Control perioperatorio de la glicemia en neurocirugía
Perioperative glucose control in neurosurgical patients.
Godoy DA, Di Napoli M, Biestro A, Lenhardt R.
Neurocritical Care Unit, Sanatorio Pasteur, Catamarca, Argentina.
Anesthesiol Res Pract. 2012;2012:690362. Epub 2012 Feb 13.
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
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3286889/pdf/ARP2012-690362.pdf
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3286889/
Una revisión del control glicémico perioperatorio en la población neuroquirúrgica
A review of perioperative glucose control in the neurosurgical population.
Atkins JH, Smith DS.
Department of Anesthesiology and Critical Care, University of Pennsylvania, Philadelphia, Pennsylvania 19104, USA. atkinsj@uphs.upenn.edu
J Diabetes Sci Technol. 2009 Nov 1;3(6):1352-64.
Abstract
Significant fluctuations in serum glucose levels accompany the stress response of surgery or acute injury and may be associated with vascular or neurologic morbidity. Maintenance of euglycemia with intensive insulin therapy (IIT) continues to be investigated as a therapeutic intervention to decrease morbidity associated with derangements in glucose metabolism. Hypoglycemia is a common side effect of IIT with potential for significant morbidity, especially in the neurologically injured patient. Differences in cerebral versus systemic glucose metabolism, the time course of cerebral response to injury, and heterogeneity of pathophysiology in 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 specific use of IIT for maintenance of euglycemia in the perioperative management of neurosurgical patients. Existing data are summarized and reviewed in this context.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2787035/pdf/dst-03-1352.pdf
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2787035/
Control de la glicemia en el periodo perioperatorio
Blood glucose control in the perioperative period.
Kadoi Y.
Department of Anesthesiology, Gunma University Hospital, Japan. kadoi@med.gunma-u.ac.jp
Minerva Anestesiol. 2012 May;78(5):574-95. Epub 2012 Feb 10.
Abstract
Extensive data have shown that acute hyperglycemia is commonly present in the perioperative period among patients undergoing surgery or with critical illness, and a direct relationship between perioperative hyperglycemia and mortality has been established. An outstanding trial by Van den Berghe showed that intensive insulin therapy (IIT) (target blood glucose, 80-110 mg/dL) reduced in-hospital mortality. However, recent large trials have questioned the efficacy and safety of IIT and raised concerns about increased mortality rates due to hypoglycemia. This review focused on how anesthetic agents and techniques, fluid management and preoperative oral intake would affect glucose metabolism and insulin resistance, in addition to recent controversial effects of IIT on improved mortality rate. Anesthesiologists should pay attention not only to the efficacy and risks of IIT during the perioperative period, but also to effects of fluid management, anesthetic agents and techniques during anesthesia on glucose homeostasis.
http://www.minervamedica.it/en/journals/minerva-anestesiologica/article.php?cod=R02Y2012N05A0574
http://www.minervamedica.it/en/getfreepdf/dtCF%252Bp%252BS9HFmEiXyJJ7%252F7Z%252B2x5wzoQVc61Tb%252BD%252FuCao6iK0CjGHl%252FEcAvMzQ0TkOE3q%252BwakrlnsgDxt41SOlDQ%253D%253D/R02Y2012N05A0574.pdf
Atentamente
Anestesiología y Medicina del Dolor
www.anestesia-dolor.org
Perioperative glucose control in neurosurgical patients.
Godoy DA, Di Napoli M, Biestro A, Lenhardt R.
Neurocritical Care Unit, Sanatorio Pasteur, Catamarca, Argentina.
Anesthesiol Res Pract. 2012;2012:690362. Epub 2012 Feb 13.
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
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3286889/pdf/ARP2012-690362.pdf
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3286889/
Una revisión del control glicémico perioperatorio en la población neuroquirúrgica
A review of perioperative glucose control in the neurosurgical population.
Atkins JH, Smith DS.
Department of Anesthesiology and Critical Care, University of Pennsylvania, Philadelphia, Pennsylvania 19104, USA. atkinsj@uphs.upenn.edu
J Diabetes Sci Technol. 2009 Nov 1;3(6):1352-64.
Abstract
Significant fluctuations in serum glucose levels accompany the stress response of surgery or acute injury and may be associated with vascular or neurologic morbidity. Maintenance of euglycemia with intensive insulin therapy (IIT) continues to be investigated as a therapeutic intervention to decrease morbidity associated with derangements in glucose metabolism. Hypoglycemia is a common side effect of IIT with potential for significant morbidity, especially in the neurologically injured patient. Differences in cerebral versus systemic glucose metabolism, the time course of cerebral response to injury, and heterogeneity of pathophysiology in 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 specific use of IIT for maintenance of euglycemia in the perioperative management of neurosurgical patients. Existing data are summarized and reviewed in this context.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2787035/pdf/dst-03-1352.pdf
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2787035/
Control de la glicemia en el periodo perioperatorio
Blood glucose control in the perioperative period.
Kadoi Y.
Department of Anesthesiology, Gunma University Hospital, Japan. kadoi@med.gunma-u.ac.jp
Minerva Anestesiol. 2012 May;78(5):574-95. Epub 2012 Feb 10.
Abstract
Extensive data have shown that acute hyperglycemia is commonly present in the perioperative period among patients undergoing surgery or with critical illness, and a direct relationship between perioperative hyperglycemia and mortality has been established. An outstanding trial by Van den Berghe showed that intensive insulin therapy (IIT) (target blood glucose, 80-110 mg/dL) reduced in-hospital mortality. However, recent large trials have questioned the efficacy and safety of IIT and raised concerns about increased mortality rates due to hypoglycemia. This review focused on how anesthetic agents and techniques, fluid management and preoperative oral intake would affect glucose metabolism and insulin resistance, in addition to recent controversial effects of IIT on improved mortality rate. Anesthesiologists should pay attention not only to the efficacy and risks of IIT during the perioperative period, but also to effects of fluid management, anesthetic agents and techniques during anesthesia on glucose homeostasis.
http://www.minervamedica.it/en/journals/minerva-anestesiologica/article.php?cod=R02Y2012N05A0574
http://www.minervamedica.it/en/getfreepdf/dtCF%252Bp%252BS9HFmEiXyJJ7%252F7Z%252B2x5wzoQVc61Tb%252BD%252FuCao6iK0CjGHl%252FEcAvMzQ0TkOE3q%252BwakrlnsgDxt41SOlDQ%253D%253D/R02Y2012N05A0574.pdf
Atentamente
Anestesiología y Medicina del Dolor
www.anestesia-dolor.org
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