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Endocrine and Electrolyte Disorders. Perioper Med (Lond) 2022. [DOI: 10.1016/b978-0-323-56724-4.00040-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
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Perioperative Assessment of High-Risk Abdominal Surgery: A Case Study. AMERICAN JOURNAL OF MEDICAL CASE REPORTS 2020; 8:374-382. [PMID: 32775620 PMCID: PMC7413206 DOI: 10.12691/ajmcr-8-10-15] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Objectives • To outline the key components of a pre-operative cardiac risk assessment. • To review the major guidelines utilized to assess patients' surgical risks. • To discuss the perioperative management of surgical patients to prevent cardiac and pulmonary complications. • To review the utility of biomarkers in the pre- and post-operative period.
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Karimian N, Niculiseanu P, Amar-Zifkin A, Carli F, Feldman LS. Association of Elevated Pre-operative Hemoglobin A1c and Post-operative Complications in Non-diabetic Patients: A Systematic Review. World J Surg 2018; 42:61-72. [PMID: 28717914 DOI: 10.1007/s00268-017-4106-4] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
IMPORTANCE Pre-operative hyperglycemia is associated with post-operative adverse outcomes in diabetic and non-diabetic patients. Current pre-operative screening includes random plasma glucose, yet plasma glycated hemoglobin (HbA1c) is a better measure of long-term glycemic control. It is not clear whether pre-operative HbA1c can identify non-diabetic patients at risk of post-operative complications. OBJECTIVE The systematic review summarizes the evidence pertaining to the association of suboptimal pre-operative HbA1c on post-operative outcomes in adult surgical patients with no history of diabetes mellitus. EVIDENCE REVIEW A detailed search strategy was developed by a librarian to identify all the relevant studies to date from the major online databases. FINDINGS Six observational studies met all the eligibility criteria and were included in the review. Four studies reported a significant association between pre-operative HbA1c levels and post-operative complications in non-diabetic patients. Two studies reported increased post-operative infection rates, and two reported no difference. Of four studies assessing the length of stay, three did not observe any association with HbA1c level and only one study observed a significant impact. Only one study found higher mortality rates in patients with suboptimal HbA1c. CONCLUSIONS AND RELEVANCE Based on the limited available evidence, suboptimal pre-operative HbA1c levels in patients with no prior history of diabetes predict post-operative complications and represent a potentially modifiable risk factor.
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Affiliation(s)
- Negar Karimian
- Steinberg-Bernstein Centre for Minimally Invasive Surgery and Innovation, McGill University Health Centre, Montreal, QC, Canada.,Division of Experimental Surgery, McGill University, Montreal, QC, Canada
| | - Petru Niculiseanu
- Steinberg-Bernstein Centre for Minimally Invasive Surgery and Innovation, McGill University Health Centre, Montreal, QC, Canada
| | | | - Francesco Carli
- Department of Anesthesia, McGill University, Montreal, QC, Canada
| | - Liane S Feldman
- Steinberg-Bernstein Centre for Minimally Invasive Surgery and Innovation, McGill University Health Centre, Montreal, QC, Canada. .,Division of Experimental Surgery, McGill University, Montreal, QC, Canada. .,Department of Surgery, McGill University, Montreal, QC, Canada. .,Montreal General Hospital, 1650 Cedar Ave, L9-404, Montreal, QC, H3G 1A4, Canada.
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Aronson S, Westover J, Guinn N, Setji T, Wischmeyer P, Gulur P, Hopkins T, Seyler TM, Lagoo-Deendayalan S, Heflin MT, Thompson A, Swaminathan M, Flanagan E. A Perioperative Medicine Model for Population Health. Anesth Analg 2018; 126:682-690. [DOI: 10.1213/ane.0000000000002606] [Citation(s) in RCA: 47] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
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Şanal Baş S, Ceyhan D, Çobaner N, Bilir A, Güleç SM. Emergency surgery in a newborn patient with severe congenital hypothyrodism. J Clin Anesth 2017; 43:11. [PMID: 28915424 DOI: 10.1016/j.jclinane.2017.09.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2017] [Revised: 08/27/2017] [Accepted: 09/03/2017] [Indexed: 10/18/2022]
Affiliation(s)
- Sema Şanal Baş
- Department of Anaesthesiology and Reanimation, Eskişehir Osmangazi University, Faculty of Medicine, Eskişehir, Turkey.
| | - Dilek Ceyhan
- Department of Anaesthesiology and Reanimation, Eskişehir Osmangazi University, Faculty of Medicine, Eskişehir, Turkey
| | - Nurdan Çobaner
- Department of Anaesthesiology and Reanimation, Eskişehir Osmangazi University, Faculty of Medicine, Eskişehir, Turkey
| | - Ayten Bilir
- Department of Anaesthesiology and Reanimation, Eskişehir Osmangazi University, Faculty of Medicine, Eskişehir, Turkey
| | - Sacit Mehmet Güleç
- Department of Anaesthesiology and Reanimation, Eskişehir Osmangazi University, Faculty of Medicine, Eskişehir, Turkey
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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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Abstract
Neuroendocrine tumors which have the potential to secrete catecholamines are either associated with sympathetic adrenal (pheochromocytoma) or nonadrenal (paraganglioma) tissue. Surgical removal of these tumors is always indicated to cure and prevent cardiovascular and other organ system complications associated with catecholamine excess. Some of these tumors have malignant potential as well. The diagnosis, localization and anatomical delineation of these tumors involve measurement of catecholamines and their metabolic end products in plasma and urine, 123I-metaiodobenzylguanidine scintigraphy, computed tomography, and/or magnetic resonance imaging. Before surgical removal of the tumors, the optimization of blood pressure, as well as intravascular volume, is an important measure to avoid and suppress perioperative adverse hemodynamic events. Preoperative preparation includes the use of alpha-adrenergic antagonists, beta-adrenergic antagonists with or without other antihypertensive agents, fluid therapy as well as insulin therapy for hyperglycemia if required. Due attention should be given to type and dose of alpha-receptor antagonists to be used and the duration of this therapy to achieve an optimal level of preoperative "alpha-blockade." Despite this preoperative preparation, many patients will have hypertensive crises intraoperatively which need to be promptly and carefully managed by the anesthesia team which requires intensive and advanced monitoring techniques. The most common complication after tumor removal is hypotension which may require fluid therapy and vasopressor support for a few hours. With advancement in surgical and anesthetic techniques, the incidence of severe morbidity and mortality associated with the surgery is low in high volume centers.
