451
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d’Arby Toledano R, Madden HE, Leffert L. Anesthetic Management of Nonobstetric Surgery during Pregnancy. CURRENT ANESTHESIOLOGY REPORTS 2019. [DOI: 10.1007/s40140-019-00314-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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452
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King E. Preoperative fasting durations for adult elective surgical patients: Convenient for the professional, but detrimental to the patient? A narrative review. J Perioper Pract 2019; 29:393-397. [PMID: 30806189 DOI: 10.1177/1750458919832482] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Preoperative fasting is necessary in reducing the risk of aspiration of stomach contents when undergoing a procedure that requires anaesthesia. There are numerous guidelines based upon evidence-based practice that outline the safe duration of a fast prior to the induction of anaesthesia. Common practice however is to give advice that unnecessarily starves the patient leading to perioperative complications. There is a breadth of literature analysing the fasting durations of various institutions, with a consensus of fasting from midnight being the norm, and side effects of nausea and dehydration being unfortunate by-products of fasting. A review of the literature examines the continued poor compliance of evidenced-based practice.
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Affiliation(s)
- Emma King
- Theatre Department, Luton and Dunstable University Hospital NHS Foundation Trust, Luton, UK
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453
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Avidan A. Fasting guidelines concerning intake of solids of the American Society of Anesthesiologists are not in concert with those of the European Society of Anaesthesiologists. Minerva Anestesiol 2019; 85:799. [PMID: 30762330 DOI: 10.23736/s0375-9393.19.13553-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Alexander Avidan
- Unit for Medical Informatics, Department of Anesthesiology, Critical Care, and Pain Medicine, Hadassah Medical Center, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel -
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454
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Grant MC, Gibbons MM, Ko CY, Wick EC, Cannesson M, Scott MJ, Wu CL. Evidence review conducted for the AHRQ Safety Program for Improving Surgical Care and Recovery: focus on anesthesiology for gynecologic surgery. Reg Anesth Pain Med 2019; 44:rapm-2018-100071. [PMID: 30737316 DOI: 10.1136/rapm-2018-100071] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2018] [Revised: 12/11/2018] [Accepted: 12/27/2018] [Indexed: 12/27/2022]
Abstract
Enhanced recovery after surgery (ERAS) protocols for gynecologic (GYN) surgery are increasingly being reported and may be associated with superior outcomes, reduced length of hospital stay, and cost savings. The Agency for Healthcare Research and Quality, in partnership with the American College of Surgeons and the Johns Hopkins Medicine Armstrong Institute for Patient Safety and Quality, has developed the Safety Program for Improving Surgical Care and Recovery, which is a nationwide initiative to disseminate best practices in perioperative care to more than 750 hospitals across five major surgical service lines in a 5-year period. The program is designed to identify evidence-based process measures shown to prevent healthcare-associated conditions and hasten recovery after surgery, integrate those into a comprehensive service line-based pathway, and assist hospitals in program implementation. In conjunction with this effort, we have conducted an evidence review of the various anesthesia components which may influence outcomes and facilitate recovery after GYN surgery. A literature search was performed for each intervention, and the highest levels of available evidence were considered. Anesthesiology-related interventions for preoperative (carbohydrate loading/fasting, multimodal preanesthetic medications), intraoperative (standardized intraoperative pathway, regional anesthesia, protective ventilation strategies, fluid minimization) and postoperative (multimodal analgesia) phases of care are included. We have summarized the best available evidence to recommend the anesthetic components of care for ERAS for GYN surgery.
