randomized clinical trial for the effects of halothane and isoflurane anesthesia on blood glucose levels in the diabetic patients

Halothane and isoflurane inhibit glucose-induced insulin secretion in animal and in vitro experiments.A randomized trial was designed to determine their in vivo effects in diabetic patients. Sixty diabetic patients with various malignancies were randomized to receive anesthesia with either halothane or isoflurane. Blood glucose level [BGL] was measured before induction and every 30 minutes during surgery and then after operation in the recovery room. Patients in both arms matched with gender, age, operation time, and initial BGL. In both arms an increase in blood glucose level could be detected 30 minutes after induction of anesthesia, but higher in the halothane arm. This difference was maintained for the next 30 minutes as well as the rest of duration of the anesthesia. Both arms had higher blood glucose levels after operation compared to initial, pre-anesthesia state, and this increase was more conspicuous in the halothane arm. No Halothane toxicity was detected during hospitalization. Although the effects of stress hormones was not evaluated, halothane anesthesia caused a greater degree of hyperglycemia compared to isoflurane anesthesia. This might be secondary to halothane's greater inhibitory effect

Outcomes of breast reconstruction with pedicled transverse rectus abdominis myocutaneous [TRAM] flap at cancer institute: a retrospective study of 10 years of experience

Reconstruction of breast with transverse rectus abdominis myocutaneous [TRAM] flap is the standard for reconstruction of breast following mastectomy. In this article, authors report their experience with pedicled TRAM flap reconstruction of the breast. Records for the patients who had undergone breast reconstruction with pedicled TRAM flap were retrieved. Records of outpatient followups were also obtained. Patient satisfaction with the outcome of surgery was assessed using a detailed questionnaire including a linear visual analogue scale ranging from zero [not satisfied] to ten [most satisfied]. There were 61 reconstructions in 59 patients. In 42 [71.2%] cases a synthetic mesh and in 14 [23.7%] cases dermal graft was used for closure of the abdominal fascial defect. The mean hospital stay was 10.67 [1 - 72] days. Patients were followed up for a mean period of 621 days. The overall rates of complications were as follows: partial flap necrosis: 11 [18.6%], flap hematoma: 2 [3.4%], flap seroma: 7 [11.9%], flap wound infection: 7 [11.9%], abdominal wound hematoma: 9 [15.3%], abdominal wound seroma: 5 [8.5%], abdominal wound ischemia: 1 [1.7%], abdominal wound incisional hernia: 6 [10.2%], deep vein thrombosis: 1 [1.7%], complication requiring rehospitalization: 9 [15.3%], complication requiring reoperation: 8 [13.6%]. There were no abdominal wound infection, no umbilical necrosis, and no pulmonary embolism. Aesthetic results were classified as excellent [62%], good [28%], fair [10%]. The mean satisfaction score was 9.5 [range 6-10]. Breast reconstruction with pedicled transverse rectus abdominis myocutaneous flap was associated with a low complication rate and a high level of patient satisfaction in our center