Perioperative Medicine最新文献

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Global research trends of neuroinflammation in perioperative neurocognitive dysfunction: a bibliometric analysis. 围手术期神经认知功能障碍中神经炎症的全球研究趋势:文献计量学分析。
IF 2.1 3区 医学
Perioperative Medicine Pub Date : 2025-07-22 DOI: 10.1186/s13741-025-00565-1
Shiqian Huang, Yuxi Zhou, Jie Liu, Shujun Sun, Tianhao Zhang, Lulin Ma, Shiya Liu, Daling Deng, Shaofang Shu, Yu Wang, Yin Yuan, Xiangdong Chen
{"title":"Global research trends of neuroinflammation in perioperative neurocognitive dysfunction: a bibliometric analysis.","authors":"Shiqian Huang, Yuxi Zhou, Jie Liu, Shujun Sun, Tianhao Zhang, Lulin Ma, Shiya Liu, Daling Deng, Shaofang Shu, Yu Wang, Yin Yuan, Xiangdong Chen","doi":"10.1186/s13741-025-00565-1","DOIUrl":"10.1186/s13741-025-00565-1","url":null,"abstract":"<p><p>Perioperative neurocognitive dysfunction (PND) is a significant complication in elderly surgical patients, characterized by cognitive decline and often linked to neuroinflammation. This study conducted a bibliometric analysis of 744 publications on PND-related neuroinflammation from 1999 to 2023, using the Web of Science Core Collection (WoSCC) database. Tools such as VOSviewer, CiteSpace, and Microsoft Excel were employed to analyze publication trends, geographical distribution, and key research areas. Results showed a steady increase in publications, with China leading in output and the USA exerting significant influence. Key research areas included aging, cardiac surgery, microglial activation, and therapeutic targets. Recent studies focused on the NLRP3 inflammasome and microglial activation as central mechanisms. The analysis also identified emerging trends, such as the investigation of biomarkers and the potential of dexmedetomidine and sevoflurane in modulating neuroinflammation. This study provides a comprehensive overview of the evolving research landscape, highlighting the need for interdisciplinary collaboration and the development of novel therapeutic strategies to address PND. Future research should focus on elucidating the complex interactions between neuroinflammation and cognitive decline and exploring personalized interventions to improve patient outcomes.</p>","PeriodicalId":19764,"journal":{"name":"Perioperative Medicine","volume":"14 1","pages":"76"},"PeriodicalIF":2.1,"publicationDate":"2025-07-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12281741/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144691187","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
The influence of rotational thromboelastometry (ROTEM) on operating room and intensive care transfusion practices in major trauma bleeding: a prospective cohort study with historical control. 旋转血栓弹性测量法(ROTEM)对重大创伤出血患者手术室和重症监护输液的影响:一项具有历史对照的前瞻性队列研究。
IF 2 3区 医学
Perioperative Medicine Pub Date : 2025-07-21 DOI: 10.1186/s13741-025-00562-4
Natalia Kozera, Marek Wełna, Waldemar Goździk
{"title":"The influence of rotational thromboelastometry (ROTEM) on operating room and intensive care transfusion practices in major trauma bleeding: a prospective cohort study with historical control.","authors":"Natalia Kozera, Marek Wełna, Waldemar Goździk","doi":"10.1186/s13741-025-00562-4","DOIUrl":"10.1186/s13741-025-00562-4","url":null,"abstract":"<p><strong>Background: </strong>Despite advances in treatment, hemorrhage remains one of the leading causes of early death in trauma. Rapid, personalized treatment of coagulopathy in this population should therefore be a priority. The introduction of viscoelastic hemostatic assays may improve transfusion strategies.</p><p><strong>Methods: </strong>This prospective observational study aimed to compare the efficacy of a ROTEM-guided hemostatic treatment protocol for trauma patients with a historical control group who had received conventional coagulation testing. The study included adults with multiple trauma requiring transfusion (≥ 1 unit of RBC within 12 h). The aim was to compare transfusion requirements in the operating room, on the 1st and 2nd ICU days, the rate of massive transfusion, and the overall outcome. The data obtained were stored in a database and analyzed using Statistica™ 13.3 (Stat Soft Polska). A p-value < 0.05 was considered significant. Study was registered retrospectively at researchregistry.com (RR10995).