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Affiliation(s)
- Michael Conrad Grant
- Department of Anesthesiology and Critical Care Medicine, Johns Hopkins Hospital and Health System, Baltimore, Maryland, USA
- Armstrong Institute for Patient Safety and Quality, Johns Hopkins Hospital and Health System, Baltimore, Maryland, USA
| | - Melinda M Gibbons
- Department of Surgery, University of California Los Angeles David Geffen School of Medicine, Los Angeles, California, USA
| | - Clifford Y Ko
- Department of Surgery, University of California Los Angeles David Geffen School of Medicine, Los Angeles, California, USA
| | - Elizabeth C Wick
- Armstrong Institute for Patient Safety and Quality, Johns Hopkins Hospital and Health System, Baltimore, Maryland, USA
| | - Maxime Cannesson
- Department of Anesthesiology and Perioperative Medicine, University of California Los Angeles David Geffen School of Medicine, Los Angeles, California, USA
| | - Michael J Scott
- Department of Anesthesiology, Virginia Commonwealth University School of Medicine, Richmond, Virginia, USA
- Department of Anesthesiology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Christopher L Wu
- Anesthesiology, Hospital for Special Surgery, New York City, New York, USA
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455
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456
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Danielsson EJD, Lejbman I, Åkeson J. Fluid deficits during prolonged overnight fasting in young healthy adults. Acta Anaesthesiol Scand 2019; 63:195-199. [PMID: 30238969 DOI: 10.1111/aas.13254] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2018] [Revised: 08/02/2018] [Accepted: 08/19/2018] [Indexed: 11/30/2022]
Abstract
BACKGROUND Overnight fasting is often prolonged before scheduled surgery, and the extent of perioperative fluid replacement may influence outcome. In clinical practice, basic requirements are estimated at 1.2-2.0 mL·kg-1 ·h-1 , but there is little contemporary clinical data on what deficits result from complete fasting. This prospective preclinical study was designed to determine total fluid loss during overnight fasting, prolonged during daytime. METHODS Twenty (10 female) healthy adult volunteers, aged 24 (range 21-46) years, fasted from 22:00 until 16:00, and had their body weight and urine output measured at predefined time intervals. RESULTS The median (interquartile range) fluid deficits were 0.82 (0.73-1.00) kg, corresponding to 1.26 (1.11-1.41) g·kg-1 ·h-1 for the initial overnight fasting period, 0.59 (0.40-0.70) kg and 0.99 (0.83-1.31) g·kg-1 ·h-1 for the consecutive daytime period, and 1.47 (1.27-1.64) kg and 1.19 (1.05-1.28) g·kg-1 ·h-1 for the total period of fasting. Urine output accounted for 52% of total weight loss and was 36% of the baseline hourly level during the last four-hour period of fasting. CONCLUSIONS Ten hours of overnight fasting in young adults induces fluid deficits at the lower limit of estimated intervals referred to in clinical practice, and hourly weight loss gradually decreases further during prolonged daytime fasting. These findings indicate that current routine procedures do slightly overestimate fluid deficits resulting from prolonged fasting in perioperative clinical practice.
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Affiliation(s)
- Erik J. D. Danielsson
- Department of Clinical Sciences Malmö, Anaesthesiology and Intensive Care Medicine; Skåne University Hospital; Lund University; Malmö Sweden
| | - Ilja Lejbman
- Department of Clinical Sciences Malmö, Anaesthesiology and Intensive Care Medicine; Skåne University Hospital; Lund University; Malmö Sweden
| | - Jonas Åkeson
- Department of Clinical Sciences Malmö, Anaesthesiology and Intensive Care Medicine; Skåne University Hospital; Lund University; Malmö Sweden
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457
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Niño MC, Ferrer LE, Díaz JC, Aguirre D, Pabón S, Pasternak JJ. Radiologic assessment of gastric emptying of water-soluble contrast media: New data security from a longitudinal study. REVISTA ESPANOLA DE ANESTESIOLOGIA Y REANIMACION 2019; 66:72-77. [PMID: 30424890 DOI: 10.1016/j.redar.2018.08.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/12/2018] [Revised: 07/16/2018] [Accepted: 08/09/2018] [Indexed: 06/09/2023]
Abstract
BACKGROUND AND OBJECTIVES Practice guidelines for preoperative fasting have not clearly established the fasting time needed after oral administration of water-soluble contrast media. The aim of this study was to determine the time required for the gastric emptying during the water-soluble contrast media in patients with acute abdominal pain. METHODS This prospective longitudinal study included sixty-eight patients older than 18 years of age with acute abdominal pain, who required a water-soluble contrast media enhanced abdominal computed tomography study. Plain radiographs were obtained hourly until complete the gastric emptying. Patients with probable bowel obstruction were not included in the study. RESULTS A total of 31 (45,6%), 54 (79,4%), and 64 (94,1%) patients achieved a complete gastric clearance of barium in 1, 2 and 3 hours, respectively. All patients achieved complete emptying of water-soluble contrast media within 6 hours. Gastric emptying time was not associated with gender (P=0,44), body mass index (P=.35), fasting time prior to water-soluble contrast media intake (P=0,12), administration of opioids in the emergency room (P=0,7), and the presence of comorbidities (P=0,36). CONCLUSION Ninety-four percent of the patients with acute abdominal pain achieved complete gastric emptying within 3hours after the administration of water-soluble contrast media. All of them achieved complete gastric emptying within 6hours. The results suggested 6hours after oral intake of the contrast media is enough to complete transit of water-soluble contrast media through the stomach and avoid unnecessary risks.
