Maple syrup urine disease (MSUD) has an incidence of 1:125,000 newborns in Ireland. Patients, when fasting, or in a catabolic state build up toxic metabolites leading to progressive neurological dysfunction. We describe the necessary peri-operative management of a patient with MSUD who developed symptomatic gallstones requiring a laparoscopic cholecystectomy.

Insulin resistance develops as a response to virtually all types of surgical stress. There is an increasing body of evidence that suggests that insulin resistance in surgical stress is not beneficial for outcome. A recent large study in intensive-care patients showed that aggressive treatment of insulin resistance using intravenous insulin reduced mortality and morbidity substantially. Similarl...

BACKGROUND This prospective, observational cohort study was designed to determine the feasibility of implementing a reduced enteral fasting protocol in mechanically ventilated trauma patients undergoing selected operative and nonoperative procedures. METHODS Critically ill, mechanically ventilated trauma patients undergoing selected operative and nonoperative procedures received enteral nutri...

Abstract Introduction Given the reduction in elective operating during Covid pandemic, efficient use of theatre time is paramount to reduce waiting list times. The aims this audit were identify proportion patients who cancelled from lists on day, reasons for cancellation, and due non-adherence pre-operative fasting rules. Method previous 30 a single surgeon’s reviewed using electronic patient r...

BACKGROUND Guidelines for fasting in elderly patients with acute hip fracture are the same as for other trauma patients, and longer than for elective patients. The reason is assumed stress-induced delayed gastric emptying with possible risk of pulmonary aspiration. Prolonged fasting in elderly patients may have serious negative metabolic consequences. The aim of our study was to investigate whe...

Post-operative hyperglycaemia is important with regard to outcomes of surgical operations. It affects post-operative morbidity, length of hospital stay, and mortality. Poor peri-operative blood glucose control leads to a higher risk of post-operative complication. Insulin resistance as a cause of post-operative hyperglycaemia has been blamed for some time. Nitric Oxide (NO) is produced by nitri...