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    282 results match your criteria Perioperative Management of the Diabetic Patient

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    Management Strategies for Noncardiac Surgery Following a Coronary Artery Event.
    Curr Cardiol Rep 2018 Jan 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

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

    Perioperative management of adult diabetic patients.
    Anaesth Crit Care Pain Med 2018 Jan 6. Epub 2018 Jan 6.
    Service d'Anesthésie - Réanimation Chirurgicale, 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

    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 Feb 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

    High hemoglobin A1c associated with increased adverse limb events in peripheral arterial disease patients undergoing revascularization.
    J Vasc Surg 2018 Jan 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 A1c level) on the risk of amputation and modified major adverse limb events (mMALEs) after lower extremity revascularization. Read More

    Pharmacology and Perioperative Considerations for Diabetes Mellitus Medications.
    Curr Clin Pharmacol 2017 Aug 10. Epub 2017 Aug 10.
    Division of General Internal Medicine, Mayo Clinic, Jacksonville, Florida. 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

    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

    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

    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

    Sarcopenia is a Predictor of Surgical Morbidity in Inflammatory Bowel Disease.
    Inflamm Bowel Dis 2017 Oct;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

    Effect of Preoperative Diabetes Management on Glycemic Control and Clinical Outcomes after Elective Surgery.
    Ann Surg 2017 May 25. Epub 2017 May 25.
    *Division of Endocrinology, Diabetes, and Hypertension, Brigham and Women's Hospital, Harvard Medical School, Boston, MA †Department of Anesthesia, Pain, and Perioperative Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA ‡Baim Institute for Clinical Research, Boston, MA §Veterans Administration Hospital, 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

    [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

    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

    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

    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

    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

    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

    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

    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

    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

    The perioperative outcomes of eversion carotid endarterectomy in diabetic patients aged 80 years or older.
    J Vasc Surg 2016 Aug 22;64(2):348-353. Epub 2016 Mar 22.
    Department of Neurosciences, University of Padua, School of Medicine, Padova, Italy.
    Background: Uncertainty exists about the influence of advanced age and diabetes mellitus on the clinical effect of carotid endarterectomy (CEA). This study analyzed the perioperative (30-day) outcomes of CEA in diabetic patients aged ≥80 years.

    Methods: Data of 1872 consecutive patients who underwent 2125 primary eversion CEAs from 1990 to 2014 at our institution were prospectively stored in a vascular surgery registry. Read More

    Starvation Ketoacidosis as a Cause of Unexplained Metabolic Acidosis in the Perioperative Period.
    Am J Case Rep 2016 Oct 18;17:755-758. Epub 2016 Oct 18.
    Department of Anesthesiology and Perioperative Medicine, Penn State Milton S. Hershey Medical Center, Hershey, PA, USA.
    BACKGROUND Besides providing anesthesia for surgery, the anesthesiologist's role is to optimize the patient for surgery and for post-surgical recovery. This involves timely identification and treatment of medical comorbidities and abnormal laboratory values that could complicate the patient's perioperative course. There are several potential causes of anion and non-anion gap metabolic acidosis in surgical patients, most of which could profoundly affect a patient's surgical outcome. Read More

    Postoperative dysglycemia in elective non-diabetic surgical patients: a prospective observational study.
    Can J Anaesth 2016 Dec 3;63(12):1319-1334. Epub 2016 Oct 3.
    Department of Anesthesiology and Perioperative Medicine, Queen's University, Kingston General Hospital, 76 Stuart Street, Kingston, ON, K7L 2V7, Canada.
    Purpose: Elevated glycosylated hemoglobin (HbA1c) is often found in surgical patients with no history of diabetes. The purpose of this prospective observational study was to determine if elevated preoperative HbA1c is associated with postoperative hyperglycemia in non-diabetic surgical patients and to identify predictors of elevated HbA1c.

    Methods: This study included 257 non-diabetic adults scheduled for inpatient surgery. Read More

    The effects of optimal perioperative glucose control on morbidly obese patients undergoing bariatric surgery.
    Surg Endosc 2017 Mar 22;31(3):1407-1413. Epub 2016 Jul 22.
    Department of Surgery, University of Wisconsin - Madison, 600 Highland Avenue, CSC K7/728, Madison, WI, 53792, USA.
    Background: Bariatric surgery is the most effective treatment for morbidly obese type II diabetics. However, guidelines for perioperative glucose control are not well established. We examined management of perioperative glucose levels in diabetic patients undergoing bariatric surgery and determined the impact of optimal glucose control as defined by the American Society for Metabolic and Bariatric Surgery (ASMBS) on patient outcomes, including long-term diabetes resolution. Read More

