tailieunhanh - Improved Outcomes in Colon and Rectal Surgery part 3

Improved Outcomes in Colon and Rectal Surgery part 3. Written by many of the worlds leading colorectal surgeons, this evidence-based text investigates the risks and benefits of colorectal surgeries. By using clinical pathways, algorithms, and case discussions, the authors identify the best practices for patient safety and positive outcomes to ensure that physicians correctly recognize potential problems and carefully manage complications | IMPROVED OUTCOMES IN COLON AND RECTAL SURGERY increased risk. Intermittent pulse oximetry with observation does not provide the same level of safety. 100 Continuous positive airway pressure ventilation CPAP is given to all patients using it preoperatively. DIABETES The frequency of glucose abnormalities and type II diabetes increases with age almost 25 of patients aged more than 60 had an abnormal value in one report. 66 The diabetic patient who is recognized and well managed perioperatively can achieve a surgical mortality which is equal to the nondiabetic patient. Protein catabolism after colorectal surgery is increased in patients with type 2 diabetes mellitus. 101 The preoperative assessment should include any complaints of polyuria polydypsia or polyphagia. An associated weight loss with any of these could be a sign of diabetes. A fasting blood glucose 140 mg dl confirms a diagnosis of diabetes. Control of hyperglycemia should be started preoperatively and continued in the postoperative phase. In contrast to past doctrine that mild hyperglycemia is permissible in the perioperative period newer studies indicate that there is a benefit in tighter glucose control. These intensive insulin strategies result in less hyperglycemia and as a result appear to improve immune function and reduce infectious complications. 102 These intensive strategies require frequent monitoring of blood glucose levels but may result in more hypoglycemia which has serious potential adverse consequences causing two large scale studies of this method to be stopped. 103 Close monitoring of glucose and avoidance of hyperglycemia has clear benefit but especially in difficult-to-control diabetics it can be challenging to avoid dangerous hypoglycemia. Renal and cardiovascular disease occurs commonly in diabetics and is a major cause of death in these patients. Compared to the nondiabetic population cardiovascular disease occurs more frequently at a younger age and with more severe .