at a large tertiary care hospital between 2002 and 2009. Read More

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http://dx.doi.org/10.1016/j.arth.2017.02.056DOI Listing
September 2017
7 Reads

Ischemic Optic Neuropathy in Cardiac Surgery: Incidence and Risk Factors in the United States from the National Inpatient Sample 1998 to 2013.

Anesthesiology 2017 05;126(5):810-821

From the Department of Anesthesia and Critical Care (D.S.R., A.T.), and Department of Anesthesia and Critical Care, The Center for Health and the Social Sciences (S.R.), The University of Chicago Medicine, Chicago, Illinois; Pritzker School of Medicine of the University of Chicago, Chicago, Illinois (M.M.M.); Department of Ophthalmology and Visual Science, Department of Neurology and Rehabilitation, College of Medicine, University of Illinois at Chicago, Chicago, Illinois (H.E.M.); Department of Ophthalmology and Visual Science, College of Medicine, Division of Epidemiology and Biostatistics, School of Public Health, University of Illinois at Chicago, Chicago, Illinois (C.E.J.); and Department of Anesthesiology, Department of Ophthalmology and Visual Sciences, College of Medicine, University of Illinois at Chicago, Chicago, Illinois (S.R.). Current position: Department of Ophthalmology, Byers Eye Center, Stanford University, Palo Alto, California (H.E.M.).

Background: Ischemic optic neuropathy is the most common form of perioperative visual loss, with highest incidence in cardiac and spinal fusion surgery. To date, potential risk factors have been identified in cardiac surgery by only small, single-institution studies. To determine the preoperative risk factors for ischemic optic neuropathy, the authors used the National Inpatient Sample, a database of inpatient discharges for nonfederal hospitals in the United States. Read More

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http://dx.doi.org/10.1097/ALN.0000000000001533DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5395417PMC
May 2017
19 Reads

A Perioperative Systems Design to Improve Intraoperative Glucose Monitoring Is Associated with a Reduction in Surgical Site Infections in a Diabetic Patient Population.

Anesthesiology 2017 Mar;126(3):431-440

From the Departments of Anesthesiology, Surgery, Biomedical Informatics, Health Policy, Vanderbilt University School of Medicine, Nashville, Tennessee (J.M.E.); Department of Surgery, Uniformed Services University of the Health Sciences, Vanderbilt University Hospital, Nashville, Tennessee (J.M.E.); Departments of Anesthesiology and Biomedical Informatics, Vanderbilt University School of Medicine, Nashville, Tennessee (J.P.W.); and Department of Anesthesiology, Vanderbilt University School of Medicine, Nashville, Tennessee (M.T., B.S.R., W.S.S.).

Background: Diabetic patients receiving insulin should have periodic intraoperative glucose measurement. The authors conducted a care redesign effort to improve intraoperative glucose monitoring.

Methods: With approval from Vanderbilt University Human Research Protection Program (Nashville, Tennessee), the authors created an automatic system to identify diabetic patients, detect insulin administration, check for recent glucose measurement, and remind clinicians to check intraoperative glucose. Read More

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http://dx.doi.org/10.1097/ALN.0000000000001516DOI Listing
March 2017
14 Reads

Long-Term Outcomes in the Management of Painful Diabetic Neuropathy.

Can J Neurol Sci 2017 Jul 9;44(4):337-342. Epub 2017 Jan 9.

1Department of Clinical Neurological Sciences,Western University,London,Canada.

Background: Painful diabetic neuropathy (PDN) is a frequent complication of diabetes mellitus. Current treatment recommendations are based on short-term trials, generally of ≤3 months' duration. Limited data are available on the long-term outcomes of this chronic disease. Read More

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http://dx.doi.org/10.1017/cjn.2016.429DOI Listing
July 2017
25 Reads

Patients With Type 2 Diabetes: Anesthetic Management in the Ambulatory Setting. Part 1: Pathophysiology and Associated Disease States.

Anesth Prog 2016 ;63(4):208-215

Assistant Professor, Department of Dental Anesthesiology, University of Pittsburgh School of Dental Medicine, Pittsburgh, Pennsylvania.