</p><p><strong>Results: </strong>A total of 78 patients were compared. The number of RBC units transfused in the OR and on the 1st ICU day decreased significantly after implementation of the ROTEM treatment protocol (p = 0.01, p = 0.04). Fewer patients in the study group required RBC transfusion on the 1st and 2nd ICU days (p = 0.01, p = 0.003), as well as the number of patients requiring FFP transfusion in all examined periods of time (p = 0.02, p = 0.006, p = 0.01). While FFP use per patient in the OR and on the 1st ICU day was lower, it was not statistically significant. Fibrinogen substitution in the OR remained similar, but more patients from the study group received it on the 1st ICU day (13 vs. 5, p = 0.04). The need for other blood products and coagulation factors remained unchanged. MT incidence decreased significantly in the first 24 h (p = 0.02), while 30-day mortality remained unchanged.</p><p><strong>Conclusions: </strong>The introduction of the ROTEM- guided hemostatic treatment protocol in trauma resulted in a changes in transfusion requirements and a reduction in the incidence of MT. ROTEM can be a useful clinical tool in the rapid and targeted management of bleeding trauma patients.</p><p><strong>Trial registration: </strong>Researchregistry.com (RR10995).</p>","PeriodicalId":19764,"journal":{"name":"Perioperative Medicine","volume":"14 1","pages":"75"},"PeriodicalIF":2.0,"publicationDate":"2025-07-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12281821/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144682841","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
ORchestra: a reflective model for harmonized surgical team communication. 交响乐团:一个协调外科团队沟通的反思模型。
IF 2 3区 医学
Perioperative Medicine Pub Date : 2025-07-19 DOI: 10.1186/s13741-025-00563-3
Saeid Amini Rarani
{"title":"ORchestra: a reflective model for harmonized surgical team communication.","authors":"Saeid Amini Rarani","doi":"10.1186/s13741-025-00563-3","DOIUrl":"10.1186/s13741-025-00563-3","url":null,"abstract":"","PeriodicalId":19764,"journal":{"name":"Perioperative Medicine","volume":"14 1","pages":"74"},"PeriodicalIF":2.0,"publicationDate":"2025-07-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12275276/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144668085","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Analgesic application of a novel non-steroidal anti-inflammatory drug imrecoxib after total knee arthroplasty: a prospective randomized controlled study. 全膝关节置换术后一种新型非甾体抗炎药的镇痛应用:一项前瞻性随机对照研究。
IF 2 3区 医学
Perioperative Medicine Pub Date : 2025-07-15 DOI: 10.1186/s13741-025-00559-z
Guoyang Bai, Xiangxiang Sun, Qunli Dou, Bowei Li, Kai Qin, Xiaobo Sun, Jianbing Ma, Chao Xu, Yuanchi Huang
{"title":"Analgesic application of a novel non-steroidal anti-inflammatory drug imrecoxib after total knee arthroplasty: a prospective randomized controlled study.","authors":"Guoyang Bai, Xiangxiang Sun, Qunli Dou, Bowei Li, Kai Qin, Xiaobo Sun, Jianbing Ma, Chao Xu, Yuanchi Huang","doi":"10.1186/s13741-025-00559-z","DOIUrl":"10.1186/s13741-025-00559-z","url":null,"abstract":"<p><strong>Background: </strong>Imrecoxib is a novel non-steroidal anti-inflammatory drug. As a moderately selective COX-2 inhibitor, it has achieved certain therapeutic effects in postoperative analgesia such as spinal, arthroscopic, and total hip arthroplasty. However, the efficacy of imrecoxib in postoperative analgesia after total knee arthroplasty (TKA) is still unknown. Therefore, this study aims to explore the clinical efficacy and safety of imrecoxib in postoperative analgesia after TKA.</p><p><strong>Methods: </strong>The 120 patients were randomly assigned to two groups. The experimental group was given one tablet of imrecoxib 4 h after surgery in addition to conventional treatment. Starting from the second day, the dose of imrecoxib was 0.1 g/time, twice a day. The control group only received conventional treatment. The observation indicators included visual analogue scale (VAS) score, joint range of motion (ROM), opioid consumption, erythrocyte sedimentation rate (ESR), C-reactive protein (PCR), interleukin-6 (IL-6), and incidence of adverse reactions.