    Comparison of the effects of remifentanil-based general anesthesia and popliteal nerve block on postoperative pain and hemodynamic stability in diabetic patients undergoing distal foot amputation: A retrospective observational study.
    Medicine (Baltimore) 2016 Jul;95(29):e4302
    aDepartment of Anesthesiology and Pain Medicine bAnesthesia and Pain Research Institute cDepartment of Research Affairs, Biostatistics Collaboration Units dDepartment of Orthopedic Surgery, Yonsei University College of Medicine, Seoul, Republic of Korea.
    Diabetic foot ulcer is the most common cause of diabetes-associated nontraumatic lower extremity amputation. Most patients who undergo lower extremity amputation for a diabetic foot have had diabetes for a long time and suffer from multiorgan disorder; thus, it can be a challenge to ensure sufficient anesthetic and analgesic effects while maintaining stable hemodynamics. Recently, peripheral nerve block has gained popularity owing to its attenuating effects of systemic concerns. Read More

    Coronary artery calcium score and coronary computed tomographic angiography for major perioperative cardiovascular complications in symptomatic diabetic patients undergoing trans-femoral amputation.
    Int J Cardiol 2016 Oct 28;221:806-11. Epub 2016 Jun 28.
    Tashkent Medical Academy Second Clinic, Republican Centre of purulent surgery and complications of diabetes, 100109, Farobiy Street, 2, Olmazar District, Tashkent, Uzbekistan. Electronic address:
    Objective: Perioperative risk for major cardiovascular events (MACE) is particularly high in patients with type 2 diabetes undergoing surgery for trans-femoral amputation (TFA). The aim of this study was to identify prognostic value of coronary calcium score (CACS) and coronary computed tomographic angiography (CCTA) for perioperative MACE in these patients.

    Methods: In this prospective single center interventional cohort study, we evaluated 331 consecutive symptomatic patients with diabetes and without history of coronary intervention or myocardial infarction (MI) undergoing TFA in 2013. Read More

    Consensus on surgical aspects of managing osteomyelitis in the diabetic foot.
    Diabet Foot Ankle 2016 12;7:30079. Epub 2016 Jul 12.
    Division of Vascular Surgery and Endovascular Therapy, Michael E. DeBakey Department of Surgery, Baylor College of Medicine / Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas;
    Background: The aim of this study was to develop consensus statements that may help share or even establish 'best practices' in the surgical aspects of managing diabetic foot osteomyelitis (DFO) that can be applied in appropriate clinical situations pending the publication of more high-quality data.

    Methods: We asked 14 panelists with expertise in DFO management to participate. Delphi methodology was used to develop consensus statements. Read More

    Association between registered nurse staffing and management outcomes of patients with type 2 diabetes within primary care: a cross-sectional linkage study.
    CMAJ Open 2016 Apr-Jun;4(2):E264-70. Epub 2016 Jun 3.
    School of Nursing (Lukewich), Memorial University of Newfoundland, St. John's, Nfld.; School of Nursing (Edge, VanDenKerkhof, Tranmer), Department of Anesthesiology and Perioperative Medicine (VanDenKerkhof), School of Medicine, and Department of Public Health Sciences (Tranmer), Faculty of Health Sciences, Queen's University, Kingston, Ont.; Department of Community Health Sciences (Williamson), Cumming School of Medicine, University of Calgary, Calgary, Alta.
    Background: As the organization of primary care continues to evolve toward more interdisciplinary team structures, demonstrating effectiveness of care delivery is becoming important, particularly for nonphysician providers. Nurses are the most common nonphysician provider within primary care. The purpose of this study was to examine the relation between primary care delivery models that incorporate registered nurses and clinical outcomes of patients with type 2 diabetes. Read More

    Pre and postoperative evaluation of transcranial Doppler pulsatility index of the middle cerebral artery in patients with severe carotid artery stenosis.
    Ann Ital Chir 2016 ;87:209-13
    Unlabelled: In the management of severe carotid artery stenosis particular importance must be given to the evaluation of the risk of perioperative cerebral ischemic events. Our study analysed the possible relationship between the pre-operative middle cerebral artery Gosling Index, calculated after transcranial Doppler (TCD), and intra-operative stump pressure (SP), in order to identify patients with higher risk of ischemic accidents. Moreover, we studied pre- and post- operative Gosling Index values in association with possible events during follow-up. Read More

    30-Day Morbidity and Reoperation Following Midurethral Sling: Analysis of 8772 Cases Using a National Prospective Database.
    Urology 2016 09 16;95:72-9. Epub 2016 May 16.
    Department of Surgery, Section of Urology, University of Chicago Medicine, Chicago, IL.
    Objective: To determine 30-day complications, risk of readmission, and reoperation for midurethral slings (MUS).