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Affiliation(s)
- Rashmi Ramachandran
- Department of Anaesthesiology, Pain Medicine and Critical Care, All India Institute of Medical Sciences, New Delhi, India
| | - Vimi Rewari
- Department of Anaesthesiology, Pain Medicine and Critical Care, All India Institute of Medical Sciences, New Delhi, India
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Lee SH, Kang JG, Hahm MC, Park JH, Kim KM, Lim TW, Kim YR. Anesthetic experience in a clinically euthyroid patient with hyperthyroxinemia and suspected impairment of T4 to T3 conversion: a case report. Korean J Anesthesiol 2014; 67:144-7. [PMID: 25237453 PMCID: PMC4166388 DOI: 10.4097/kjae.2014.67.2.144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2013] [Revised: 06/21/2013] [Accepted: 07/23/2013] [Indexed: 11/24/2022] Open
Abstract
We report an anesthetic experience in a clinically euthyroid patient with hyperthyroxinemia (elevated free thyroxine, fT4 and normal 3, 5, 3'-L-triiodothyronine, T3) and suspected impairment of conversion from T4 to T3. Despite marked hyperthyroxinemia, this patient's perioperative hemodynamic profile was suspected to be the result of hypothyroidism, in reference to the presence of T4 to T3 conversion disorder. We suspected that pretreatment with antithyroid medication before surgery, surgical stress and anesthesia may have contributed to the decreased T3 level after surgery. She was treated with liothyronine sodium (T3) after surgery which restored her hemodynamic profile to normal. Anesthesiologists may be aware of potential risk and caveats of inducing hypothyroidism in patients with euthyroid hyperthyroxinemia and T4 to T3 conversion impairment.
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Affiliation(s)
- Sang Hyun Lee
- Department of Anesthesiology and Pain Medicine, Dongtan Sacred Heart Hospital, Hallym University College of Medicine, Hwasung, Korea
| | - Jin Gu Kang
- Department of Anesthesiology and Pain Medicine, Dongtan Sacred Heart Hospital, Hallym University College of Medicine, Hwasung, Korea
| | - Moon Chol Hahm
- Department of Anesthesiology and Pain Medicine, Dongtan Sacred Heart Hospital, Hallym University College of Medicine, Hwasung, Korea
| | - Jeong Heon Park
- Department of Anesthesiology and Pain Medicine, Dongtan Sacred Heart Hospital, Hallym University College of Medicine, Hwasung, Korea
| | - Kyung-Mi Kim
- Department of Anesthesiology and Pain Medicine, Dongtan Sacred Heart Hospital, Hallym University College of Medicine, Hwasung, Korea
| | - Tae-Wan Lim
- Department of Anesthesiology and Pain Medicine, Dongtan Sacred Heart Hospital, Hallym University College of Medicine, Hwasung, Korea
| | - Young Ri Kim
- Department of Anesthesiology and Pain Medicine, Dongtan Sacred Heart Hospital, Hallym University College of Medicine, Hwasung, Korea
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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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Sahai SK. Perioperative assessment of the cancer patient. Best Pract Res Clin Anaesthesiol 2013; 27:465-80. [PMID: 24267552 DOI: 10.1016/j.bpa.2013.10.001] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2013] [Revised: 10/01/2013] [Accepted: 10/02/2013] [Indexed: 11/26/2022]
Abstract
The perioperative evaluation of patients with cancer differs from that of other patients in that the former may have received prior chemotherapy or radiation therapy. These cancer treatments have a wide range of side effects and complications that may affect patients' perioperative risks. The perioperative specialist who evaluates the cancer patient prior to surgery must be familiar with the effects of these treatments and their consequences for the major organ systems. The perioperative specialist must also be familiar with the natural history of cancer and have a basic understanding of how cancer affects the body. In this article, we review the perioperative concerns that are specific to the patient with cancer.
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Affiliation(s)
- Sunil Kumar Sahai
- The Internal Medicine Perioperative Assessment Center, The University of Texas MD Anderson Cancer Center, Houston, TX, USA; Department of General Internal Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
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Herlich A. Anesthetic emergencies in oral surgery: malignant hyperthermia, endocrinopathy, and neurologic events. Oral Maxillofac Surg Clin North Am 2013; 25:507-14, vii. [PMID: 23664228 DOI: 10.1016/j.coms.2013.03.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Despite the impressive safety of office-based anesthesia, serious emergencies still occur. Early and appropriate treatment is likely to improve outcomes. This article discusses selected emergencies with backgrounds and rationale for emergent treatment.
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Affiliation(s)
- Andrew Herlich
- Department of Anesthesiology, University of Pittsburgh School of Medicine, 1400 Locust Street, Suite 2192, Pittsburgh, PA 15219, USA.
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