Hyperglycemia and ambulatory surgery.

BACKGROUND: Perioperative hyperglycemia is associated with postoperative complications after major surgery. However, more than 50% of surgical procedures are performed in an ambulatory setting, where glucose is not routinely measured. The objectives of this study were to investigate the change in capillary glucose during ambulatory surgery, to identify patients at risk for perioperative increasing glucose and to evaluate whether hyperglycemia predisposes for complications after ambulatory surgery. METHODS: In this prospective multicenter cohort study, adult patients planned for ambulatory surgery, were included and capillary glucose was measured 1 hour before and 1 hour after surgery. Patients were contacted 90 days after surgery to determine the occurrence of postoperative complications. RESULTS: Nine hundred and nine patients were included, 48 (5.3%) patients had diabetes mellitus (DM). Overall median glucose increased from 5.4 mmol L-1 preoperatively to 5.6 mmol L-1 postoperatively (P<0.001). Hyperglycemia, glucose ≥7.8 mmol L-1, occurred in 8.8% of the patients. Dexamethasone administration (given in 406 [44.7%] patients) was a risk factor for glucose increase (P<0.001). Hyperglycemia was not a risk factor for postoperative complications (OR 1.19, 95%CI 0.57-2.48, P=0.646). However, prediagnosed DM was a risk factor for postoperative complications, independent of hyperglycemia (OR 2.56, 95%CI 1.10-5.97, P=0.030). CONCLUSION: Minor ambulatory surgery is not associated with a clinically relevant increase in glucose. The very small glucose increase we observed could be attributed to the administration of dexamethasone for PONV prophylaxis. Hyperglycemia during ambulatory surgery is not associated with complications after discharge.

[Electroconvulsive therapy in therapy-resistant mania. A case study]. / Elektroconvulsieve therapie bij therapieresistente manie.

A 25-year-old woman was separated for 6 weeks on account of her suicidal and chaotic behaviour occurring within the framework of a first manic episode. Her response to medication (olanzapine 20 mg, clorazepate 50 mg and lithium (serum level 0.9 mmol/l)) was inadequate. After only one ect treatment her condition had improved to such an extent that she no longer needed to be isolated. After about 4 weeks her mental condition was reasonably good; her medication consisted only of 10 mg of olanzapine and she could be transferred to out-patient care. ect can bring about rapid improvement in patients with therapy-resistant manic symptoms.

[Experiences with outpatient laparoscopic cholecystectomy]. / Ervaringen met poliklinische laparoscopische cholecystectomie.

OBJECTIVE: To determine the feasibility and desirability of laparoscopic cholecystectomy in day care. DESIGN: Prospective, pilot study. SETTING: Academic Medical Centre, Amsterdam, the Netherlands. METHOD: Fifteen patients (ASA I/II according to the American Society of Anesthesiologists) with symptomatic gallstones underwent laparoscopic cholecystectomy with the intention to discharge them the same day. Data were collected about: pain (visual analogue scale); pain medication before and after discharge; (rc)admissions; consultations of general practitioner or day care centre; complications; satisfaction of the patients about this treatment modality. RESULTS: Fourteen patients could be discharged after 6.2 hour (standard deviation 1.2) of observation. The pain scores and medication use were low. Readmissions did not take place and there were no consultations of general practitioners or the day care centre. These patients had no complications. Thirteen of them preferred day care over admission in hospital. One patient was admitted because of colicky pains and a common bile duct stone was diagnosed, which was removed endoscopically. CONCLUSION: Laparoscopic cholecystectomy in day care appears feasible in patients with symptomatic gallstones and no functional incapacities if day care facilities are present.