    Methods: The National Surgical Quality Improvement Program database from 2006 to 2013 was queried for MUS alone by excluding concurrent reconstructive, urologic, or gynecologic procedures. We assessed baseline characteristics, 30-day perioperative outcomes and 30-day readmission. Read More

    Readmissions After Colectomy: The Upstate New York Surgical Quality Initiative Experience.
    Dis Colon Rectum 2016 May;59(5):419-25
    1 Department of Surgery, Surgical Health Outcomes and Research Enterprise, University of Rochester Medical Center, Rochester, New York 2 Department of Surgery, State University of New York, Upstate Medical University, Syracuse, New York 3 Department of Surgery, Basset Healthcare, Cooperstown, New York.
    Background: Hospital readmissions remain a major medical and financial concern to the healthcare system and have become an area of interest in health outcomes performance metrics. There is a pressing need to identify process measures that may help reduce readmissions.

    Objective: Our aim was to assess the patient characteristics and surgical factors associated with 30-day readmissions for colorectal surgery in Upstate New York. Read More

    Impact of diabetes on carotid artery revascularization.
    J Vasc Surg 2016 Apr;63(4):1099-107.e4
    Division of Vascular Surgery, Li Ka Shing Knowledge Institute of St. Michael's Hospital, Toronto, Ontario, Canada; Department of Surgery, University of Toronto, Toronto, Ontario, Canada; King Saud University-Li Ka Shing Collaborative Research Program and Department of Surgery, King Saud University, Riyadh, Saudi Arabia. Electronic address:
    Objective: Diabetes has been suggested as a marker of higher operative risk during carotid artery revascularization. The aim of this study was to summarize the current evidence comparing the effectiveness of carotid revascularization in diabetic vs nondiabetic patients.

    Methods: We conducted a systematic search of MEDLINE, Embase, and the Cochrane Library databases (1946 to January 2015) for all studies comparing the clinical outcomes of diabetic vs nondiabetic patients who underwent carotid endarterectomy (CEA) or carotid artery stenting (CAS) in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Read More

    Comparison of logistic EuroSCORE and EuroSCORE II in predicting operative mortality of 1125 total arterial operations.
    Eur J Cardiothorac Surg 2016 Sep 22;50(3):509-18. Epub 2016 Mar 22.
    Erasmus Medical Centre, Rotterdam, Netherlands.
    Objectives: The purpose of this study was to compare effectiveness of the 1999 logistic EuroSCORE (LES) and of the 2012 EuroSCORE II (ESII) in a real-world patient population of 1125 patients undergoing total arterial grafting (TAG) coronary artery bypass graft (CABG) surgery.

    Methods: The performance of the two risk scores was compared using (i) discrimination (accuracy of discriminating non-survivors from survivors), (ii) calibration (assessment of agreement between the predicted/observed outcomes) and (iii) agreement between the two scores. By averaging medians of LES and ESII and then sub-division into 10 equal groups, actual operative mortality rate was compared with the median LES and ESII within each risk group, the difference plotted against the average risk score (as in a Bland and Altman plot), and using the traditional risk groupings for EuroSCORE of low (0-2. Read More

    A "Diabetes Acute Care Day" for medical students increases their knowledge and confidence of diabetes care: a pilot study.
    BMC Med Educ 2016 Mar 9;16:88. Epub 2016 Mar 9.
    Department of Endocrinology and Diabetes, Medical Block, Glasgow Royal Infirmary, 84 Castle Street, Glasgow, Scotland.
    Background: Evidence suggests that junior doctors lack the confidence and skills to manage acute/inpatient diabetes. We investigated the impact of the introduction of a "Diabetes Acute Care Day" on undergraduate medical students' knowledge and confidence in acute/inpatient diabetes.

