viernes, 7 de julio de 2017

Diabetes y anestesia / Diabetes and anaesthesia

Julio 7, 2017. No. 2742

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Efecto de los diferentes tipos de anestesia en la glucosa intraoperatoria en sangre de pacientes diabéticos
Effect of different types of anesthesia on intraoperative blood glucose of diabetic patients: A PRISMA-compliant systematic review and meta-analysis.
Medicine (Baltimore). 2017 Mar;96(13):e6451. doi: 10.1097/MD.0000000000006451.
BACKGROUND: Systematic review which analyzes the impact of different anesthesia on intraoperative blood glucose levels of diabetespatients. METHODS: We searched Medline (via PubMed), Embase, Cochrane Library, Web of Science, Wangfang, CNKI, and CBM database through June 2016, included in randomized controlled trial (RCT), about different anesthesia on intraoperative blood glucose levels in patients with diabetes. Two researchers in 1 group independently screened literatures with eligibility criteria, extracted information, and used RevMan5.3 software to perform meta-analysis. RESULTS: We included 11 trials and performed the meta-analysis with 10 trials. The meta-analysis results suggested that compared with general anesthesia, the combined general-epidural anesthesia has a better glycemic control in intraoperative blood glucose levels (WMD -1.26, 95% confidence interval [CI] -1.77 to 0.76), the epidural anesthesia had no significant effects compared with general anesthesia (WMD -0.74, 95% CI 4.41-2.92), and the combined spinal-epidural anesthesia had no significant effects compared with epidural anesthesia (WMD -0.28, 95% CI -1.02 to 0.46). One study suggested that compared with epidural anesthesia, the combined general-epidural anesthesia can lower blood glucose levels CONCLUSION:: Existing evidence showed that compared with general anesthesia, the combined general-epidural anesthesia has a better glycemic control in intraoperative blood glucose levels.

Relación entre el momento de las visitas médicas preoperatorias y la glucosa  del día de la cirugía en la diabetes mal controlada.
Relationship between the timing of preoperative medical visits and day-of-surgery glucose in poorly controlled diabetes.
Future Sci OA. 2016 Jun 2;2(2):FSO123. doi: 10.4155/fsoa-2016-0009. eCollection 2016 Jun.Abstract
BACKGROUND: This study evaluated referral patterns for preoperative evaluations of patients with poorly controlled diabetes mellitus (DM) and determined whether intervals between evaluations and surgery day were associated with preoperative glucose levels. RESULTS/METHODOLOGY: In this retrospective analysis of DM patients with a hemoglobin A1c level greater than 8.0%, of the 163 patients who underwent preoperative medical evaluation, only 45% were evaluated by endocrinology. Patients who had surgery earlier than 10 days after the preoperative medical evaluation had preoperative glucose levels 18% higher than those of patients who waited more than 10 days. Preoperative outpatient contact with endocrinology was not associated with preoperative glucose level (p = 0.90). CONCLUSION: For poorly controlled DM, more than 10 days are needed to achieve preoperative glycemic control.

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