The increasing prevalence of diabetes mellitus in the general population has many implications for the ambulatory anesthesia provider. Complications, particularly associated with poor glycemic control, can affect multiple organ systems and jeopardize the safety of any planned anesthetic. It is essential that anesthesiologists and sedation providers have in-depth knowledge of the pathophysiology of diabetes mellitus and the comorbid conditions that commonly accompany it. Read More

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http://dx.doi.org/10.2344/0003-3006-63.4.208DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5157149PMC
June 2017
11 Reads

Pre-treatment clinical assessment in head and neck cancer: United Kingdom National Multidisciplinary Guidelines.

J Laryngol Otol 2016 May;130(S2):S13-S22

Department of Anaesthesia,Freeman Hospital,Newcastle upon Tyne NHS Foundation Trust,Newcastle upon Tyne,UK.

This is the official guideline endorsed by the specialty associations involved in the care of head and neck cancer patients in the UK. This paper provides recommendations on the pre-treatment clinical assessment of patients presenting with head and neck cancer. Recommendations • Comorbidity data should be collected as it is important in the analysis of survival, quality of life and functional outcomes after treatment as well as for comparing results of different treatment regimens and different centres. Read More

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http://dx.doi.org/10.1017/S0022215116000372DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4873895PMC
May 2016
35 Reads

Diabetes Mellitus with Chronic Complications in Relation to Carotid Endarterectomy and Carotid Artery Stenting Outcomes.

J Stroke Cerebrovasc Dis 2017 Jan 31;26(1):217-224. Epub 2016 Oct 31.

Department of Epidemiology, University of Alabama at Birmingham, Birmingham, Alabama. Electronic address:

Background: Carotid endarterectomy and carotid artery stenting are effective treatment procedures for carotid artery stenosis. Although diabetes mellitus is highly prevalent among patients undergoing these revascularization procedures, few studies have examined their impact on periprocedural outcomes.

Objectives: The study aimed to determine whether perioperative outcomes among patients undergoing carotid artery stenting and carotid endarterectomy varied depending on the presence of diabetes with or without chronic complications. Read More

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http://dx.doi.org/10.1016/j.jstrokecerebrovasdis.2016.09.012DOI Listing
January 2017
8 Reads
1 Citation
1.993 Impact Factor

ANAESTHESIA DURING OPERATIONS ON THE LOWER EXTREMITIES AT PATIENTS WITH COMPLICATED DIABETES MELLITUS.

Anesteziol Reanimatol 2016 Nov;61(6):474-478

Diabetes mellitus type 2 morbidity has increased signficantly in recent years. In spite of substantial advances in anesthesiology in past 25 years, there are no commonly used criteria in choosing anaesthetic techniques in these patients during lower limb surgery. The main risk factors in these patients are the most often complications of diabetes such as cardiovascular system diseases, polyneuropathia, nephropathia and retinopathia. Read More

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November 2016
3 Reads

Aortic Valve Stenosis in a Dialysis Patient Waitlisted for Kidney Transplantation.

Ann Thorac Surg 2016 Nov;102(5):e437-e438

Medical Clinic III, Department of Cardiology, University Hospital Frankfurt, Frankfurt, Germany. Electronic address:

Management of dialysis patients with valvular heart disease waitlisted for kidney transplantation is challenging. Development of severe aortic valve stenosis can lead to the exclusion from the transplant program or even death while on the waiting list. In dialysis patients, surgical aortic valve replacement is associated with a high perioperative risk with increased morbidity and mortality. Read More

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http://dx.doi.org/10.1016/j.athoracsur.2016.04.033DOI Listing
November 2016
51 Reads

Acute post-operative diabetic ketoacidosis: Atypical harbinger unmasking latent diabetes mellitus.

Indian J Anaesth 2016 Oct;60(10):763-765

Department of Anaesthesiology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India.

Hyperglycaemia following surgical and anaesthetic stress is a well-established entity which might have undesirable clinical consequences in known diabetics. We encountered a rare event where an undiagnosed diabetic patient developed ketoacidosis in the immediate post-operative period which was her initial presenting symptom of deranged glucoregulation. Presumably, the stress induced by surgery and anaesthesia lead to the genesis of this event. Read More

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http://dx.doi.org/10.4103/0019-5049.191697DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5064702PMC
October 2016
4 Reads