Anesthetic considerations in diabetic patients. Part I: preoperative considerations of patients with diabetes mellitus

Kikuchi, Yuji

doi:10.1007/s00540-010-0987-1

Cited by 41 publications

(23 citation statements)

References 78 publications

(95 reference statements)

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“…Ahondar en los medicamentos de enfermedades asociadas y antidiabéticos, presencia de enfermedad cardiovascular (incluyendo una evaluación de la tolerancia al ejercicio), enfermedad renal, neuropatía periférica y autonómica (en particular gastroparesia) y trastornos musculo-esqueléticos tales como el síndrome de articulación rígida (debido a la glicosilación) 29,30 . Adicionalmente, se debe realizar una evaluación detallada del estado de salud base del paciente, (Ver Figura 4).…”

Section: Período Preoperatoriounclassified

“…Es recomendable suspender la metformina uno a dos días previos a la cirugía, especialmente en pacientes en diabéticos tipo 2 o con riesgo de hipoperfusión renal, hipoxia tisular y acumulación de lactato . Esta medida busca evitar la hipoglucemia reactiva dado que los pacientes que sufren de hipoglucemia tienen una mayor duración de la estancia y un aumento en la incidencia de complicaciones, especialmente la causada por hipoglicemiantes de tipo sulfonilureas 29,[37][38][39] . Si se presentan picos de hiperglucemia, estos se deben tratar con insulina de acción rápida por vía subcutánea 25,31 .…”

Section: Período Preoperatoriounclassified

“…Vale la pena enfatizar que la dosis apropiada de insulina tiene que ser individualizada para cada paciente; en pacientes diabéticos no insulino-dependientes se recomienda infusión continua de insulina si el nivel de glucosa es superior a 140 mg/dL, por otra parte, en pacientes diabéticos insulino-dependientes se aconseja iniciar infusión de insulina cuando la glucosa es superior a 70 mg/dL. Puede usarse un bolo inicial de insulina en pacientes con glicemia superior a 200 mg/dL 25,29 . El paciente requiere un manejo intrahospitalario previo al procedimiento quirúrgico, especialmente aquellos que tienen mal control glucémico (HbA1c superior a 8%), para así iniciar la infusión de insulina antes de la cirugía 25 .…”

Section: Peroodo Intraoperatoriounclassified

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Factores fisiopatológicos y metas terapéuticas perioperatorias que influyen en procedimientos quirúrgicos reconstructivos mediante colgajos en pacientes con Diabetes Mellitus

Alvear

et al. 2017

revmed

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Artículo recibido el 12 de Junio de 2016 y aceptado para publicación el 16 de Noviembre de 2016 RESUMEN Introducción: la diabetes mellitus es considerada un factor de riesgo para complicaciones locales y fracaso quirúrgico en cirugías reconstructivas mediante el uso de colgajos debido a las alteraciones en el proceso de cicatrización propias de este patología. Objetivo: hacer una revisión de la literatura disponible sobre los factores fisiopatológicos que influyen en los resultados posquirúrgicos a corto, mediano y largo plazo en la población diabética, así como de las metas terapéuticas perioperatorias asociadas a mayores tasas de éxito. Metodología de Búsqueda: se realizó búsqueda en las bases de datos PUBMED, MEDLINE Y SCIELO, mediante el gestor de búsqueda utilizando los términos: "Period perioperative", "Reconstructive surgical procedures", "Surgical flaps", "Diabetes mellitus", obteniendo un total de 160 artículos de revistas en línea, de los cuales se seleccionaron 50. Resultados: la realización de colgajos en pacientes con diabetes mellitus se asocia a mayor riesgo de fracaso y complicaciones, las cuales disminuyen considerablemente si se realiza un estricto manejo perioperatorio enfocado en metas. Conclusiones: la diabetes mellitus causa alteraciones en la respuesta inflamatoria, disfunción microvascular y mayor estrés oxidativo, lo cual se ve reflejado en un proceso de cicatrizacion anormal, generando mayores tasas de infeccion y perdidas de colgajos; un estricto manejo peri operatorio guiado por metas logra disminuir las complicaciones y aumentar el exito quirurgico. Pathophysiologic factors and perioperative therapeutic goals that affect reconstructive surgical procedures with flaps in patients with Diabetes MellitusABSTRACT Introduction: diabetes mellitus is considered a risk factor for local complications and surgical failure in reconstructive surgeries, mainly in flaps due to the fact that it causes alterations in the cicatrization process. Objective: to review the available literature on the pathophysiological factors that influence the short-, medium-and long-term results in the diabetic population, the perioperative therapeutic goals associated with higher success rates, and to establish a baseline protocol for the perioperative management of these patients. Searching methodology: we searched the PUBMED, MEDLINE and SCIELO databases using the search terms "Period

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Section: Período Preoperatoriounclassified

