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Omiya K, Nakadate Y, Sato H, Koo BW, Schricker T. Accuracy of the Nova StatStrip ® glucometer in patients undergoing major abdominal surgery: an observational study. Can J Anaesth 2023; 70:1970-1977. [PMID: 37919630 DOI: 10.1007/s12630-023-02606-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Revised: 05/03/2023] [Accepted: 05/16/2023] [Indexed: 11/04/2023] Open
Abstract
PURPOSE While the Nova StatStrip® Glucose Hospital Meter System (Nova Biomedical, Waltham, MA, USA) is approved for point-of-care testing (POCT) in critically ill patients, its use during major abdominal surgery has not been evaluated. The purpose of this study was to assess the accuracy of the Nova StatStrip glucometer in patients undergoing major hepatobiliary procedures using the Parkes error grid (ISO15197:2013) and criteria defined by the Clinical and Laboratory Standards Institute (CLSI) POCT12-A3 guideline. METHODS This study was a post hoc exploratory study of patients participating in a prospective randomized controlled trial on the effects of hyperinsulinemic normoglycemia (HNC) on infectious outcomes after hepatobiliary surgery. Arterial blood samples were collected before surgery and one hour, two hours, and three hours after baseline. Blood glucose levels were analyzed by the Nova StatStrip glucometer and the GEM® PremierTM 5000 blood gas analyzer. Accuracy of the StatStrip glucometer was assessed using the Parkes error grid for type 1 diabetes mellitus (when 99% of samples were within zones A and B on the Parkes error grid and clinical accuracy was acceptable) and the CLSI POCT12-A3 criteria. RESULTS Blood glucose levels were analyzed in 135 patients, 70 of whom received the HNC. In the Parkes error grid plotted, all samples at all time-points were within zones A and B. The Nova StatStrip glucometer also satisfied CLSI POCT12-A3 criteria at all time-points. CONCLUSION The Nova StatStrip glucometer was accurate in patients undergoing major upper abdominal surgery, independent of the administration of high-dose insulin therapy. STUDY REGISTRATION ClinicalTrials.gov (NCT01528189); registered 7 February 2012.
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Affiliation(s)
- Keisuke Omiya
- Department of Anesthesia, McGill University Health Centre, Royal Victoria Hospital-Glen Site, Montreal, QC, Canada.
- Department of Anesthesia, McGill University Health Centre, Royal Victoria Hospital-Glen Site, 1001 Decarie Blvd., Montreal, QC, H4A 3J1, Canada.
| | - Yosuke Nakadate
- Department of Anesthesiology, University of Tsukuba Hospital, Tsukuba, Ibaraki, Japan
| | - Hiroaki Sato
- Department of Anesthesia, McGill University Health Centre, Royal Victoria Hospital-Glen Site, Montreal, QC, Canada
| | - Bon-Wook Koo
- Department of Anesthesia, McGill University Health Centre, Royal Victoria Hospital-Glen Site, Montreal, QC, Canada
| | - Thomas Schricker
- Department of Anesthesia, McGill University Health Centre, Royal Victoria Hospital-Glen Site, Montreal, QC, Canada
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Wang TY, Price M, Mehta VA, Bergin SM, Sankey EW, Foster N, Erickson M, Gupta DK, Gottfried ON, Karikari IO, Than KD, Goodwin CR, Shaffrey CI, Abd-El-Barr MM. Preoperative optimization for patients undergoing elective spine surgery. Clin Neurol Neurosurg 2021; 202:106445. [PMID: 33454498 DOI: 10.1016/j.clineuro.2020.106445] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Revised: 09/21/2020] [Accepted: 12/17/2020] [Indexed: 01/16/2023]
Affiliation(s)
- Timothy Y Wang
- Department of Neurosurgery, Division of Spine, Duke University Medical Center, Durham, NC, USA
| | - Meghan Price
- Department of Neurosurgery, Division of Spine, Duke University Medical Center, Durham, NC, USA
| | - Vikram A Mehta
- Department of Neurosurgery, Division of Spine, Duke University Medical Center, Durham, NC, USA
| | - Stephen M Bergin
- Department of Neurosurgery, Division of Spine, Duke University Medical Center, Durham, NC, USA
| | - Eric W Sankey
- Department of Neurosurgery, Division of Spine, Duke University Medical Center, Durham, NC, USA
| | - Norah Foster
- Department of Orthopedic Surgery, Division of Spine, Duke University Medical Center, Durham, NC, USA
| | - Melissa Erickson
- Department of Orthopedic Surgery, Division of Spine, Duke University Medical Center, Durham, NC, USA
| | - Dhanesh K Gupta
- Department of Anesthesiology, Division of Neuroanesthesiology, Duke University Medical Center, Durham, NC, USA
| | - Oren N Gottfried
- Department of Neurosurgery, Division of Spine, Duke University Medical Center, Durham, NC, USA
| | - Isaac O Karikari
- Department of Neurosurgery, Division of Spine, Duke University Medical Center, Durham, NC, USA
| | - Khoi D Than
- Department of Neurosurgery, Division of Spine, Duke University Medical Center, Durham, NC, USA
| | - C Rory Goodwin
- Department of Neurosurgery, Division of Spine, Duke University Medical Center, Durham, NC, USA
| | - Christopher I Shaffrey
- Department of Neurosurgery, Division of Spine, Duke University Medical Center, Durham, NC, USA
| | - Muhammad M Abd-El-Barr
- Department of Neurosurgery, Division of Spine, Duke University Medical Center, Durham, NC, USA.
