Comparison of Accu Chek Inform II point-of-care test blood glucose meter with Hexokinase Plasma method for a diabetes mellitus population during surgery under general anesthesia

Glucose measurements with accu check inform II versus hexokinase plasma method during surgery under general anesthesia, an observational cohort study

PURPOSE

Limited research exists on translation of in-vitro glucose measurement interfering compounds to the in-vivo situation. We investigated whether Point-of-Care glucose measurements by Accu Chek Inform II (ACI II) were accurate to monitor glucose concentrations during surgery with general anesthesia by comparing with the reference laboratory hexokinase plasma glucose test.

METHOD

Patients undergoing surgery with general anesthesia were included. Anesthesia was maintained with either Sevoflurane or Total intravenous anesthesia (TIVA). Prior to and after induction, blood glucose was measured with ACI II and the hexokinase test. Bland-Altman analysis was performed to assess method agreement. Subgroup analyses on glucose measurement differences per type of maintenance anesthesia were performed.

RESULTS

Thirty-nine patients were included, and 78 measurements were performed. All paired measurements had clinically acceptable agreement with a percentage error of 10.0% (95% CI 8.0 to 11.9). The mean difference (95% limits of agreement) between ACI II and hexokinase for all measurements was 0.0 mmol/L (-0.7 to 0.7 mmol/L). Before induction (n = 39), mean difference was -0.1 mmol/L (-0.6 to 0.4 mmol/L), and after induction (n = 39), mean difference was 0.1 mmol/L (-0.8 to 0.9 mmol/L). Further investigation showed the difference varied per test for patients receiving Sevoflurane compared to patients receiving TIVA (-0.2 ± 0.4 mmol/L vs. 0.4 ± 0.3 mmol/L, p < 0.001). Before and after induction, the difference between ACI II and hexokinase measurements increased for patients receiving Sevoflurane compared to patients receiving TIVA (0.4 ± 0.4 mmol/L vs. -0.4 ± 0.3 mmol/L, p < 0.001).

CONCLUSION

The agreement between glucose measurements using ACI II and the reference laboratory hexokinase test was clinically acceptable with a percentage error of 10.0% (95% CI 8.0 to 11.9). The use of TIVA may negatively affect the measurement performance of the ACI II.

A not so sweet scenario: impact of perioperative glucose control on regional anesthetic techniques for orthopedic surgery

PURPOSE OF REVIEW

Diabetes and hyperglycemia are well established risk factors for complications associated with common orthopedic surgeries. In some practice settings, these conditions are also viewed as contraindications to regional nerve catheters. In this article, we aim to present our approach to offering the benefits of this modality in a safe manner for patients with diabetes and even some with preexisting, localized infections.

RECENT FINDINGS

Evidence suggests that reduction in opioids and avoidance of general anesthesia can be particularly beneficial for patients with diabetes and high blood sugar, who often suffer from comorbid conditions such as obesity and obstructive sleep apnea. On our high volume, high acuity acute pain service, we take a selective approach to nerve catheter placement in this population and even some who already have localized infections. In our experience, with careful monitoring and risk mitigation strategies these patients have improved pain control and an exceedingly low rate of complications associated with nerve catheter use.

SUMMARY

Based on our experience and reading of the literature, we advocate for a liberalized approach to use of continuous regional anesthesia for diabetic patients having for orthopedic surgery. A set of consensus guidelines tailored to institutions' resources and monitoring capabilities can be a useful tool for standardizing care. It may also increase access to the clinical benefits of this modality in a population particularly vulnerable to opioid related adverse effects.

Preparation of boronic acid-modified polymer dots under mild conditions and their applications in pH and glucose detection

For the first time, boronic acid-modified polymer dots (B-PDs) were fabricated by a "synthesis-modification integration" route using polyethylenimine (PEI) and phenylboronic acid as precursors. Under optimized preparation conditions, the B-PDs exhibited an average size of 2.2 nm, good water solubility, and high fluorescence quantum yield of 8.69%. The B-PDs showed reversible fluorescence response in acid solutions (blue emissions) and alkaline solutions (green emissions). The fluorescence emissions of B-PDs demonstrated an obvious red shift with varying the pH value from 1 - 13. Moreover, glucose could assemble on the surface of B-PDs due to the reversible reaction between boronic acid and cis-diols, which resulted in a blue shift of emission wavelength and an obvious increase of FL intensity at λ_ex = 380 nm based on the aggregation-induced enhancement effect. The glucose sensing method was thus developed in the range 0.0001 - 1.0 mol L^-1. Applications to real human blood and glucose injection samples demonstrated satisfactory results. The B-PDs based on the analytical method display good selectivity, wide detection range, and simplicity in preparation and detection, implying promising applications as a practical platform for biosensing.