scholarly journals Perioperative Management of Diabetes: A Review

2014 ◽  
Vol 2 (2) ◽  
pp. 71-76 ◽  
Author(s):  
Md Nazmul Kayes ◽  
NMN Kabir Prodhan ◽  
Refat Hossain Malik
Keyword(s):  
Preoperative Evaluation ◽  
Subcutaneous Administration ◽  
Rapid Onset ◽  
Postoperative Management ◽  
Hypoglycemic Agents ◽  
Renal Diseases ◽  
Oral Hypoglycemic Agents ◽  
Acid Base Balance ◽  
Perioperative Morbidity ◽  
Base Balance

Diabetes increases the requirements of surgery as well as perioperative morbidity and mortality. Careful preoperative evaluation and treatment of cardiac and renal diseases, intensive intraoperative and postoperative management are essential to optimize the best outcome. Stress hyperglycemia in response to surgery, osmotic diuresis and hypoinsulinemia can lead to life threatening complications like ketoacidosis or hyperglycemic hyperosmolar syndrome. Wound healing is impaired by hyperglycemia and chance of postoperative wound infection is more in diabetics. Therefore aseptic precautions must be taken. Adequate insulin, glucose, fluid and electrolytes should be provided for good metabolic control. Though some current study reveals that oral hypoglycemic agents can be used for the effective management of perioperative diabetes; the adverse effects of newly introduced agents need more clinical observations. Subcutaneous administration of insulin as in Sliding Scale may be a less preferable method, because of unreliable absorption and unpredictable blood glucose. Intravenous administration of rapid onset soluble (short acting) insulin as in Alberti (GIK) regimen, is safe and effective method controlling perioperative hyperglycemia. Patient with type 1 diabetes needs frequent monitoring of glucose, electrolytes and acid-base balance as chance of high hyperglycemia and ketoacidosis is more. In case of emergency surgery assessment for diabetic ketoacidosis (DKA) and meticulous management is essential. Postoperative pain and hyperglycemia should be treated carefully to avoid complications. DOI: http://dx.doi.org/10.3329/dmcj.v2i2.20528 Delta Med Col J. Jul 2014; 2(2): 71-76

The Diabetic Surgical Patient

2020 ◽  
Author(s):  
Cathline Layba ◽  
Lance Griffin
Keyword(s):  
Diabetes Mellitus ◽  
Perioperative Period ◽  
The United States ◽  
Postoperative Management ◽  
Hypoglycemic Agents ◽  
Surgical Patient ◽  
Diabetic Patients ◽  
Preoperative Management ◽  
Oral Hypoglycemic Agents ◽  
Intraoperative Management

Diabetes mellitus is the seventh leading cause of death in the United States; diabetic patients have a 50% chance of undergoing a surgical procedure during their lifetime, and operations in this patient population have been associated with a reported mortality of 4% to 13%. Careful planning of operative management and perioperative care must be taken into account when scheduling surgery for diabetic patients, especially patients taking insulin or oral hypoglycemic agents. Debate continues and inconsistencies remain regarding the management of both diabetes and hyperglycemia in the surgical setting. The review covers the evaluation of the diabetic patient, preoperative management, intraoperative management, postoperative management, total parenteral nutrition and blood glucose, cardiovascular and renal assessment, infection, and special populations.  This review contains 2 figures, 5 tables, and 21 references Keywords: Glucose, Hyperglycemia, perioperative period, surgery, diabetes mellitus, surgical site infection, preoperative management, postoperative management, wound healing

The Diabetic Surgical Patient

2020 ◽  
Author(s):  
Cathline Layba ◽  
Lance Griffin
Keyword(s):  
Diabetes Mellitus ◽  
Perioperative Period ◽  
The United States ◽  
Postoperative Management ◽  
Hypoglycemic Agents ◽  
Surgical Patient ◽  
Diabetic Patients ◽  
Preoperative Management ◽  
Oral Hypoglycemic Agents ◽  
Intraoperative Management

Diabetes mellitus is the seventh leading cause of death in the United States; diabetic patients have a 50% chance of undergoing a surgical procedure during their lifetime, and operations in this patient population have been associated with a reported mortality of 4% to 13%. Careful planning of operative management and perioperative care must be taken into account when scheduling surgery for diabetic patients, especially patients taking insulin or oral hypoglycemic agents. Debate continues and inconsistencies remain regarding the management of both diabetes and hyperglycemia in the surgical setting. The review covers the evaluation of the diabetic patient, preoperative management, intraoperative management, postoperative management, total parenteral nutrition and blood glucose, cardiovascular and renal assessment, infection, and special populations.  This review contains 2 figures, 5 tables, and 21 references Keywords: Glucose, Hyperglycemia, perioperative period, surgery, diabetes mellitus, surgical site infection, preoperative management, postoperative management, wound healing

The Diabetic Surgical Patient

2021 ◽  
Author(s):  
Cathline Layba ◽  
Lance Griffin
Keyword(s):  
Diabetes Mellitus ◽  
Perioperative Period ◽  
The United States ◽  
Postoperative Management ◽  
Hypoglycemic Agents ◽  
Surgical Patient ◽  
Diabetic Patients ◽  
Preoperative Management ◽  
Oral Hypoglycemic Agents ◽  
Intraoperative Management

