Perioperative Management of the Diabetic Patient Referred to Cardiac Surgery

Abstract

Currently there is a progressive increase in the prevalence of diabetes in a referred for cardiovascular surgery. Benefits of glycemic management (< 180 mg/dL) in diabetic patients compared to patients without diabetes in perioperative cardiac surgery. The purpose of this study is to present recommendations based on international evidence and adapted to our clinical practice for the perioperative management of hyperglycemia in adult patients with and without diabetes undergoing cardiovascular surgery. This update is based on the latest current literature derived from articles and guidelines regarding perioperative management of diabetic patients to cardiovascular surgery.

Data-driven coaching to improve statewide outcomes in CABG: before and after interventional study

“…The second REPLICCAR project had two objectives: upgrading our data collection for a quality registry 16 and creating training strategies for better surgical outcomes based on the data collected during the before-implementation phase. Based on the data, the committee decided to provide training to hospital teams in nontechnical subjects: root cause analysis of mortality with POCMA 41 , glycemic control 19 , blood management 36 , 37 , 42 , ERAS protocol timing optimization 22 , 43 , 44 , reduction of failure to rescue 45 , 46 , and orientation based on surgical coaching for artery dissection and use of arterial grafts 47 – 49 .…”

“…2 ). Thus, the chosen strategies encompassed the training of hospital teams in five nonsurgical skills: 1) Phase of Care Mortality Analysis (POCMA) 18 , 2) patient glycemic control 19 , 3) patient blood management 20 , 4) optimization of hospitalization times based on Enhanced Recovery After Surgery (ERAS) protocol 21 , 22 , and 5) impact of failure to rescue 23 . In addition, guidance based on surgical coaching was provided to enhance the use of arterial grafts and the rate of skeletonized dissection of the internal thoracic artery 24 .…”

Resultados Imediatos após Múltiplos Enxertos Arteriais em Cirurgia de Revascularização Miocárdica no Estado de São Paulo: Estudo de Coorte

“…Tendo em vista de que a hemoglobina glicosilada elevada influenciou no desenvolvimento de IPFT no grupo multiarterial, levanta-se o questionamento relacionado à atual conduta das equipes médicas, onde pacientes portadores de diabetes, ou com níveis aumentados de hemoglobina glicosilada são gerenciados para o não uso da ATI bilateral e sim para métodos alternativos como enxerto de artéria radial e/ou safena, com o intuito de reduzir a probabilidade de ocorrer o desfecho de infecção. 20,21 Entretanto, nossos achados mostram que para evitar IFPT, os valores glicêmicos precisam ser estritamente corrigidos antes, durante e após a cirurgia de forma soberana à escolha dos enxertos utilizados, desta forma, acreditamos que a otimização mais criteriosa da glicemia 22,23 pode trazer mais benefícios ao paciente que simplesmente evitar o uso da ATI bilateral. Dorman et al 24 compararam retrospectivamente após PSM, pacientes diabéticos controlados e assistidos submetidos a CRM uni e multi arterial em um seguimento de 30 anos e mostraram que, por mais que o paciente fosse diabético o uso de ATI bilateral não aumentou as taxas de morbidade e tampouco de mortalidade, Zhou et al 25 também mostraram benefícios no uso da técnica mutliarterial para pacientes diabéticos devidamente controlados em sua metanálise, Estes achados reforçam a teoria colocada pelos autores deste artigo, onde o controle da glicemia do paciente é soberano à escolha dos enxertos.…”

Teams, Rapid Recovery Protocols and Technology to Resume Cardiac Surgery in the COVID-19 Era

“…For a successful implementation, it is necessary for healthcare professionals to modify and adapt the traditional thinking to this ‘new normal’. This care includes team education regarding new evidence-based strategies that demonstrate proactive attitudes such as exhaustive interventions for perioperative glycemic control [ 14 ] , smoking cessation, multimodal pain control, adequate nutritional intake, break of prolonged fasting, reincorporation of cardiorespiratory and motor activity as soon as possible, among others.…”