    Methods: Participants attended four short lectures on the basics of diabetes, diabetic emergencies, inpatient diabetes management and peri-operative/procedure care followed by case-based learning tutorials on diabetic ketoacidosis (DKA), hyperosmolar hyperglycaemic state (HHS) and hypoglycaemia using capillary blood glucose charts to interpret and practice subsequent insulin prescription and adjustment. Read More

    Prevalence, Diagnosis, Perioperative Monitoring and Treatment of Right Ventricular Dysfunction and/or Pulmonary Arterial Hypertension in Cardiac Surgical Patients in Germany-A Postal Survey.
    Thorac Cardiovasc Surg 2017 Dec 24;65(8):593-600. Epub 2016 Feb 24.
    Department of Anesthesiology, Heart and Diabetic Center NRW, Ruhr University of Bochum, Bad Oeynhausen, Germany.
    Background Sparse data are available on the prevalence of right ventricular dysfunction and/or pulmonary arterial hypertension in patients scheduled for cardiac surgery in Germany as well as on the intensity and modalities used for diagnosis, perioperative monitoring, and treatment of these comorbidities. Methods A postal survey including questions on the prevalence of preoperative right ventricular dysfunction and/or pulmonary arterial hypertension in patients undergoing cardiac surgery in 2009 was sent to 81 German heart centers. Total 47 of 81 (58%) heart centers returned the questionnaires. Read More

    Perioperative glycaemic control in diabetic patients undergoing cataract surgery under local anaesthesia: a survey of practices of Singapore ophthalmologists and anaesthesiologists.
    Singapore Med J 2016 Feb;57(2):64-8
    Department of Anaesthesia, Khoo Teck Puat Hospital, Singapore.
    Introduction: Perioperative glycaemic control is an important aspect of clinical management in diabetic patients undergoing cataract surgery under local anaesthesia. While poor long-term glycaemic control has significant implications for surgery, perioperative hypoglycaemia or hyperglycaemia may also compromise patient safety and surgical outcomes. We aimed to survey ophthalmologists and anaesthesiologists on their approach and to identify the prevalent practice patterns in Singapore. Read More

    Impact of Perioperative Complications After Endovascular Therapy in Diabetic Patients With Critical Limb Ischemia due to Isolated Infrapopliteal Lesions.
    J Endovasc Ther 2016 Apr 12;23(2):371-7. Epub 2016 Feb 12.
    Cardiovascular Center, Kansai Rosai Hospital, Amagasaki, Japan.
    Purpose: To investigate the thus far poorly defined impact of perioperative complications (POCs) on clinical outcomes after endovascular therapy (EVT) of diabetic patients with critical limb ischemia (CLI) due to isolated infrapopliteal lesions.

    Methods: A multicenter registry of CLI patients was interrogated to identify 780 consecutive diabetic patients (mean age 71 ± 10 years; 553 men) who successfully underwent balloon angioplasty for isolated infrapopliteal lesions. More than half of the population (487 patients) was on dialysis. Read More

    Perioperative diagnosis of euglycaemic ketoacidosis.
    J Intensive Care Soc 2016 Feb 9;17(1):79-81. Epub 2015 Jul 9.
    Regional Oesophago-Gastric Cancer Unit, Royal Surrey County Hospital, Guildford, UK.
    Euglycaemic diabetic ketoacidosis is a term describing features of diabetic ketoacidosis but with normoglycaemia. We present a case of a perioperative diagnosis of euglycaemic ketoacidosis in a patient not known to be diabetic, and the subsequent management of the patient. A 65-year-old lady was scheduled for re-exploration of a giant paraoesophageal hernia, which had been initially repaired over six weeks previously. Read More

    Diabetes Is Related to Worse Patient-Reported Outcomes at Two Years Following Spine Surgery.
    J Bone Joint Surg Am 2016 Jan;98(1):15-22
    Department of Orthopaedics, Vanderbilt Orthopaedic Institute, Medical Center East, South Tower, 1215 21st Avenue South, Suite 4200, Nashville, TN 37232-8774. E-mail address for C.J. Devin:
    Background: Diabetes has been associated with poor outcomes following elective spine surgery. The purpose of our study was to determine if diabetes predicts worse patient-reported outcomes at two years postoperatively and to evaluate the effect of perioperative blood glucose levels and control on patient-reported outcomes in patients with diabetes.