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Affiliation(s)
- M C Niño
- Departamento de Anestesia, Hospital Universitario Fundación Santa Fe de Bogotá, Bogotá, Colombia; Facultad de Medicina, Universidad de los Andes, Bogotá, Colombia.
| | - L E Ferrer
- Departamento de Anestesia, Hospital Universitario Fundación Santa Fe de Bogotá, Bogotá, Colombia; Facultad de Medicina, Universidad de los Andes, Bogotá, Colombia
| | - J C Díaz
- Departamento de Anestesia, Hospital Universitario Fundación Santa Fe de Bogotá, Bogotá, Colombia
| | - D Aguirre
- Departamento de Radiología, Hospital Universitario Fundación Santa Fe de Bogotá, Bogotá, Colombia
| | - S Pabón
- Departamento de Anestesia, Hospital Universitario Fundación Santa Fe de Bogotá, Bogotá, Colombia
| | - J J Pasternak
- Departamento de Anestesiología, Mayo Clinic College of Medicine, Rochester, Minnesota, EE. UU
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458
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Kim H, Lim C. General anesthesia for an adolescent with Pelizaeus-Merzbacher disease - A case report -. Anesth Pain Med (Seoul) 2019. [DOI: 10.17085/apm.2019.14.1.44] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Affiliation(s)
- Hyuckgoo Kim
- Department of Anesthesiology and Pain Medicine, Yeungnam University College of Medicine, Daegu, Korea
| | - Chaeseok Lim
- Department of Anesthesiology and Pain Medicine, Yeungnam University College of Medicine, Daegu, Korea
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459
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Rajwade D, Dhansura T. Chewing gum, the anaesthesiologist and perioperative checklists. Indian J Anaesth 2019; 63:951-952. [PMID: 31772409 PMCID: PMC6868671 DOI: 10.4103/ija.ija_387_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2019] [Revised: 05/24/2019] [Accepted: 06/26/2019] [Indexed: 11/04/2022] Open
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460
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Dagher C, Tohme J, Bou Chebl R, Chalhoub V, Richa F, Abou Zeid H, Madi-Jebara S. Preoperative fasting: Assessment of the practices of Lebanese Anesthesiologists. Saudi J Anaesth 2019; 13:184-190. [PMID: 31333361 PMCID: PMC6625281 DOI: 10.4103/sja.sja_720_18] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Background: Although new guidelines developed by the American Society of Anesthesiologists (ASA) recommend a liberalized preoperative nutrition, authorized clinical practice guidelines or recommendations have not yet been proposed by the Lebanese Society of Anesthesia (LSA). Objective: The purpose of this study was to examine Lebanese anesthesiologists’ preoperative fasting routines and determine their knowledge and acceptance of the ASA recommendations, their attitude toward liberalized fasting, and the factors favoring their nonadherence to the new recommendations. Materials and Methods: This study was conducted in university hospitals, affiliated hospitals, and nonuniversity hospitals located in different regions of Lebanon. The survey was approved by the local ethics committee. A written questionnaire was emailed to all anesthesiologist members of the LSA which was completed anonymously. Results: Out of the 294 anesthesiologists registered in the LSA and who read the email, 118 (40.1%) completed the questionnaire. Of respondents, 90% are aware of the latest ASA practice guidelines for preoperative fasting, and 78.7% claim to apply them in their practices; however, 75% of respondents still require adult patients to stop eating after midnight, and only 45% allow them to drink clear fluids up to 2 h preoperatively. One of the main reasons for not complying with the ASA guidelines was “to allow flexibility for changes in the operating schedule.” Conclusion: A long preoperative fasting period is still the common practice for Lebanese anesthesiologists. National guideline for preoperative fasting as liberal as that recommended by the ASA should be considered.
