ABSTRACT Perioperative hyperglycemia is common in patients with type 2 diabetes undergoing cardiac surgery and is linked to adverse outcomes. Glucagon-like peptide-1 receptor agonists (GLP-1 RAs) offer glucose-dependent insulinotropic effects and potential cardiac benefits, but their perioperative role remains uncertain. This review evaluated the efficacy and safety of GLP-1 RA therapy as an adjunct to insulin in this setting. Three electronic databases (PubMed, Cochrane, and Google Scholar) were searched for relevant articles up to October 2025. The primary endpoint was blood glucose levels during the perioperative period, while secondary endpoints included hypoglycemia incidence, total insulin requirement, time in target glucose range, and postoperative complications. Three randomized controlled trials (RCTs) including 168 patients with type 2 diabetes undergoing cardiac surgery were assessed. Perioperative use of liraglutide (subcutaneously in doses of 0.6-1.8 mg/day) was associated with preliminary evidence of improved glycemic control across preoperative, intraoperative, and early postoperative periods, including lower glucose levels, reduced glycemic variability, and fewer insulin adjustments, with a low incidence of hypoglycemia. However, heterogeneity in dosing, timing, and monitoring protocols across studies limits direct comparisons. Mild gastrointestinal adverse events, such as nausea and vomiting, were more frequent with liraglutide. One study reported exploratory immunometabolic effects in adipose tissue. Preliminary evidence from these heterogeneous studies suggests that adding liraglutide to insulin may improve perioperative glycemic control compared to insulin or placebo in patients with type 2 diabetes undergoing cardiac surgery. However, findings are limited by the small number of studies, methodological variability, and lack of long-term outcomes, necessitating larger, standardized trials.
ABSTRACT Context: Remimazolam is an ultra-short-acting benzodiazepine used for general anesthesia, including cardiac surgery; however, its effect on postoperative emergence following cardiopulmonary bypass remains unclear. Aims: We aimed to compare postoperative emergence following remimazolam- and propofol-based total intravenous anesthesia in adult patients undergoing cardiac valve surgery. Settings and Design: A retrospective observational study. Methods and Materials: We included adult patients who underwent elective cardiac valve replacement surgery at a single center between April 2023 and September 2024. Patients received either remimazolam- or propofol-based total intravenous anesthesia according to institutional practice. The primary endpoint was postoperative emergence time. Secondary endpoints included time to extubation and early postoperative hemodynamic stability assessed using the vasoactive–inotropic score. Statistical Analysis Used: Baseline characteristics and perioperative variables were compared between the groups. Univariate and multivariable linear regression analyses were performed. Results: Sixty-three patients were included in the analysis (remimazolam group, n = 21; propofol group, n = 42). Postoperative emergence time did not differ significantly between the two groups (164 [120–253] min vs. 137 [95–188] min, P = 0.193). Time to extubation was also comparable between the groups (1,009 [914–1,070] min vs. 1,033 [906–1,057] min, P = 0.844). Early postoperative hemodynamic parameters, including vasoactive–inotropic scores, were comparable between the two groups. Conclusions: I n adult patients undergoing cardiac valve surgery, postoperative emergence time was comparable between remimazolam- and propofol-based total intravenous anesthesia. More prospective studies are warranted to clarify the role of remimazolam in cardiac anesthesia.
ABSTRACT Characterized by unexpected hypoxia, hypotension, or hemodynamic collapse, bone cement implantation syndrome (BCIS) is a rare complication of orthopedic surgeries. During the process of utilizing cement to aid in prosthetic implantation, increased intramedullary pressure can lead to embolization of mixed contents (cement, fat, air,) into the heart. By mechanical obstruction and inflammatory response, BCIS can lead to catastrophic cardiovascular collapse. Herein, we present an 81-year-old man with grade three BCIS with pulseless electrical activity during a left hip arthroplasty with the aid of transesophageal echocardiography.