    Methods: One thousand and five patients undergoing elective spine surgery were included in this prospective cohort study. Read More

    Preoperative HBA1c and risk of postoperative complications in patients with gynaecological cancer.
    Arch Gynecol Obstet 2016 Jul 16;294(1):161-4. Epub 2015 Dec 16.
    Gynaecological Oncology Department, Christie Hospital, 550 Wilmslow Rd, Manchester, M20 4BX, UK.
    Background: HBA1c is used as an indicator for the long-term control of the glycaemic state and outcome predictors in diabetic patients. Diabetic patients have an increased risk of post-operative complications especially those related to infection. The aim of our study is to ascertain the relationship between HBA1c levels and post-operative recovery within the subspecialty of gynaecological oncology. Read More

    Successful Spinal Cord Stimulator Trial and Permanent Implant in Patient with Diabetic Peripheral Neuropathy on Chronic Dual Antiplatelet Therapy.
    Pain Physician 2015 Sep-Oct;18(5):E905-9
    Department of Anesthesia and Perioperative Medicine, Medical University of South Carolina, Charleston, SC.
    The safety of neuraxial anesthetic techniques in the setting of oral and parenteral anticoagulation is an area of growing interest and clinical inquiry as the multitude of anticoagulant medications rapidly increases. Additionally, the indications for spinal cord stimulation therapy are evolving as both technique and technology in the field continue to advance. The estimated incidence of spinal hematoma following epidural injection has been estimated to be 1 in 150,000-200,000. Read More

    Anti-vascular endothelial growth factor for prevention of postoperative vitreous cavity haemorrhage after vitrectomy for proliferative diabetic retinopathy.
    Cochrane Database Syst Rev 2015 Aug 7(8):CD008214. Epub 2015 Aug 7.
    Sunderland Eye Infirmary, Queen Alexandra Road, Sunderland, UK, SR2 9HP.
    Background: Postoperative vitreous cavity haemorrhage (POVCH) is a significant complication following vitrectomy for proliferative diabetic retinopathy (PDR). It delays visual recovery and can make further treatment difficult if the view of the fundus is significantly obscured. A number of interventions to reduce the incidence of POVCH have been proposed, including the perioperative use of anti-vascular endothelial growth factor (anti-VEGF). Read More

    Perioperative Glycemic Control and the Effect on Surgical Site Infections in Diabetic Patients Undergoing Foot and Ankle Surgery.
    Foot Ankle Spec 2016 Feb 30;9(1):24-30. Epub 2015 Jun 30.
    UPMC Mercy Center for Healing and Amputation Prevention, Pittsburgh, Pennsylvania (DS, DKW)University of Pittsburgh Graduate School of Public Health, Pittsburgh, Pennsylvania (NCS)
    Introduction: Diabetes mellitus is one of the leading causes of hyperglycemia in the perioperative setting. Hyperglycemia has been shown to cause increased risk of surgical site infections (SSIs) in multiple surgical specialties, but to our knowledge it has not been investigated for orthopaedic foot and ankle surgery. The aim of this study was to determine if hyperglycemia increased the rate of SSI in elective, diabetic patients that required perioperative hospitalization. Read More

    Pancreatic cancer and diabetes: A two-way relationship in the perspective of diabetologist.
    Int J Surg 2015 Sep 27;21 Suppl 1:S72-7. Epub 2015 Jun 27.
    Depart. of Internal and Experimental Medicine "Magrassi - Lanzara", Second University of Naples, Italy. Electronic address:
    Diabetes is a risk factor for pancreatic cancer as roughly half of all patients with pancreatic cancer are found to have diabetes at time of diagnosis. Moreover, an around 2-fold risk of pancreatic malignancy in diabetic patients has even be recently resulted from two meta-analysis. Actually, there is a bidirectional association between the two entities that implies a complex and reverse causality. Read More

    [Patients in need for major lower extremity amputations are a challenge].
    Ugeskr Laeger 2015 Jun;177(25)
    Ortopædkirurgisk Afdeling, Hvidovre Hospital, Kettegaard Allé 30, 2650 Hvidovre.
    Major lower extremity amputations based on end-stage chronic leg ischaemia or diabetic ulcers with infection are relatively common orthopaedic procedures. Patients are usually evaluated for the possibility of lower extremity revascularisation. Those who are not fit for vascular surgery are transferred to an orthopaedic department for amputation. Read More

    Guidelines for Perioperative Management of the Diabetic Patient.
    Surg Res Pract 2015 19;2015:284063. Epub 2015 May 19.
    Division of Pulmonary, Critical Care & Sleep Medicine, Texas A&M Health Science Center, Corpus Christi, 1177 West Wheeler Avenue, Suite 1, Aransas Pass, TX 78336, USA.
    Management of glycemic levels in the perioperative setting is critical, especially in diabetic patients. The effects of surgical stress and anesthesia have unique effects on blood glucose levels, which should be taken into consideration to maintain optimum glycemic control. Each stage of surgery presents unique challenges in keeping glucose levels within target range. Read More

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