Current opinion in anaesthesiology
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Diabetes mellitus and its related comorbidities present a growing challenge in perioperative medicine. And also largely independent from a history of diabetes, dysregulations of glucose homeostasis occur as part of the body's stress response. Dysregulations of glucose homeostasis, acute or chronic, are closely correlated with impaired prognosis in perioperative medicine. Treatment strategies remain somewhat controversial, as both the affliction and its correction have a blind side. ⋯ Literature clearly shows that leaving glycemic control out of focus is dangerous for the patient; efforts to control glycemia to a moderate target improve the patient's outcome.
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Curr Opin Anaesthesiol · Aug 2013
ReviewAnaesthetic considerations for endoscopic retrograde cholangio-pancreatography procedures.
The purpose of this review is to evaluate the current literature on the use of general anaesthesia and propofol deep sedation for patients undergoing endoscopic retrograde cholangio-pancreatography (ERCP) procedures. Propofol is primarily an anaesthetic agent, but its use in a sedative capacity has resulted in the extensive off-label administration of this drug by gastroenterologists and other nonanaesthesia personnel. This has created controversy and enabled the gastroenterology community to gather evidence and campaign for US Food and Drug Administration approval to administer propofol to patients undergoing ERCP and other endoscopic procedures. ⋯ Deep sedation with propofol, administered by anaesthesia personnel, can be used as an alternative to general anaesthesia for a select group of patients undergoing ERCP procedures. Further research is necessary to clarify the nature and parameters of deep sedation.