Hyperglycemia and postoperative outcomes in pediatric neurosurgery

Filho, Eduardo Mekitarian; Carvalho, Werther Brunow de; Cavalheiro, Sérgio; Horigoshi, Nelson; Freddi, Norberto Antônio; Vieira, Gil Kruppa

doi:10.1590/s1807-59322011000900022

Cited by 12 publications

(5 citation statements)

References 12 publications

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“…Hipergliseminin ateş, enfeksiyon, kan transfüzyonu, hipotermi gibi faktörlere bağlı olmadığının belirlenmesi gerekir (27). Bununla beraber hipergliseminin, mekanik ventilasyonda kalış süresi, yoğun bakımda ve hastanede kalış sürelerini uzatmadığı gösterilmiştir (28).…”

Section: Metabolik Sorunlarunclassified

Anesthesia Management for Craniosynostosis Surgery

Özlü¹

2022

JARSS

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Craniosynostosis is premature fusion of one or more cranial sutures. In isolated craniosynostosis, surgical procedures are applied to ensure normal brain development and normal cognitive functions, to correct cosmetic deformities in order to prevent psychosocial negative consequences. The fact that they are mostly infants, combined with significant blood loss in the perioperative period, makes these cases challenging for the anesthetist. Ensuring airway safety, coping with metabolic complications related to blood transfusions and infusion of electrolyte fluids, preventing hypothermia, postoperative pain management, treatment of nausea and vomiting are the main subjects of anesthesia management. Excellent results can be obtained with proper preoperative planning, monitoring and timely blood and fluid infusion. Keywords: Craniosynostosis, anesthesia, neurosurgery

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Section: Metabolik Sorunlarunclassified

Anesthesia Management for Craniosynostosis Surgery

Özlü¹

2022

JARSS

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“…It is thought that hyperglycemia compromises all major components of the innate immune system, including phagocytosis and opsonization,9 causing glycosylation and inactivation of circulating immunoglobulins that contributes to an increased risk of infection and is an important cause of postoperative mortality in vulnerable individuals 2. Importantly, coagulopathies and hyperglycemia tend to occur simultaneously and correlate with the magnitude of trauma and wound size 9,10…”

Section: Pathophysiology: the Deleterious Effects Of Glucosementioning

confidence: 99%

“… 2 Importantly, coagulopathies and hyperglycemia tend to occur simultaneously and correlate with the magnitude of trauma and wound size. 9 , 10 …”

Section: Pathophysiology: the Deleterious Effects Of Glucosementioning

confidence: 99%

“… 22 The perioperative period is an extremely unusual period of time for the body characterized by extremes in blood volume, body temperature, plasma composition, and tissue blood flow, as reported by Alves et al 9 Further, Filho et al stress the importance of selecting an appropriate target group because the consequences of any fluctuations in blood glucose depend on the intervention performed and preoperative morbidity. 10 …”

Section: Pediatric Glycemiamentioning

confidence: 99%

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Does tight glycemic control improve outcomes in pediatric patients undergoing surgery and/or those with critical illness?

Forbes¹,

Anders²

2013

IJGM

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This literature review examines the current evidence regarding the potential usefulness of tight glycemic control in pediatric surgical patients. In adults, fluctuations in glucose levels and/or prolonged hyperglycemia have been shown to be associated with poor outcomes with respect to morbidity and mortality. This review begins by summarizing the findings of key papers in adult patients and continues by investigating whether or not similar results have been seen in pediatric patients by performing a comprehensive literature review using Medline (OVID). A database search using the OVID interface and including the search terms (exp glucose) AND (exp surgery) AND (exp Paediatric/pediatric) AND (exp Hypoglycaemia/hypoglycemia) AND (exp Hyperglycaemia/hyperglycemia) yielded a total of 150+ papers, of which 24 fulfilled our criteria. We isolated papers utilizing pediatric patients who were hospitalized due to illness and/or surgery. Our review highlights several difficulties encountered in addressing this potentially useful clinical intervention. An absence of scientifically robust and randomized trials and the existence of several small-powered trials yielding conflicting results mean we cannot recommend tight glycemic control in these patients. Differences in study design and disagreements concerning the crucial stage of surgery where hyperglycemia becomes important are compounded by an over-reliance on the discretion of clinicians in the absence of well described treatment protocols. Closer inspection of key papers in adult patients identified fundamental discrepancies between exact definitions of both hyperglycemia and hypoglycemia. This lack of consensus, along with a fear of inducing iatrogenic hypoglycemia in pediatric patients, has resulted in professional bodies advising against this form of intervention. In conclusion, we cannot recommend use of tight glycemic control in pediatric surgical patients due to unclear glucose definitions, unclear thresholds for treatment, and the unknown long-term effects of iatrogenic hypoglycemia on the developing body and brain.

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“…No publications exist on systematic approaches to pharmacological neuroprotection, and pharmacological interventions are only sporadically reported in the literature [ 46 – 50 ]. Glucocorticosteroids are routinely given to most patients pre-, intra- and post-operatively to reduce inflammation and edema [ 51 ] [ 52 ], but there is no consensus recommendation and the impact on the clinical course of CMS is undetermined.…”

Section: Introductionmentioning

confidence: 99%

Cerebellar mutism syndrome in children with brain tumours of the posterior fossa

et al. 2017

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BackgroundCentral nervous system tumours constitute 25% of all childhood cancers; more than half are located in the posterior fossa and surgery is usually part of therapy. One of the most disabling late effects of posterior fossa tumour surgery is the cerebellar mutism syndrome (CMS) which has been reported in up to 39% of the patients but the exact incidence is uncertain since milder cases may be unrecognized. Recovery is usually incomplete. Reported risk factors are tumour type, midline location and brainstem involvement, but the exact aetiology, surgical and other risk factors, the clinical course and strategies for prevention and treatment are yet to be determined.MethodsThis observational, prospective, multicentre study will include 500 children with posterior fossa tumours. It opened late 2014 with participation from 20 Nordic and Baltic centres. From 2016, five British centres and four Dutch centres will join with a total annual accrual of 130 patients. Three other major European centres are invited to join from 2016/17. Follow-up will run for 12 months after inclusion of the last patient. All patients are treated according to local practice. Clinical data are collected through standardized online registration at pre-determined time points pre- and postoperatively. Neurological status and speech functions are examined pre-operatively and postoperatively at 1–4 weeks, 2 and 12 months. Pre- and postoperative speech samples are recorded and analysed. Imaging will be reviewed centrally. Pathology is classified according to the 2007 WHO system. Germline DNA will be collected from all patients for associations between CMS characteristics and host genome variants including pathway profiles.DiscussionThrough prospective and detailed collection of information on 1) differences in incidence and clinical course of CMS for different patient and tumour characteristics, 2) standardized surgical data and their association with CMS, 3) diversities and results of other therapeutic interventions, and 4) the role of host genome variants, we aim to achieve a better understanding of risk factors for and the clinical course of CMS - with the ultimate goal of defining strategies for prevention and treatment of this severely disabling condition.Trial registration Clinicaltrials.gov: NCT02300766, date of registration: November 21, 2014.

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Hyperglycemia and postoperative outcomes in pediatric neurosurgery

Cited by 12 publications

References 12 publications

Anesthesia Management for Craniosynostosis Surgery

Anesthesia Management for Craniosynostosis Surgery

Does tight glycemic control improve outcomes in pediatric patients undergoing surgery and/or those with critical illness?

Cerebellar mutism syndrome in children with brain tumours of the posterior fossa

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