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Perioperative insulin therapy. ASIAN BIOMED 2018. [DOI: 10.1515/abm-2018-0014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Abstract
Surgical patients commonly develop hyperglycemia secondary to the neuroendocrine stress response. Insulin treatment of hyperglycemia is required to overcome the perioperative catabolic state and acute insulin resistance. Besides its metabolic actions on glucose metabolism, insulin also displays nonmetabolic physiological effects. Preoperative glycemic assessment, maintenance of normoglycemia, and avoidance of glucose variability are paramount to optimize surgical outcomes. This review discusses the basic physiology and effects of insulin as well as practical issues pertaining to its management during the perioperative period.
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Setji T, Hopkins TJ, Jimenez M, Manning E, Shaughnessy M, Schroeder R, Mendoza-Lattes S, Spratt S, Westover J, Aronson S. Rationalization, Development, and Implementation of a Preoperative Diabetes Optimization Program Designed to Improve Perioperative Outcomes and Reduce Cost. Diabetes Spectr 2017; 30:217-223. [PMID: 28848317 PMCID: PMC5556583 DOI: 10.2337/ds16-0066] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Affiliation(s)
- Tracy Setji
- Department of Medicine (Endocrinology Division), Duke University Medical Center, Durham, NC
| | - Thomas J. Hopkins
- Department of Anesthesiology, Duke University Medical Center, Durham, NC
| | - Maria Jimenez
- Department of Anesthesiology, Duke University Medical Center, Durham, NC
| | - Erin Manning
- Department of Anesthesiology, Duke University Medical Center, Durham, NC
| | | | - Rebecca Schroeder
- Department of Anesthesiology, Duke University Medical Center, Durham, NC
| | | | - Susan Spratt
- Department of Medicine (Endocrinology Division), Duke University Medical Center, Durham, NC
| | - Julie Westover
- Department of Anesthesiology, Duke University Medical Center, Durham, NC
| | - Solomon Aronson
- Department of Anesthesiology, Duke University Medical Center, Durham, NC
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McCutcheon BA, Kerezoudis P, Porter AL, Rinaldo L, Murphy M, Maloney P, Shepherd D, Hirshman BR, Carter BS, Lanzino G, Bydon M, Meyer F. Coma and Stroke Following Surgical Treatment of Unruptured Intracranial Aneurysm: An American College of Surgeons National Surgical Quality Improvement Program Study. World Neurosurg 2016; 91:272-8. [PMID: 27108027 DOI: 10.1016/j.wneu.2016.04.039] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2016] [Revised: 04/12/2016] [Accepted: 04/12/2016] [Indexed: 01/08/2023]
Abstract
OBJECTIVE A large national surgical registry was used to establish national benchmarks and associated predictors of major neurologic complications (i.e., coma and stroke) after surgical clipping of unruptured intracranial aneurysms. METHODS The American College of Surgeons National Surgical Quality Improvement Program data set between 2007 and 2013 was used for this retrospective cohort analysis. Demographic, comorbidity, and operative characteristics associated with the development of a major neurologic complication (i.e., coma or stroke) were elucidated using a backward selection stepwise logistic regression analysis. This model was subsequently used to fit a predictive score for major neurologic complications. RESULTS Inclusion criteria were met by 662 patients. Of these patients, 57 (8.61%) developed a major neurologic complication (i.e., coma or stroke) within the 30-day postoperative period. On multivariable analysis, operative time (log odds 0.004 per minute; 95% confidence interval [CI], 0.002-0.007), age (log odds 0.05 per year; 95% CI, 0.02-0.08), history of chronic obstructive pulmonary disease (log odds 1.26; 95% CI, 0.43-2.08), and diabetes (log odds 1.15; 95% CI, 0.38-1.91) were associated with an increased odds of major neurologic complications. When patients were categorized according to quartile of a predictive score generated from the multivariable analysis, rates of major neurologic complications were 1.8%, 4.3%, 6.7%, and 21.2%. CONCLUSIONS Using a large, national multi-institutional cohort, this study established representative national benchmarks and a predictive scoring system for major neurologic complications following operative management of unruptured intracranial aneurysms. The model may assist with risk stratification and tailoring of decision making in surgical candidates.