</p><p><strong>Results: </strong>At rest, the VAS pain scores of the experimental group at 24 and 48 h after surgery (3.033 ± 1.154, 2.700 ± 0.988) were lower than those of the control group (2.017 ± 0.128, 1.950 ± 0.589), with statistical differences (P = 0.000 < 0.05, P = 0.000 < 0.05). At movement state, the VAS scores of the experimental group at four postoperative time points (4.050 ± 0.805, 4.633 ± 1.048, 4.517 ± 1.057, 4.233 ± 0.844) were lower than those of the control group (4.433 ± 0.782, 5.067 ± 0.910, 5.800 ± 0.945, 5.167 ± 1.003), with statistical differences (P = 0.013 < 0.05, P = 0.027 < 0.05, P = 0.000, P = 0.000).The joint ROM of the experimental group at 24 h (84.783 ± 7.902) and 48 h (86.403 ± 10.367) was higher than that of the control group (76.725 ± 9.499, 79.802 ± 8.400), with statistical differences (P = 0.000 < 0.05, P = 0.000 < 0.05).The postoperative opioid consumption of the experimental group (0.567 ± 0.692) was significantly lower than that of the control group (2.783 ± 1.156), with a statistical difference (P = 0.000 < 0.05).</p><p><strong>Conclusion: </strong>Our prospective randomized controlled trial demonstrates that imrecoxib can effectively alleviate postoperative pain after TKA, reduce opioid dosage, and does not cause additional adverse reactions, providing a new option for analgesic treatment after TKA.</p><p><strong>Trial registration: </strong>The study was registered with the China Clinical Trial Registry (registration number: ChiCTR2300072839). Registered date: 20,230,616.</p>","PeriodicalId":19764,"journal":{"name":"Perioperative Medicine","volume":"14 1","pages":"73"},"PeriodicalIF":2.0,"publicationDate":"2025-07-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12261630/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144643065","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Sugammadex versus cholinesterase inhibitors to antagonize respiratory dysfunction after neuromuscular blockade in patients undergoing pulmonary surgery: a systematic review and meta-analysis. Sugammadex与胆碱酯酶抑制剂对抗肺部手术患者神经肌肉阻断后的呼吸功能障碍:一项系统回顾和荟萃分析
IF 2 3区 医学
Perioperative Medicine Pub Date : 2025-07-10 DOI: 10.1186/s13741-025-00557-1
Bo Liu, Keqin Song, Peilin Wang, Fangshuo Li, Qianfeng Guo
{"title":"Sugammadex versus cholinesterase inhibitors to antagonize respiratory dysfunction after neuromuscular blockade in patients undergoing pulmonary surgery: a systematic review and meta-analysis.","authors":"Bo Liu, Keqin Song, Peilin Wang, Fangshuo Li, Qianfeng Guo","doi":"10.1186/s13741-025-00557-1","DOIUrl":"10.1186/s13741-025-00557-1","url":null,"abstract":"<p><strong>Objective: </strong>The incidence of respiratory dysfunction associated with postoperative residual curarization (PORC) after thoracic surgery is high, even affecting the prognosis. There is no consensus on whether sugammadex is beneficial. This study aimed to elucidate the effect of sugammadex in the management of PORC-related respiratory dysfunction following thoracic surgery.</p><p><strong>Methods: </strong>PubMed, Embase, Cochrane Library, and Web of Science were searched from database inception to January 2025 for studies on respiratory outcomes after thoracic surgery when sugammadex was used as an antagonist. The pooled risk ratio or weighted mean difference was used to evaluate the outcomes.</p><p><strong>Results: </strong>Among 1398 studies searched, 11 studies were finally included, involving 1445 subjects. The results showed that sugammadex could reduce the incidence of postoperative respiratory complications (RR = 0.77, 95% CI: 0.66-0.90), particularly atelectasis (RR = 0.61, 95% CI: 0.47-0.79) and pneumonia (RR = 0.64, 95% CI: 0.46-0.91). In addition, according to the subgroup analysis by age, surgery type, anesthesia duration, and body mass index, sugammadex was associated with a shortened extubation period (P ≤ 0.005).</p><p><strong>Conclusion: </strong>Compared with traditional muscle relaxant antagonists, the use of sugammadex after thoracic surgery can help reverse the respiratory dysfunction related to residual muscle relaxants and reduce the risk of atelectasis, pneumonia, and reintubation. However, there is no difference in the risk of pleural effusion and pneumothorax. Except for post-anesthesia care unit duration, the differences in hospitalization and chest tube dwelling duration between the two groups remain to be clarified.