Surgery
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Hyperglycemia with insulin resistance is commonly seen in severely burned patients and tight glycemia control with insulin may be beneficial in this condition. The most potent insulinotropic hormone, glucagon-like peptide 1 (GLP-1), stimulates insulin secretion in a glucose-dependent manner. Because infusion of GLP-1 never reduces glucose levels to below ∼70 mg/dL, the risk of hypoglycemia by using insulin is reduced. In this study we investigated the metabolic effects of GLP-1 infusion after burn injury in an animal model. ⋯ Burn injury reduced plasma GLP-1 in association with insulin resistance. GLP-1 infusion improved glucose tolerance and showed anabolic effects on protein metabolism and reduced total energy expenditure after burn injury, possibly via insulinotropic and non insulinotropic mechanisms.
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Randomized Controlled Trial
Intensive insulin treatment increases donor site wound protein synthesis in burn patients.
In the treatment of burns, patients' own skin is the preferred material to cover burn wounds, resulting in the need to create a donor site wound. Enhancement of healing of the donor site wound would be beneficial in burn patients. Insulin, an anabolic agent, is used routinely to treat hyperglycemia after injury. We investigated whether intensive insulin treatment increases fractional synthesis rate (FSR) of the donor site wound protein and decreases the length of hospitalization normalized for total body surface area burned (LOS/TBSA). ⋯ Insulin treatment increased FSR of the donor site wound protein in the early period of wound healing; FSR correlated with LOS/TBSA independent of the treatment regimen.
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Randomized Controlled Trial Comparative Study
A comparative study between 1 and 2 effective doses of rocuronium for intraoperative neuromonitoring during thyroid surgery.
The goal of this study was to explore an ideal application of rocuronium to enable adequate muscle relaxation for intubation without significantly affecting the evoked potentials measured by intraoperative neuromonitoring during thyroid surgery. ⋯ A total of 1 ED(95) of rocuronium (0.3 mg/kg) is an optimal dose for intraoperative neuromonitoring during thyroid surgery. Positive and high EMG signals were obtained in all patients at an early stage of operation, and satisfactory intubating conditions were achieved in most patients.
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Multicenter Study
Surgical outcome measurement for a global patient population: validation of the Surgical Apgar Score in 8 countries.
Surgical care is a vital component of health care worldwide, yet there is no clinically meaningful measure of operative outcomes that could be applied globally. The Surgical Apgar Score, a simple metric derived from 3 intraoperative parameters, has been shown in U.S. academic medical centers to predict 30-day patient outcomes after operation, but has not been validated more broadly. ⋯ The Surgical Apgar Score is easily calculated, predictive, and moderately discriminative for major complications among adults undergoing inpatient noncardiac operative procedures. Such a score could provide objective indication of relative postoperative risk for inpatients and provide a potential target for quality improvement efforts, particularly in resource-limited settings.
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An abdominal operation combines a somatic abdominal wall wound with a second autonomic wound to the peritoneal cavity and viscera and little attention has been paid the autonomic/peritoneal wound that communicates directly to the brain by the vagus nerve. Moreover, vagal input originating from the peritoneum modulates and regulates postoperative recovery. Consequently, blockade of the afferent neural and inflammatory input from this autonomic/peritoneal wound will reduce postoperative neurohormonal stress and enhance patient recovery from an abdominal operation.