RESUMEN
OBJECTIVE: Assess the impact of guidelines on the care of patients with diabetes undergoing elective surgery. METHODS: A multidisciplinary team developed perioperative guidelines. Overall changes in key measures were evaluated after guidelines were introduced and compared with a historical cohort. RESULTS: The historical cohort included 254 surgical procedures, and the post-guidelines implementation cohort comprised 1,387. Glucose monitoring was performed preoperatively in 93% of cases in the post-guidelines implementation cohort and in 88% in the historical cohort (P<.01), but the percentage of cases with measurements decreased over 12 months (from 95% to 91%, P = .044). Glucose was intraoperatively monitored in 67% of cases after guidelines were introduced and in 29% historically (P<.01); the post-guidelines implementation percentage decreased over 12 months from 67% to 55% (P<.01). The performance of glucose monitoring in the postanesthesia care unit (PACU) did not differ (86% vs. 87%, P = .57), but it decreased over 12 months, from 91% to 84% (P<.01). After introduction of the guidelines, insulin use increased in the preoperative, intraoperative, and PACU areas (all P≤.01) but decreased by the end of 12 months (all P<.01). Mean preoperative and PACU glucose levels in the post- guidelines implementation cohort were significantly lower than in the historical cohort (P<.01). CONCLUSION: Multidisciplinary management guidelines for diabetes patients undergoing surgery can improve the performance of key measures of care. Although adherence to recommendations generally remained higher after guideline implementation than in the historical period, the improvement in several measures began to decline over time.
Asunto(s)
Diabetes Mellitus/sangre , Procedimientos Quirúrgicos Electivos/métodos , Cuidados Intraoperatorios/métodos , Complicaciones Intraoperatorias/prevención & control , Anciano , Anestesia , Glucemia/análisis , Diabetes Mellitus/tratamiento farmacológico , Femenino , Hemoglobina Glucada/análisis , Estado de Salud , Humanos , Insulina/administración & dosificación , Comunicación Interdisciplinaria , Masculino , Persona de Mediana Edad , Cuidados Posoperatorios , Guías de Práctica Clínica como Asunto , Cuidados Preoperatorios/métodosRESUMEN
Thyroid hormones have a significant impact on cardiac function and structure. Excess thyroid hormone affects cardiovascular hemodynamics, leading to high-output heart failure and, in late stages, dilated cardiomyopathy. In this review, we discuss how hyperthyroidism affects cardiovascular pathophysiology and molecular mechanisms and examine the complications caused by excess thyroid hormone, such as heart failure and atrial fibrillation.
Asunto(s)
Cardiopatías/fisiopatología , Corazón/fisiopatología , Hipertiroidismo/fisiopatología , Glándula Tiroides/fisiopatología , Metabolismo Energético , Cardiopatías/diagnóstico , Cardiopatías/epidemiología , Cardiopatías/prevención & control , Hemodinámica , Humanos , Hipertiroidismo/diagnóstico , Hipertiroidismo/epidemiología , Hipertiroidismo/terapia , Pronóstico , Medición de Riesgo , Factores de Riesgo , Glándula Tiroides/metabolismo , Hormonas Tiroideas/sangreRESUMEN
Hypothyroidism is a commonly encountered clinical condition with variable prevalence. It has profound effects on cardiac function that can impact cardiac contractility, vascular resistance, blood pressure, and heart rhythm. With this review, we aim to describe the effects of hypothyroidism and subclinical hypothyroidism on the heart. Additionally, we attempt to briefly describe how hypothyroid treatment affects cardiovascular parameters.