Section: Peroodo Intraoperatoriounclassified

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Factores fisiopatológicos y metas terapéuticas perioperatorias que influyen en procedimientos quirúrgicos reconstructivos mediante colgajos en pacientes con Diabetes Mellitus

Alvear

et al. 2017

revmed

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“…In the recent two or three decades, the prevalence of diabetes mellitus (DM) has rapidly increased throughout the world, the estimation being that it will increase by 200 % in the next several decades (1)(2)(3)(4)(5). As a result, physicians will be encountered with an increasing population of diabetic patients undergoing anesthesia and surgery with serious complications, such as hypertension, ischemic heart disease in association with signifi cant increases in length of stay and mortality rates in hospital, as well as nephropathy, and autonomic neuropathy (1)(2)(3).…”

mentioning

confidence: 99%

Investigation of the effects of propofol and vitamin C administration on erythrocyte deformability in rats with streptozotocin-induced

Fm¹,

Öztürk²,

Alkan³

et al. 2014

BLL

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Abstract:Purpose: In the current study we aim to investigate the effects of vitamin C and profol on red blood cell deformability in diabetic rats Materials and methods: Twenty-eight Wistar Albino rats were included in the study after streptozocin (60 mg/ kg) treatment for 4 weeks of observation for diabetes presence. Twenty-eight rats were allocated to 4 groups. In group DP (n = 7) 150 mg.kg -1 of propofol was injected intraperitoneally. In group DP-vit C (n = 7) rats 100 mg/kg of vitamin C (Ascorbic acid, Redoxon ® 1000 mg/5 mL -Roche) were applied one hour before administrating 150 mg.kg -1 of propofol, while rats in control group (n = 7), and diabetic control group (n = 7) received intraperitoneally physiological saline. Deformability measurements were achieved by using erythrocyte suspensions with hematocrit level of 5 % in PBS buffer. Results: Erythrocyte deformability was signifi cantly higher in diabetic control group than in control and vitamin C plus propofol groups (p = 0.00, p = 0.025, respectively). Erythrocyte deformability indexes were found similar in control group and vitamin C plus propofol group (p = 0.949). Relative resistance was increased in diabetic rat model. Conclusions: Erythrocyte deformability was damaged in rats with diabetes. This injury might lead to further problems in microcirculation. Application of propofol did not alter red cell deformability in diabetic rats. Vitamin C supplementation seems to reverse those negative effects and variations in erythrocyte deformability (Fig. 2

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“…Moreover, the diabetics have as much as two to three fold higher frequency of cardiovascular disorders and three times higher mortality rates in comparison to the healthy population (4). Thus, a more careful perioperative care is necessary for these patients (5).…”

mentioning

confidence: 99%

Effect of dexmedetomidine on erythrocyte deformability during ischemia-reperfusion injury of liver in diabetic rats

Arslan¹,

Çomu²,

Işık³

et al. 2012

BLL

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Abstract:Aim: The aim of this study is to evaluate the effect of dexmedetomidine on erythrocyte deformability during IR injury of liver in diabetic rats. Methods: Twenty-eight Wistar Albino rats were included in the study after a 4 week streptozocin (65 mg/kg) treatment to observe the existence of diabetes. The animals were randomly assigned to one of the four experimental groups: GroupC and DC (sham-control group): The abdomen was dissected with a median laparotomy and the liver was collected. GroupDIR: The liver was collected after IR following the abdominal median laparotomy. GroupDIRD: The liver was collected after IR following the abdominal median laparotomy and 30 min of infusion of dexmedetomidine 100 μg/kg ip The deformability measurements were performed in erythrocyte suspensions containing Htc 5% in PBS buffer. Results: The deformability index was signifi cantly increased in diabetic rats, however it was similar in the GroupC and DIRD. It was signifi cantly increased in the GroupDIR when compared to the GroupC, DIRD and DC. The relative resistance was increased in IR models. Conclusion: Erythrocyte deformability was damaged in rats having diabetes and IR injury. This injury might lead to further problems in microcirculation. It was shown that dexmedetomidine may be useful in enhancing the adverse effects of this injury (Tab. 1, Fig. 2

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Anesthetic considerations in diabetic patients. Part I: preoperative considerations of patients with diabetes mellitus

Cited by 41 publications

References 78 publications

Factores fisiopatológicos y metas terapéuticas perioperatorias que influyen en procedimientos quirúrgicos reconstructivos mediante colgajos en pacientes con Diabetes Mellitus

Factores fisiopatológicos y metas terapéuticas perioperatorias que influyen en procedimientos quirúrgicos reconstructivos mediante colgajos en pacientes con Diabetes Mellitus

Investigation of the effects of propofol and vitamin C administration on erythrocyte deformability in rats with streptozotocin-induced

Effect of dexmedetomidine on erythrocyte deformability during ischemia-reperfusion injury of liver in diabetic rats

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