Diabetes mellitus is the seventh leading cause of death in the United States; diabetic patients have a 50% chance of undergoing a surgical procedure during their lifetime, and operations in this patient population have been associated with a reported mortality of 4% to 13%. Careful planning of operative management and perioperative care must be taken into account when scheduling surgery for diabetic patients, especially patients taking insulin or oral hypoglycemic agents. Debate continues and inconsistencies remain regarding the management of both diabetes and hyperglycemia in the surgical setting. The review covers the evaluation of the diabetic patient, preoperative management, intraoperative management, postoperative management, total parenteral nutrition and blood glucose, cardiovascular and renal assessment, infection, and special populations.  This review contains 2 figures, 5 tables, and 21 references Keywords: Glucose, Hyperglycemia, perioperative period, surgery, diabetes mellitus, surgical site infection, preoperative management, postoperative management, wound healing

Cardiogenic Shock

2017 ◽  
Author(s):  
Martin Chen ◽  
Muoi Trinh
Keyword(s):  
Heart Failure ◽  
Cardiogenic Shock ◽  
Acute Decompensated Heart Failure ◽  
Preoperative Evaluation ◽  
Perioperative Period ◽  
Decompensated Heart Failure ◽  
Postoperative Management ◽  
Perioperative Morbidity ◽  
Circulatory Assist Devices ◽  
Patients At Risk

Heart failure and cardiogenic shock are important causes of perioperative morbidity and mortality that require prompt recognition prior to the institution of specialized monitoring and treatment, including the consideration of circulatory assist devices. Patients at risk for perioperative heart failure require special consideration with respect to preoperative evaluation, medical optimization prior to proceeding with surgery, and monitoring throughout the perioperative period. The intraoperative and postoperative management need to be carefully planned in order to avoid the development of acute decompensated heart failure and cardiogenic shock. This chapter reviews the perioperative assessment and management of heart failure patients as well as the management of perioperative cardiogenic shock.

scholarly journals Histomorphological Spectrum of Renal diseases: A Prospective Study for A Period of Two Years

2020 ◽  
Vol 7 (8) ◽  
pp. A416-421
Author(s):  
Deepthi K N ◽  
Shilpa Karamchedu ◽  
Apurva .
Keyword(s):  
Malignant Tumors ◽  
The Body ◽  
Chronic Pyelonephritis ◽  
Renal Diseases ◽  
Acid Base Balance ◽  
Medical College ◽  
Neoplastic Lesion ◽  
Renal Biopsies ◽  
Base Balance ◽  
A Prospective Study

INTRODUCTION: Kidneys are vital organs of the body with multiple functions like excretory, acid base balance and maintenance of blood pressure. Renal parenchyma is mostly subjected to noxious insults but is last to respond. Simple nephrectomy is done for irreversibly damaged kidney. Most common indication for nephrectomy is chronic pyelonephritis. Aim of the study is to analyze the histopathological patterns of renal lesions and to analyze age and sex distribution. MATERIALS AND METHODS: The study included a total number of 70 cases, during a period of 2 years i.e., from October 2017 to September 2019. All renal biopsies and nephrectomy specimens received in pathology department, SVS Medical College, Mahabubnagar, Telangana, India were included in the study. RESULTS: In our study, 70 cases were analyzed. Out of which majority of the lesions (25.7 % ) were in the age group of 21-40 years and showed male preponderance (68.5 %). Present study showed chronic pyelonephritis being the most common non-neoplastic lesion. Among malignant tumors renal cell carcinoma was most common. CONCLUSION: The present study reveals various histological patterns of lesions in renal biopsies and nephrectomy specimens. Our study reveals that non-neoplastic lesions are more commonly encountered lesions.

Higher Dietary Acidity is Associated with Lower Bone Mineral Density in Postmenopausal Iranian Women, Independent of Dietary Calcium Intake

2014 ◽  
Vol 84 (3-4) ◽  
pp. 0206-0217 ◽  
Author(s):  
Seyedeh-Elaheh Shariati-Bafghi ◽  
Elaheh Nosrat-Mirshekarlou ◽  
Mohsen Karamati ◽  
Bahram Rashidkhani
Keyword(s):  
Calcium Intake ◽  
Dietary Calcium ◽  
Dietary Calcium Intake ◽  
Dietary Intakes ◽  
Iranian Women ◽  
Acid Base Balance ◽  
Mineral Density ◽  
Acid Base ◽  
Base Balance ◽  
Dietary Acid

Findings of studies on the link between dietary acid-base balance and bone mass are relatively mixed. We examined the association between dietary acid-base balance and bone mineral density (BMD) in a sample of Iranian women, hypothesizing that a higher dietary acidity would be inversely associated with BMD, even when dietary calcium intake is adequate. In this cross-sectional study, lumbar spine and femoral neck BMDs of 151 postmenopausal women aged 50 - 85 years were measured using dual-energy x-ray absorptiometry. Dietary intakes were assessed using a validated food frequency questionnaire. Renal net acid excretion (RNAE), an estimate of acid-base balance, was then calculated indirectly from the diet using the formulae of Remer (based on dietary intakes of protein, phosphorus, potassium, and magnesium; RNAERemer) and Frassetto (based on dietary intakes of protein and potassium; RNAEFrassetto), and was energy adjusted by the residual method. After adjusting for potential confounders, multivariable adjusted means of the lumbar spine BMD of women in the highest tertiles of RNAERemer and RNAEFrassetto were significantly lower than those in the lowest tertiles (for RNAERemer: mean difference -0.084 g/cm2; P=0.007 and for RNAEFrassetto: mean difference - 0.088 g/cm2; P=0.004). Similar results were observed in a subgroup analysis of subjects with dietary calcium intake of >800 mg/day. In conclusion, a higher RNAE (i. e. more dietary acidity), which is associated with greater intake of acid-generating foods and lower intake of alkali-generating foods, may be involved in deteriorating the bone health of postmenopausal Iranian women, even in the context of adequate dietary calcium intake.

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