</p>","PeriodicalId":19764,"journal":{"name":"Perioperative Medicine","volume":"14 1","pages":"72"},"PeriodicalIF":2.0,"publicationDate":"2025-07-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12243294/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144601125","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Development and validation of a nomogram prediction model for surgical site infection after instrumentation for degenerative lumbar spinal diseases. 腰椎退行性疾病内固定术后手术部位感染的nomogram预测模型的建立与验证。
IF 2 3区 医学
Perioperative Medicine Pub Date : 2025-07-07 DOI: 10.1186/s13741-025-00556-2
Yongjun Liu, Xiaodong Wei, Xiaoyan Chen, Yan Ding
{"title":"Development and validation of a nomogram prediction model for surgical site infection after instrumentation for degenerative lumbar spinal diseases.","authors":"Yongjun Liu, Xiaodong Wei, Xiaoyan Chen, Yan Ding","doi":"10.1186/s13741-025-00556-2","DOIUrl":"10.1186/s13741-025-00556-2","url":null,"abstract":"<p><strong>Purpose: </strong>This retrospective study aimed to investigate the incidence and risk factors for surgical site infection (SSI) following instrumentation for degenerative lumbar spinal diseases, and to develop a predictive nomogram model.</p><p><strong>Method: </strong>Patients who underwent posterior instrumentation for degenerative lumbar spinal diseases between January 2020 and December 2022 with a minimum 12-month follow-up were included. Patients were classified as having an SSI or not, and differences in demographics, clinical data, and laboratory indicators were compared. Multivariate logistic regression was performed to identify independent risk factors, and a nomogram was constructed to visualize the results.</p><p><strong>Results: </strong>The study included 1,462 patients (687 men, 775 women) with a mean age of 52.9 ± 13.7 years and 53 patients (3.5%) developed an SSI. Multivariate analysis identified several risk factors for SSI: higher ASA class (III or IV vs I or II, OR = 2.362; 95%CI, 1.312 to 4.249), surgery involving sacral vertebrae (OR = 2.319; 95%CI, 1.242 to 4.330), open surgery compared to minimally invasive surgery (OR = 3.081; 95%CI, 1.701 to 5.581), prolonged surgical time (per hour increase, OR = 1.482; 95%CI, 1.017 to 2.160), and preoperative hemoglobin < 100 g/L (OR = 4.962; 95%CI, 1.728 to 6.943). The nomogram model demonstrated good discrimination, with a C-index of 0.743 (95% CI: 0.682-0.804), which remained robust at 0.722 after 1,000 bootstrap verifications. The calibration curve indicated the predicted SSI probability aligned well with the actual probability.</p><p><strong>Conclusions: </strong>This study found a moderate 3.5% SSI rate following instrumentation for degenerative lumbar spinal diseases and identified several risk factors. These findings can inform preoperative patient counseling, risk assessment, and the development of personalized strategies to mitigate SSI.</p>","PeriodicalId":19764,"journal":{"name":"Perioperative Medicine","volume":"14 1","pages":"71"},"PeriodicalIF":2.0,"publicationDate":"2025-07-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12235930/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144584495","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Efficient statistical analysis of trial designs: win ratio and related approaches for composite outcomes. 试验设计的有效统计分析:复合结果的胜率和相关方法。
IF 2 3区 医学
Perioperative Medicine Pub Date : 2025-07-05 DOI: 10.1186/s13741-025-00550-8
Wilson Fandino, Matthew Dodd, Gudrun Kunst, Tim Clayton