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Affiliation(s)
- Christine Dagher
- Department of Anesthesiology and Critical Care Unit, Hotel Dieu de France Hospital, Saint Joseph University, Beirut, Lebanon
| | - Joanna Tohme
- Department of Anesthesiology and Critical Care Unit, Hotel Dieu de France Hospital, Saint Joseph University, Beirut, Lebanon
| | - Rita Bou Chebl
- Department of Anesthesiology and Critical Care Unit, Hotel Dieu de France Hospital, Saint Joseph University, Beirut, Lebanon
| | - Viviane Chalhoub
- Department of Anesthesiology and Critical Care Unit, Hotel Dieu de France Hospital, Saint Joseph University, Beirut, Lebanon
| | - Freda Richa
- Department of Anesthesiology and Critical Care Unit, Hotel Dieu de France Hospital, Saint Joseph University, Beirut, Lebanon
| | - Hicham Abou Zeid
- Department of Anesthesiology and Critical Care Unit, Hotel Dieu de France Hospital, Saint Joseph University, Beirut, Lebanon
| | - Samia Madi-Jebara
- Department of Anesthesiology and Critical Care Unit, Hotel Dieu de France Hospital, Saint Joseph University, Beirut, Lebanon
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461
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Panjiar P, Kochhar A, Vajifdar H, Bhat K. A prospective survey on knowledge, attitude and current practices of pre-operative fasting amongst anaesthesiologists: A nationwide survey. Indian J Anaesth 2019; 63:350-355. [PMID: 31142877 PMCID: PMC6530283 DOI: 10.4103/ija.ija_50_19] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background and Aims: Pre-operative fasting is a routine practice to minimise the risk of pulmonary aspiration. The leading societies of anaesthesia have adopted more liberal fasting guidelines to avoid the adverse effect of prolonged fasting. This survey was conducted to assess the knowledge, attitude and current practice of fasting guidelines among Indian anaesthesiologists and to analyse the reasons for non-compliance of these guidelines. Methods: A questionnaire consisted of 11 questions was distributed via 'Survey Monkey' software to 621 anaesthesiologists who attended the annual conference of the Indian Society of Anaesthesiologists held in Ludhiana, in 2016. American Society of Anaesthesiologists (ASA) practice guidelines for fasting were the standard of assessment. Results: The response rate to the survey was 52%. Of the respondents, 69% described correctly the practice guidelines to pre-operative fasting. Only seven percent respondents were aware of the benefits of liberalised fasting. More than 2/3rd of the respondents advised fasting as per ASA guidelines during pre-anaesthetic check-up (PAC). However, only about 50% respondents confirmed that these guidelines are actually followed in their institution. Not having control on scheduling of cases in operation theatre and poor knowledge of ward nurses and surgeons were the common reasons for non-compliance of these guidelines. Twenty four percent respondents did not use routinely any drug for aspiration prophylaxis. Conclusion: Majority of the respondents were aware of the ASA fasting guidelines. However, the implementation of the guidelines and knowledge regarding benefits of liberalised fasting is poor among respondents.
