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Dtsch Arztebl Int 2021 09 17;118(Forthcoming). Epub 2021 Sep 17.

Background: 30-80% of patients being treated in intensive care units in the perioperative period develop hyperglycemia. This stress hyperglycemia is induced and maintained by inflammatoryendocrine and iatrogenic stimuli and generally requires treatment. There is uncertainty regarding the optimal blood glucose targets for patients with diabetes mellitus. Read More

Br J Anaesth 2021 Jul 30;127(1):e5-e7. Epub 2021 Apr 30.

Department of Diabetes and Endocrinology, Royal Melbourne Hospital, Parkville, Australia; Department of Medicine, Royal Melbourne Hospital, University of Melbourne, Parkville, Australia.

Surg Endosc 2021 Mar 19. Epub 2021 Mar 19.

Department of Surgery, NorthShore University Health System, 2650 Ridge Ave, GCSI Suite B665, Evanston, IL, 60201, USA.

Background: The endoluminal functional lumen imaging probe (FLIP) can be used to obtain real-time measurements of the diameter (D), cross-sectional area (CSA), and distensibility of the pylorus before and after peroral pyloromyotomy (POP), an emerging endoscopic treatment for delayed gastric emptying. Our study aims to report our single-center experience in performing POP with FLIP measurements before and after pyloromyotomy.

Methods: A retrospective review of a prospectively maintained gastroesophageal database was performed. Read More

Diabetes Metab Res Rev 2021 Jan 21:e3439. Epub 2021 Jan 21.

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

With the increased incidence of diabetes, the number of diabetic patients who require surgical treatment is also increasing. Unfortunately, practices in this area lack standardisation. The purpose of this multidisciplinary, evidence-based guidelines for perioperative blood glucose management is to provide a comprehensive set of recommendations for clinicians treating diabetes with different types of surgery. Read More

Pain Med 2021 Feb 9. Epub 2021 Feb 9.

Mount Sinai Hospital, Department of Anesthesia and Pain Medicine, University of Toronto, Toronto, Canada.

Objective: To assess the efficacy and safety of N-acetylcysteine in the treatment of chronic pain.

Methods: A systematic search was carried out until April 2020 for clinical studies of N-acetylcysteine in the management of any persistent or recurrent chronic pain condition for adults ≥ 18 years old. Risk of Bias was assessed using the validated risk of bias tools. Read More

A A Pract 2021 Jan 14;15(1):e01380. Epub 2021 Jan 14.

From the Department of Anesthesiology and Perioperative Medicine, University of California Los Angeles David Geffen School of Medicine, Los Angeles, California.

The use of sodium-glucose cotransporter 2 (SGLT2) inhibitors is increasingly common in type 2 diabetes mellitus (DM) management. Patients taking an SGLT2 inhibitor are at risk for euglycemic diabetic ketoacidosis (EDKA). We report an intraoperative diagnosis of EDKA. Read More

JAMA Netw Open 2021 01 4;4(1):e2035632. Epub 2021 Jan 4.

Mayo Clinic Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, Minnesota.

Int J Surg Case Rep 2020 11;77:463-466. Epub 2020 Nov 11.

Department of Anesthesia Critical Care and Pain, Massachusetts General Hospital, Boston, MA, USA.

Introduction: Sodium glucose cotransporter-2 inhibitors (SGLT2) are an increasingly administered class of medication used to lower blood glucose levels in patients with type 2 diabetes mellitus. Diabetic ketoacidosis (DKA) and Fournier's gangrene are rare, but potentially catastrophic side effects of SGLT2 inhibitors. This manuscript reports a case of both DKA and Fournier's gangrene in the context of SGLT2 inhibitor use. Read More

Front Surg 2020 18;7:600754. Epub 2020 Dec 18.

Department of Gynecology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China.

The transobturator suburethral tape procedure is emerging as a preferred surgical option in the management of stress urinary incontinence. This procedure, also called tension-free vaginal tape transobturator (TVT-O) procedure, has fewer risks of injury to the bladder, similar effectiveness, and shorter surgery duration compared with the older tension-free vaginal tape (TVT) procedure. In this study, we report the case of a female patient with type 2 diabetes mellitus who developed emergency ketoacidosis and severe cellulitis after a TVT-O procedure, which was successfully managed without sling removal and open drainage of abscesses after multi-point puncture drainage, guided by ultrasound and appropriate antibiotic administration. Read More

Cas Lek Cesk 2020 ;159(6):210-212

Metformin is the drug of choice in the treatment of type 2 diabetes mellitus. Diabetic patients treated with metformin, who are scheduled for surgery, have always been subjects to discussion regarding the perioperative management of metformin because of the risk of developing lactic acidosis. The article presents the basic informations about this adverse event, describes new approach to the metformin treatment in the perioperative period, and summarizes the recommendations of professional societies and expert groups. Read More

J Assoc Physicians India 2020 Dec;68(12[Special]):55-59

Chairman and Chief Diabetologist, Dr. Mohan's Diabetes Specialities Centre, Chennai, Tamil Nadu.

Both hyperglycemia and hypoglycemia in hospitalized patients represent a major concern as they are associated with adverse outcomes-including increased rates of infection, longer hospital stay, and even death. Insulin therapy is the mainstay in the management of inpatient hyperglycemia. The traditional approach of sliding scale insulin (SSI) therapy for the temporary management of blood glucose levels in hospitalized patients, has now given way to basal-bolus insulin (BBI) therapy. Read More

Mayo Clin Proc 2020 12 6;95(12):2760-2774. Epub 2020 Nov 6.

Division of General Internal Medicine, Mayo Clinic, Rochester, MN.