{"title":"Efficient statistical analysis of trial designs: win ratio and related approaches for composite outcomes.","authors":"Wilson Fandino, Matthew Dodd, Gudrun Kunst, Tim Clayton","doi":"10.1186/s13741-025-00550-8","DOIUrl":"10.1186/s13741-025-00550-8","url":null,"abstract":"<p><p>In randomized controlled clinical trials, composite outcomes are often used to study treatment effects. This approach is popular because it increases the number of observed events, enhancing statistical power while reducing the required patient sample size. However, composite outcomes do not provide insight into the effect of individual endpoints. This becomes particularly relevant when mortality is combined with less critical but clinically relevant endpoints or when the clinical importance of individual endpoints varies significantly. As a result, interpreting composite outcomes can be challenging.This narrative review introduces the win ratio (WR), a method for prioritizing individual endpoints within a composite outcome. The WR offers an alternative to composite outcomes by considering the clinical importance of each component and prioritizing the most critical endpoint, such as death, over less significant events.Despite the popularity of the WR among cardiovascular trialists, this approach has not been extensively used in other areas of clinical research. We contend, that perioperative and periprocedural researchers could consider the WR and related approaches when the outcomes of interest are not of similar clinical importance. To this end, understanding the benefits and limitations of the WR will be essential to exploit its benefits, while avoiding potential misuses of the technique.</p>","PeriodicalId":19764,"journal":{"name":"Perioperative Medicine","volume":"14 1","pages":"70"},"PeriodicalIF":2.0,"publicationDate":"2025-07-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12229281/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144567719","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Platform trials-an emerging methodology for perioperative medicine: a narrative review. 平台试验——围手术期医学的一种新兴方法:叙述性回顾。
IF 2 3区 医学
Perioperative Medicine Pub Date : 2025-07-04 DOI: 10.1186/s13741-025-00543-7
Tom E F Abbott, Sarah-Louise Watson, Salma Begum, Priyanthi Dias, Joanne S Haviland, James Glasbey, Lawani Ismail, Sharon Love, Rupert M Pearse
{"title":"Platform trials-an emerging methodology for perioperative medicine: a narrative review.","authors":"Tom E F Abbott, Sarah-Louise Watson, Salma Begum, Priyanthi Dias, Joanne S Haviland, James Glasbey, Lawani Ismail, Sharon Love, Rupert M Pearse","doi":"10.1186/s13741-025-00543-7","DOIUrl":"10.1186/s13741-025-00543-7","url":null,"abstract":"<p><p>The traditional model for testing new treatments, before widespread usage in clinical practice, is the parallel group randomised trial. However, these are often inefficient, time-consuming and expensive, which can be barriers to the timely improvement of clinical care. This is a particular issue for anaesthesia and perioperative medicine where funding for large clinical trials is often scarce. Platform trials are an emerging methodology for testing new interventions, which offer benefits over the traditional parallel group paradigm. Platform trials have the ability to test multiple interventions at the same time, and to add or remove interventions during the course of the programme without undermining the validity or integrity of the trial findings. They are most often structured around a master protocol, which describes the core methods and research governance processes, with each intervention described in either a sub-section or appendix to the master protocol. The principal benefit to researchers and to research funders is that, unlike the sequential parallel group trial model, platform trials can use the same research infrastructure (e.g. database, standard operating procedures etc.) to answer multiple research questions, which is much more time and cost effective. The benefits of platform trials can be further enhanced with the use of adaptive designs or by sharing control patients, for example, by using a multi-arm multi-stage design. Perioperative medicine, anaesthesia and surgery are ideally placed to benefit from platform trials.</p>","PeriodicalId":19764,"journal":{"name":"Perioperative Medicine","volume":"14 1","pages":"67"},"PeriodicalIF":2.0,"publicationDate":"2025-07-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12228343/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144565074","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
A case of perioperative euglycemic ketoacidosis in a patient without diabetes: are current guidelines enough? 无糖尿病患者围手术期正常血糖酮症酸中毒1例:现行指南是否足够?
