Comparison of sevoflurane and propofol anesthesia on the incidence of hyperglycemia in patients with type 2 diabetes undergoing lung surgery / 영남의대학술지

BACKGROUND@#The type and regimen of anesthesia may affect perioperative hyperglycemia following major surgical stress. This study compared the effects of sevoflurane and propofol on the incidence of hyperglycemia and clinical outcomes in diabetic patients undergoing lung surgery.@*METHODS@#This retrospective study included 176 patients with type 2 diabetes mellitus who had undergone lung surgery. Blood glucose levels and clinical outcomes from the preoperative period to the first 2 postoperative days (PODs) were retrospectively examined in patients who received sevoflurane (group S, n= 87) and propofol (group P, n=89) for maintenance of general anesthesia. The primary endpoint was the incidence of persistent hyperglycemia (2 consecutive blood glucose levels > 180 mg/dL [10.0 mmol/L]) during the perioperative period. The secondary composite endpoint was the incidence of major postoperative complications and 30-day mortality rate after surgery.@*RESULTS@#Blood glucose levels similarly increased from the preoperative period to the second POD in both groups (p=0.857). Although blood glucose levels at 2 hours after surgery were significantly lower in group P than in group S (p=0.022; 95% confidence interval for mean difference, −27.154 to −2.090), there was no difference in the incidence of persistent hyperglycemia during the perioperative period (group S, 70%; group P, 69%; p=0.816). The composite of major postoperative complications and all-cause in-hospital and 30-day mortality rates were also comparable between the two groups.@*CONCLUSION@#Sevoflurane and propofol were associated with a comparable incidence of perioperative hyperglycemia and clinical outcomes in diabetic patients undergoing lung surgery.

Comparison of sevoflurane and propofol anesthesia on the incidence of hyperglycemia in patients with type 2 diabetes undergoing lung surgery / 영남의대학술지

BACKGROUND: The type and regimen of anesthesia may affect perioperative hyperglycemia following major surgical stress. This study compared the effects of sevoflurane and propofol on the incidence of hyperglycemia and clinical outcomes in diabetic patients undergoing lung surgery.METHODS: This retrospective study included 176 patients with type 2 diabetes mellitus who had undergone lung surgery. Blood glucose levels and clinical outcomes from the preoperative period to the first 2 postoperative days (PODs) were retrospectively examined in patients who received sevoflurane (group S, n= 87) and propofol (group P, n=89) for maintenance of general anesthesia. The primary endpoint was the incidence of persistent hyperglycemia (2 consecutive blood glucose levels > 180 mg/dL [10.0 mmol/L]) during the perioperative period. The secondary composite endpoint was the incidence of major postoperative complications and 30-day mortality rate after surgery.RESULTS: Blood glucose levels similarly increased from the preoperative period to the second POD in both groups (p=0.857). Although blood glucose levels at 2 hours after surgery were significantly lower in group P than in group S (p=0.022; 95% confidence interval for mean difference, −27.154 to −2.090), there was no difference in the incidence of persistent hyperglycemia during the perioperative period (group S, 70%; group P, 69%; p=0.816). The composite of major postoperative complications and all-cause in-hospital and 30-day mortality rates were also comparable between the two groups.CONCLUSION: Sevoflurane and propofol were associated with a comparable incidence of perioperative hyperglycemia and clinical outcomes in diabetic patients undergoing lung surgery.

Autoimmune Pancreatitis Featuring a Pseudocyst Requiring Drainage despite Steroid Therapy / 대한내과학회지

Autoimmune pancreatitis (AIP) is rarely associated with pancreatic pseudocysts. AIP-associated pseudocysts requiring drainage despite steroid therapy are rather rare. We report a case of AIP with an infected pseudocyst requiring drainage despite steroid therapy. A 68-year-old male was diagnosed with AIP via pancreatic imaging, a high serum immunoglobulin G4 level, and steroid responsiveness. The AIP was accompanied by a pancreatic pseudocyst. Steroid therapy was prescribed, but the pancreatic pseudocyst became aggravated during steroid tapering. Endoscopic ultrasonography-guided cyst drainage was required; the pseudocyst then became completely resolved.

IgG4-Related Sclerosing Cholangitis Showing Natural Course of Progression to Decompensated Liver Cirrhosis / 대한췌담도학회지

Immunoglobulin G4-related disease (IgG4-RD) is characterized by extensive IgG4-positive plasma cells infiltration resulting in inflammation and fibrosis of the affected organs. Patient with IgG4-RD shows an excellent response to glucocorticoid therapy especially when given at early onset stages. IgG4-related sclerosing cholangitis (IgG4-SC) is considered biliary manifestation of IgG4-RD. The natural history and long-term prognosis of IgG4-SC is not well defined and most of the previous case series have reported short duration of follow-up. We present the case of development of decompensated liver cirrhosis from IgG4-related sclerosing cholangitis with a 6-year natural clinical course.

Removal of Pancreatic Duct Stones by Endoscopic Ultrasonography-Guided Rendezvous ERCP / 대한내과학회지

Symptomatic pancreatic ductal stones can be removed nonsurgically by endoscopic retrograde cholangiopancreatography (ERCP), either alone or in combination with extracorporeal shock-wave lithotripsy (ESWL). Here, we report a case of successful endoscopic ultrasonography (EUS)-guided rendezvous ERCP for removal of radiolucent pancreatic stones after failed ERCP and ESWL. A 79-year-old male with painful chronic pancreatitis associated with pancreatic stones and a dilated upstream duct underwent transgastric antegrade pancreatography via EUS-guided pancreatic duct access followed by rendezvous ERCP. In this patient, EUS-guided rendezvous ERCP was successful in salvaging pancreatic duct cannulation after unsuccessful ERCP due to a tight stricture at the pancreatic duct orifice and removing radiolucent pancreatic stones after ESWL, which was unsuccessful because of failure to localize the stones due to their radiolucency under x-ray fluoroscopy.

Anaphylaxis to topical bovine thrombin used for hemostasis during surgery for herniated nucleus pulposus: A case report

Anaphylaxis is a type I allergic reaction and its clinical features occur after re-exposure to the same allergen. Numerous types of drugs can cause anaphylaxis during general anesthesia. Topical bovine thrombin (TBT) is usually used for hemostasis during surgery. However, TBT can cause interruption of the normal blood coagulation pathways, delay wound repair, and lead to uncontrolled bleeding, anaphylaxis, or death. Anaphylaxis caused by TBT during the perioperative period is very rare. We report the case of a patient who developed severe hypotension, tachycardia, and bronchospasm while undergoing discectomy for herniated nucleus pulposus. Based on the symptoms and signs, anaphylaxis was considered most likely. Identification of the causative agents is important in these cases because it can be very helpful for the management and prevention of anaphylaxis.