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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

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

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

Endocr Pract 2018 Oct 5. Epub 2018 Oct 5.

Division of Colon and Rectal Surgery, Mayo Clinic, Rochester, Minnesota.

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

Pain Physician 2018 Sep;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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Adv Skin Wound Care 2016 Nov;29(11):518-526

Aaron Pinkhasov, MD, FAPA • Clinical Associate • Professor of Medicine and Psychiatry • Stony Brook University School of Medicine • Stony Brook, New York • Chairman • Department of Behavioral Health • Winthrop University Hospital • Mineola, New York Deepan Singh, MD, FAPA • Clinical Assistant Professor • Psychiatry • Stony Brook University School of Medicine • Stony Brook, New York • Child, Adolescent and Adult Psychiatrist • Winthrop University Hospital • Mineola, New York Benjamin Kashan, MD • Clinical Research Fellow • Division of Wound Healing and Regenerative Medicine, Department of Surgery • Winthrop University Hospital • Mineola, New York Julie DiGregorio, CCRP • Supervisor • Research and Clinical Trials • Division of Wound Healing and Regenerative Medicine, Department of Surgery • Winthrop University Hospital • Mineola, New York Theresa M. Criscitelli, EdD, RN, CNOR • Assistant Vice President • Perioperative Services, Division of Wound Healing and Regenerative Medicine, Department of Surgery • Winthrop University Hospital • Mineola, New York Scott Gorenstein, MD, FACEP • Clinical Assistant Professor • Surgery • Stony Brook University School of Medicine • Stony Brook, New York • Clinical Director • Division of Wound Healing and Regenerative Medicine, Department of Surgery • Winthrop University Hospital • Mineola, New York Harold Brem, MD, FACS • Professor • Surgery • Stony Brook University School of Medicine • Stony Brook, New York • Chief • Division of Wound Healing and Regenerative Medicine, Department of Surgery • Winthrop University Hospital • Mineola, New York.

General Purpose: To provide information about the effect of psychiatric comorbidities on wound healing in patients with diabetes mellitus (DM).

Target Audience: This continuing education activity is intended for physicians, physician assistants, nurse practitioners, and nurses with an interest in skin and wound care.

Learning Objectives/outcomes: After participating in this educational activity, the participant should be better able to:1. Read More

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

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

Masui 2016 10;65(10):1054-1057

A 50-year-old man with type 2 diabetes mellitus was scheduled for laparoscopic partial liver resection. Six months prior to the surgery, he developed frequent hypoglycemic attacks and was diagnosed as anti-insulin antibody positive. The operation was performed under general anesthesia with epidural anesthesia. Read More

Crit Care 2016 09 15;20:297. Epub 2016 Sep 15.

Department of Intensive Care, Austin Hospital, 145 Studley Rd, Heidelberg, 3084, VIC, Australia.

Background: It is uncertain whether liberal glucose control in critically ill diabetic patients leads to increased ketone production and ketoacidosis. Therefore, we aimed to assess the prevalence of ketosis, ketonuria and ketoacidosis in critically ill diabetic patients treated in accordance with a liberal glycemic control protocol.

Methods: We performed a prospective observational cohort study of 60 critically ill diabetic patients with blood and/or urine ketone bodies tested in ICU. Read More