Optimal Glucose Management in the Perioperative Period

Evans, Charity H.; Lee, Jane; Ruhlman, Melissa K

doi:10.1016/j.suc.2014.11.003

Cited by 29 publications

(27 citation statements)

References 64 publications

(59 reference statements)

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“…Después de la cirugía, la insulina intravenosa se debe continuar por lo menos dos horas después de la primera comida y la primera dosis subcutánea de insulina debe ser administrada antes de la interrupción de la infusión de insulina intravenosa 24,25,31,42 . Los antidiabéticos orales se pueden reiniciar cuando el paciente inicie vía oral, excepto la metformina, la cual se debe iniciar tras verificar que la función renal esté normal 25 .…”

Section: Periodo Postoperatoriounclassified

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: Periodo Postoperatoriounclassified

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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show abstract

“…Changes in diet, activity level, stress, illness, and other medications all affect the glucose levels and insulin sensitivity of the diabetic patient. In addition, patients without a diagnosis of diabetes frequently experience dysglycemia in an inpatient situation [243]. It has become increasingly clear that effective management of hyperglycemia in the hospital setting improves outcomes, reduces complications and length of stay, and thereby reduces costs [244,245].…”

Section: Healthcare Provider Requirementsmentioning

confidence: 99%

Electrochemical Glucose Biosensors for Diabetes Care

Ocvirk¹,

Buck²,

DuVall³

2016

Trends in Bioelectroanalysis

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Blood glucose monitoring (BGM) is the most successful application of electrochemical biosensor technology and has motivated tremendous improvements in biology, chemistry, measurement, and fabrication methods of biosensors. The performance of electrochemical biosensors used for BGM has improved greatly over the last four decades. Technological advance has allowed to measure blood glucose (BG) over a wide range of glucose concentration, a wide temperature and hematocrit range in the presence of an abundance of interfering substances with ever-increasing accuracy, and precision in minute sample volumes. The use of optimized enzymes, mediators, and electrochemical measurement methods enables this tremendous progress in performance. Continuous glucose monitoring (CGM) systems based on minimally invasive amperometric sensors, inserted into the subcutaneous tissue, have significantly improved over initial offerings over the last 15 years with regard to time of use, accuracy, reliability, and convenience due to a multitude of parallel advances: materials needed for enzyme immobilization, polymeric cover membranes, and biocompatible coatings needed to tackle the response by the complex body interface have been developed; wireless transfer and processing of unprecedented data volume have been established; effortless and painless insertion schemes of ever smaller sensors have been realized in order to overcome the concerns of persons with diabetes (PwDs) to use a minimally invasive sensor; and scalable manufacturing technologies of miniaturized minimally invasive sensors have allowed for ever improved reproducibility and increased production volume. Looking ahead, the demands on blood glucose system performance G. Ocvirk (*) Roche Diabetes Care GmbH, Mannheim, Germany e-mail: gregor.ocvirk@roche.com H. Buck and S.H. DuVall Roche Diabetes Care, Inc., Indianapolis, IN, USA e-mail: harvey.buck@roche.com; stacy.duvall@roche.com are expected to grow even as the pressures to lower the cost of systems increase. The drive for the future is to continue to push the limits on system performance under real-life conditions while lowering cost, all while finding ways to provide the best medical value to PwDs and healthcare providers. Technical issues of commercially available CGM sensors remain to be solved which currently impede reliable hypo-and hyperglycemic alarms, safe insulin dosing recommendations, or insulin pump control at any time of use. It is realistic to assume that continuous glucose monitoring (CGM) systems will be adopted in the future by a larger population of PwDs. Yet it is also clear that BGM systems will remain a major choice of the great majority of PwDs on a global scale. This review offers a technical overview about user, system, and major regulatory requirements and available suitable sensor technology and demonstrated performance of electrochemical BGM and CGM systems from an industrial R&D perspective.

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“…15,18 The underlying pathophysiologic mechanisms by which hyperglycemia leads to an increase in deleterious outcomes have not yet been fully elucidated. 19 However, multiple mechanisms by which hyperglycemia might contribute to postoperative complications have been proposed. First, clinical studies suggest that hyperglycemia causes decreased monocyte and neutrophil function, reduced intracellular antibacterial activity, and glycosylation of immuno globulins resulting in an increased risk of infections.…”

Section: Perioperative Hyperglycemia and Complicationsmentioning

confidence: 99%

“…22 Third, experimental animal models showed that hyperglycemia is associated with lower cell count of endothelial progenitor cells and decreased nitric oxide bioavailability leading to decreased endothelial function and contributing to a higher risk of infections, impaired wound healing, and thrombotic complications. 19,23 Finally, an increase in glucose leads to upregulation of coagulation factors, thereby promoting a pro-thrombotic state in the perioperative period. 24,25 Furthermore, untreated hyperglycemia can result in severe dehydration, ketoacidosis, and hyperosmolar states.…”

Section: Perioperative Hyperglycemia and Complicationsmentioning

confidence: 99%

“…The difference between capillary and venous glucose is usually small, provided there are no major physiological derangements. 19,86 However, practitioners have to keep in mind that the US Food and Drug Administration allows a 15% error margin in monitors and that point-of-care devices typically overestimate blood glucose levels in the hypoglycemic range. [86][87][88] Thus, in the hypoglycemic range, more frequent monitoring and verification with central laboratory tests should be performed.…”

Section: 13mentioning

confidence: 99%

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Ambulatory anesthesia: optimal perioperative management of the diabetic patient

Polderman¹,

Wilpe²,

Eshuis³

et al. 2016

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Given the growing number of patients with diabetes mellitus (DM) and the growing number of surgical procedures performed in an ambulatory setting, DM is one of the most encountered comorbidities in patients undergoing ambulatory surgery. Perioperative management of ambulatory patients with DM requires a different approach than patients undergoing major surgery, as procedures are shorter and the stress response caused by surgery is minimal. However, DM is a risk factor for postoperative complications in ambulatory surgery, so should be managed carefully. Given the limited time ambulatory patients spend in the hospital, improvement in management has to be gained from the preanesthetic assessment. The purpose of this review is to summarize current literature regarding the anesthesiologic management of patients with DM in the ambulatory setting. We will discuss the risks of perioperative hyperglycemia together with the pre-, intra-, and postoperative considerations for these patients when encountered in an ambulatory setting. Furthermore, we provide recommendations for the optimal perioperative management of the diabetic patient undergoing ambulatory surgery.

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Optimal Glucose Management in the Perioperative Period

Cited by 29 publications

References 64 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

Electrochemical Glucose Biosensors for Diabetes Care

Ambulatory anesthesia: optimal perioperative management of the diabetic patient

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