Evaluation of endocrine issues is a sometimes overlooked yet important component of the preoperative medical evaluation. Patients with diabetes, thyroid disease, and hypothalamic-pituitary-adrenal axis suppression are commonly encountered in the surgical setting and require unique consideration to optimize perioperative risk. For patients with diabetes, perioperative glycemic control has the strongest association with postsurgical outcomes. Read More

Semin Cardiothorac Vasc Anesth 2021 Mar 15;25(1):46-50. Epub 2020 Oct 15.

Institut Mutualiste Montsouris, Paris, France.

The coronavirus disease 2019 (COVID-19) may lead to an acute respiratory distress syndrome by an inappropriate cytokine response and may predispose to a prothrombotic state through multiple pathways. Both can complicate the management of cardiac surgery with cardiopulmonary bypass, which is known to activate the hemostatic system and to exacerbate systemic inflammatory response. Little is known about the impact of cardiac surgery with cardiopulmonary bypass on viral pneumonia, particularly with the new coronavirus. Read More

Gen Thorac Cardiovasc Surg 2021 Mar 28;69(3):478-486. Epub 2020 Sep 28.

Department of General Thoracic Surgery, Juntendo University School of Medicine, 1-3 Hongo 3-chome, Bunkyo-ku, Tokyo, 113-8431, Japan.

Objectives: The rate of lung resection in patients on hemodialysis (HD) is increasing with the increasing number of HD. However, studies assessing lung resection in HD are limited. The study aimed to investigate the perioperative management and postoperative complications of lung resection in HD patients. Read More

J Perioper Pract 2020 Sep 8:1750458920948693. Epub 2020 Sep 8.

Department of Intensive Care Medicine, Peninsula Health, Melbourne, Australia.

Purpose: Current guidelines recommend withholding sodium-glucose cotransporter 2 inhibitors perioperatively due to concerns of euglycaemic diabetic ketoacidosis. However, such guidelines are largely based on case reports and small case series, many extrapolated from non-surgical patients. The aim was to investigate whether withholding sodium-glucose cotransporter 2 inhibitors as per current perioperative guidelines was associated with a reduction in serious adverse events, including euglycaemic diabetic ketoacidosis. Read More

J Diabetes Sci Technol 2020 09 12;14(5):928-944. Epub 2020 Aug 12.

Mills-Peninsula Medical Center, San Mateo, CA, USA.

Patients with diabetes may experience adverse outcomes related to their glycemic control when hospitalized. Continuous glucose monitoring systems, insulin-dosing software, enhancements to the electronic health record, and other medical technologies are now available to improve hospital care. Because of these developments, new approaches are needed to incorporate evolving treatments into routine care. Read More

J Clin Med 2020 Aug 6;9(8). Epub 2020 Aug 6.

Department of Anesthesiology, Amsterdam University Medical Centers, Location AMC, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands.

The COVID-19 pandemic poses great challenges for healthcare workers around the world, including perioperative specialists. Previously, we provided a first overview of available literature on SARS-CoV-2 and COVID-19, relevant for anaesthetists and intensivists. In the current review, we provide an update of this topic, after a literature search current through May 2020. Read More

Hip Int 2020 Aug 4:1120700020945221. Epub 2020 Aug 4.

Stavros Niarchos Foundation Complex Joint Reconstruction Center, Hospital for Special Surgery, New York, USA.

Introduction: Revision total hip arthroplasty (rTHA) is becoming a more common procedure due to the increasing volume of primary total hip arthroplasty. Diabetes mellitus (DM) is currently projected to affect 4.4% of the global population by 2030. Read More

Nutrients 2020 Jul 23;12(8). Epub 2020 Jul 23.

Department of Anesthesiology and Pain Medicine, Seoul National University Bundang Hospital, Seongnam-si, Gyeonggi-do 13620, Korea.

In terms of antinociceptive action, the main mode of action of magnesium involves its antagonist action at the -methyl-d-aspartate (NMDA) receptor, which prevents central sensitization and attenuates preexisting pain hypersensitivity. Given the pivotal function of NMDA receptors in pain transduction, magnesium has been investigated in a variety of pain conditions. The oral and parenteral administration of magnesium via the intravenous, intrathecal, or epidural route may alleviate pain and perioperative anesthetic and analgesic requirements. Read More

J Diabetes Investig 2021 Apr 26;12(4):664-667. Epub 2020 Aug 26.

The First Department of Medicine, Wakayama Medical University, Wakayama, Japan.

We report the first case of intraoperatively detected euglycemic diabetic ketoacidosis (DKA) associated with sodium-glucose cotransporter 2 inhibitors during thoracic surgery. A 59-year-old man had a 12-year history of type 2 diabetes mellitus treated with insulin and empagliflozin. The patient developed bacterial empyema and was initiated with antibiotics at a local hospital. Read More

Acta Anaesthesiol Scand 2020 10 30;64(9):1253-1261. Epub 2020 Jul 30.

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

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

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

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

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

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

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

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

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

J Clin Endocrinol Metab 2020 08;105(8)

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

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

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

J Perioper Pract 2020 12 17;30(12):372-377. Epub 2020 Apr 17.

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

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

Ann Card Anaesth 2020 Apr-Jun;23(2):122-126

Department of Anaesthesiology, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, Karnataka, India.

Introduction: Off-pump coronary artery bypass (OPCAB) surgery is associated with evasion of complications of cardiac bypass. The incidence of postoperative atrial fibrillation (POAF) may also be reduced because of less ischemia and inflammation.

Aim: Prospective evaluation of utility of CHADS-VASc score in the prediction of POAF after OPCAB surgery. Read More

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

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

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

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

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

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