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Affiliation(s)
- Brandon A McCutcheon
- Department of Neurosurgery, Mayo Clinic, Rochester, Minnesota, USA; Mayo Clinic Neuro-Informatics Laboratory, Mayo Clinic, Rochester, Minnesota, USA
| | - Panagiotis Kerezoudis
- Department of Neurosurgery, Mayo Clinic, Rochester, Minnesota, USA; Mayo Clinic Neuro-Informatics Laboratory, Mayo Clinic, Rochester, Minnesota, USA
| | - Amanda L Porter
- Department of Neurosurgery, Mayo Clinic, Rochester, Minnesota, USA; Mayo Clinic Neuro-Informatics Laboratory, Mayo Clinic, Rochester, Minnesota, USA
| | - Lorenzo Rinaldo
- Department of Neurosurgery, Mayo Clinic, Rochester, Minnesota, USA; Mayo Clinic Neuro-Informatics Laboratory, Mayo Clinic, Rochester, Minnesota, USA
| | - Meghan Murphy
- Department of Neurosurgery, Mayo Clinic, Rochester, Minnesota, USA; Mayo Clinic Neuro-Informatics Laboratory, Mayo Clinic, Rochester, Minnesota, USA
| | - Patrick Maloney
- Department of Neurosurgery, Mayo Clinic, Rochester, Minnesota, USA; Mayo Clinic Neuro-Informatics Laboratory, Mayo Clinic, Rochester, Minnesota, USA
| | - Daniel Shepherd
- Department of Neurosurgery, Mayo Clinic, Rochester, Minnesota, USA; Mayo Clinic Neuro-Informatics Laboratory, Mayo Clinic, Rochester, Minnesota, USA
| | - Brian R Hirshman
- Department of Neurosurgery, University of California, San Diego, La Jolla, California, USA
| | - Bob S Carter
- Department of Neurosurgery, University of California, San Diego, La Jolla, California, USA
| | - Giuseppe Lanzino
- Department of Neurosurgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Mohamad Bydon
- Department of Neurosurgery, Mayo Clinic, Rochester, Minnesota, USA; Mayo Clinic Neuro-Informatics Laboratory, Mayo Clinic, Rochester, Minnesota, USA.
| | - Fredric Meyer
- Department of Neurosurgery, Mayo Clinic, Rochester, Minnesota, USA
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Sebranek J, Lugli AK, Coursin D. Glycaemic control in the perioperative period. Br J Anaesth 2013; 111 Suppl 1:i18-34. [DOI: 10.1093/bja/aet381] [Citation(s) in RCA: 57] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
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Perioperative glucose control in neurosurgical patients. Anesthesiol Res Pract 2012; 2012:690362. [PMID: 22400022 PMCID: PMC3286889 DOI: 10.1155/2012/690362] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2011] [Revised: 09/29/2011] [Accepted: 10/21/2011] [Indexed: 02/06/2023] Open
Abstract
Many neurosurgery patients may have unrecognized diabetes or may develop stress-related hyperglycemia in the perioperative period. Diabetes patients have a higher perioperative risk of complications and have longer hospital stays than individuals without diabetes. Maintenance of euglycemia using intensive insulin therapy (IIT) continues to be investigated as a therapeutic tool to decrease morbidity and mortality associated with derangements in glucose metabolism due to surgery. Suboptimal perioperative glucose control may contribute to increased morbidity, mortality, and aggravate concomitant illnesses. The challenge is to minimize the effects of metabolic derangements on surgical outcomes, reduce blood glucose excursions, and prevent hypoglycemia. Differences in cerebral versus systemic glucose metabolism, time course of cerebral response to injury, and heterogeneity of pathophysiology in the neurosurgical patient populations are important to consider in evaluating the risks and benefits of IIT. While extremes of glucose levels are to be avoided, there are little data to support an optimal blood glucose level or recommend a specific use of IIT for euglycemia maintenance in the perioperative management of neurosurgical patients. Individualized treatment should be based on the local level of blood glucose control, outpatient treatment regimen, presence of complications, nature of the surgical procedure, and type of anesthesia administered.
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Validation of the DeLiT Trial intravenous insulin infusion algorithm for intraoperative glucose control in noncardiac surgery: a randomized controlled trial. Can J Anaesth 2011; 58:606-616. [DOI: 10.1007/s12630-011-9509-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2011] [Accepted: 04/08/2011] [Indexed: 11/29/2022] Open
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