IF 2 3区 医学
Perioperative Medicine Pub Date : 2025-07-04 DOI: 10.1186/s13741-025-00548-2
Shushmita Hoque, Rebecca Longo, Paul Teague, Eugene Kim
{"title":"A case of perioperative euglycemic ketoacidosis in a patient without diabetes: are current guidelines enough?","authors":"Shushmita Hoque, Rebecca Longo, Paul Teague, Eugene Kim","doi":"10.1186/s13741-025-00548-2","DOIUrl":"10.1186/s13741-025-00548-2","url":null,"abstract":"<p><strong>Background: </strong>Euglycemic ketoacidosis (eKA) is a serious and potential life-threatening complication of SGLT2-inhibitor (SGLT2i) use. eKA associated with SGLT2i has been increasingly reported in patients without diabetes likely due to more widespread use. The perioperative setting is a particularly vulnerable time for patients due to decreased carbohydrate intake, volume depletion, medication changes, and increased counterregulatory hormone activity due to surgical stress. Current guidelines recommend that patients with type 2 diabetes hold SGLT2i for at least 24-72 h prior to elective surgery.</p><p><strong>Case presentation: </strong>We report a case of an 82-year-old woman without a history of diabetes who held empagliflozin for 72 h prior to planned bowel resection for management of colon cancer. The indication for empagliflozin was heart failure with reduced ejection fraction. Intraoperatively, she was found to have profound metabolic acidosis, high-normal anion gap, normal glucose, and elevated serum beta hydroxybutyrate. Given the high risk for decompensation intraoperatively, the patient was empirically given dextrose and insulin to treat eKA. The surgery was otherwise uncomplicated. Afterward, the patient was transferred to the intensive care unit for treatment of eKA with insulin and dextrose infusions. She recovered and was discharged home. Empagliflozin was not restarted.</p><p><strong>Conclusions: </strong>Our patient's case demonstrates that there is not a one-size-fits-all approach to withholding SGLT2i in patients in the perioperative setting. Despite holding the SGLT2i preoperatively, our patient without a history of diabetes nonetheless developed eKA. Upon further review, this patient had risk factors for developing eKA, including age, sex, chronic kidney disease, and preoperative nutrition status. Additional preoperative workup may have been warranted due to suspected preoperative hypovolemia associated with bowel preparation, perhaps allowing us to identify eKA prior to surgery. Future considerations include obtaining a basic metabolic panel on day of surgery for patients taking SGLT2i to evaluate for acute renal dysfunction and metabolic acidosis prior to surgical intervention. Point-of-care serum beta-hydroxybutyrate could also be incorporated into clinical decision-making though this may not be widely available. Future investigation should examine risk factors that predispose patients to developing eKA and drive development of protocols to guide which patients require more monitoring perioperatively.</p>","PeriodicalId":19764,"journal":{"name":"Perioperative Medicine","volume":"14 1","pages":"68"},"PeriodicalIF":2.0,"publicationDate":"2025-07-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12228281/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144565071","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Ultrasound-guided iliopsoas plane block combined with lateral femoral cutaneous nerve block for postoperative analgesia in hip arthroplasty: a retrospective case series. 超声引导髂腰肌平面阻滞联合股外侧皮神经阻滞用于髋关节置换术后镇痛:回顾性病例系列。
IF 2 3区 医学
Perioperative Medicine Pub Date : 2025-07-04 DOI: 10.1186/s13741-025-00542-8
Jian Chen, Cong Liu, Meng-Lan Zhou, Hui-Wen Wang
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