Intraoperative Diagnosis of Sodium-Glucose Cotransporter 2 Inhibitor-Associated Euglycemic Diabetic Ketoacidosis: A Case Report.

The use of sodium-glucose cotransporter 2 (SGLT2) inhibitors is increasingly common in type 2 diabetes mellitus (DM) management. Patients taking an SGLT2 inhibitor are at risk for euglycemic diabetic ketoacidosis (EDKA). We report an intraoperative diagnosis of EDKA. The patient was found to have an arterial pH of 7.21 and serum beta-hydroxybutyrate of 88.8 mg/dL (normal: <3.0 mg/dL) with serum glucose <250 mg/dL. Acidosis resolved with insulin and glucose infusions. Perioperative specialists must recognize the potential for EDKA in patients taking SGLT2 inhibitors. Expert opinion suggests preoperative cessation for 2-3 days and intraoperative serum ketone concentration measurement for at-risk patients.

Recent advances in the technology of anesthesia.

The practice of anesthesiology is inextricably dependent upon technology. Anesthetics were first made possible, then increasingly safe, and now more scalable and efficient in part due to advances in monitoring and delivery technology. Herein, we discuss salient advances of the last three years in the technology of anesthesiology. Consumer technology and telemedicine have exploded onto the scene of outpatient medicine, and perioperative management is no exception. Preoperative evaluations have been done via teleconference, and copious consumer-generated health data is available. Regulators have acknowledged the vast potential found in the transfer of consumer technology to medical practice, but issues of privacy, data ownership/security, and validity remain. Inside the operating suite, monitoring has become less invasive, and clinical decision support systems are common. These technologies are susceptible to the "garbage in, garbage out" conundrum plaguing artificial intelligence, but they will improve as network latency decreases. Automation looms large in the future of anesthesiology as closed-loop anesthesia delivery systems are being tested in combination (moving toward a comprehensive system). Moving forward, consumer health companies will search for applications of their technology, and loosely regulated health markets will see earlier adoption of next-generation technology. Innovations coming to anesthesia will need to account for human factors as the anesthesia provider is increasingly considered a component of the patient care apparatus.

A Novel Negative Pressure Isolation Device for Aerosol Transmissible COVID-19.

The coronavirus disease 2019 (COVID-19) pandemic creates a need to protect health care workers (HCWs) from patients undergoing aerosol-generating procedures which may transmit the severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2). Existing personal containment devices (PCDs) may protect HCWs from respiratory droplets but not from potentially dangerous respiratory-generated aerosols. We describe a new PCD and its aerosol containment capabilities. The device ships flat and folds into a chamber. With its torso drape and protective arm sleeves mounted, it provides contact, droplet, and aerosol isolation during intubation and cardiopulmonary resuscitation (CPR). Significantly improved ergonomics, single-use workflow, and ease of removal distinguish this device from previously published designs.

Impact of Hypothyroidism and Heart Failure on Hospitalization Risk.

BACKGROUND: Prior studies suggest that the relationship between hypothyroidism and mortality is dependent on underlying cardiovascular risk. Little is known about the association of hypothyroidism with hospitalization risk, and how these associations are modified by cardiovascular status. METHODS: This study examined the association of thyroid status, defined by serum thyrotropin (TSH), with hospitalization risk among patients who received care at a large university-based tertiary care center between 1990 and 2015. Thyroid status was categorized as hypothyroidism versus euthyroidism (TSH >4.7 vs. 0.3-4.7 mIU/L, respectively). The relationship between thyroid status and hospitalization risk stratified by cardiovascular status was examined using multivariable Cox models. RESULTS: Among 52,856 patients who met eligibility criteria, 49,791 (94.2%) had euthyroidism and 3065 (5.8%) had hypothyroidism. In analyses stratified by congestive heart failure (CHF) status, compared to euthyroidism, hypothyroidism was associated with higher risk of hospitalization in those with CHF but slightly lower risk in those without CHF (adjusted hazard ratio [aHRs] = 1.86 [confidence interval (CI) 1.17-2.94] and HR = 0.95 [CI 0.92-0.99], respectively; p = 0.006). In sensitivity analyses accounting for death as a competing event, underlying coronary artery disease modified the hypothyroidism-hospitalization relationship, such that stronger associations were observed among those with versus without coronary artery disease. In competing risk analyses, hypothyroidism was associated with higher versus lower risk of hospitalization among those with versus without cerebrovascular disease, respectively. CONCLUSIONS: Hypothyroidism is associated with higher hospitalization risk among patients with underlying cardiovascular disease. Future studies are needed to determine whether correction of thyroid status with replacement therapy ameliorates hospitalization risk in this population.