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Affiliation(s)
- Pratibha Panjiar
- Department of Anaesthesiology and Critical Care, Hamdard Institute of Medical Sciences and Research, New Delhi, India
| | - Anjali Kochhar
- Department of Anaesthesia and Critical Care, Vardhman Mahavir Medical College and Safdarjang Hospital, New Delhi, India
| | - Homay Vajifdar
- Department of Anaesthesiology and Critical Care, Hamdard Institute of Medical Sciences and Research, New Delhi, India
| | - Kharat Bhat
- Department of Anaesthesiology and Critical Care, Hamdard Institute of Medical Sciences and Research, New Delhi, India
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462
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Anfang RR, Jatana KR, Linn RL, Rhoades K, Fry J, Jacobs IN. pH-neutralizing esophageal irrigations as a novel mitigation strategy for button battery injury. Laryngoscope 2019; 129:49-57. [PMID: 29889306 DOI: 10.1002/lary.27312] [Citation(s) in RCA: 69] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2018] [Revised: 04/25/2018] [Accepted: 05/03/2018] [Indexed: 12/25/2022]
Abstract
OBJECTIVES/HYPOTHESIS Ingestion of button batteries (BB) can rapidly lead to caustic esophageal injury in infants and children, resulting in significant morbidity and mortality. To identify novel mitigation strategies, we tested common weakly acidic household beverages, viscous liquids, and Carafate® for their ability to act as protective esophageal irrigations until endoscopic removal of the BB. STUDY DESIGN Cadaveric and live animal model. METHODS Apple juice, orange juice, Gatorade®, POWERADE®, pure honey, pure maple syrup, and Carafate® were screened using a 3 V lithium (3 V-CR2032) BB on cadaveric porcine esophagus. The most promising in vitro options were tested against a saline control in live American Yorkshire piglets with anode-facing placement of the BB on the posterior wall of the proximal esophagus for 60 minutes. BB voltage and tissue pH were measured before battery placement and after removal. The 10 mL irrigations occurred every 10 minutes from t = 5 minutes. Gross and histologic assessment was performed on the esophagus of piglets euthanized 7 ± 0.5 days following BB exposure. RESULTS Honey and Carafate® demonstrated to a significant degree the most protective effects in vitro and in vivo. Both neutralized the tissue pH increase and created more localized and superficial injuries; observed in vivo was a decrease in both full-thickness injury (i.e., shallower depths of necrotic and granulation tissue) and outward extension of injury in the deep muscle beyond surface ulcer margins (P < .05). CONCLUSIONS In the crucial period between BB ingestion and endoscopic removal, early and frequent ingestion of honey in the household setting and Carafate® in the clinical setting has the potential to reduce injury severity and improve patient outcomes. LEVEL OF EVIDENCE NA Laryngoscope, 129:49-57, 2019.
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Affiliation(s)
- Rachel R Anfang
- Division of Otolaryngology, Department of Surgery, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Kris R Jatana
- Department of Otolaryngology-Head and Neck Surgery, Nationwide Children's Hospital and Wexner Medical Center at Ohio State University, Columbus, Ohio
| | - Rebecca L Linn
- Division of Anatomic Pathology, Department of Pathology and Laboratory Medicine, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Keith Rhoades
- Intertek Product Intelligence Group Inc, Oakbrook, Illinois
| | - Jared Fry
- Intertek Product Intelligence Group Inc, Oakbrook, Illinois
| | - Ian N Jacobs
- Division of Otolaryngology, Department of Surgery, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
- Department of Otorhinolaryngology-Head and Neck Surgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, U.S.A
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463
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Kruisselbrink R, Gharapetian A, Chaparro LE, Ami N, Richler D, Chan VWS, Perlas A. Diagnostic Accuracy of Point-of-Care Gastric Ultrasound. Anesth Analg 2019; 128:89-95. [DOI: 10.1213/ane.0000000000003372] [Citation(s) in RCA: 47] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
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464
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Kaushal-Deep SM, Ahmad R, Lodhi M, Chana RS. A prospective study of evaluation of operative duration as a predictor of mortality in pediatric emergency surgery: Concept of 100 minutes laparotomy in resource-limited setting. J Postgrad Med 2018; 65:248492. [PMID: 30588925 PMCID: PMC6380133 DOI: 10.4103/jpgm.jpgm_52_18] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2018] [Revised: 02/16/2018] [Accepted: 03/26/2018] [Indexed: 02/05/2023] Open
Abstract
INTRODUCTION Operative duration is an important but under-studied predictor of mortality in emergency laparotomies. AIMS AND OBJECTIVES The primary objective of this study was to quantify the effect of duration of emergency laparotomy in children on mortality; and to identify a rough cut-off duration of laparotomy to serve as a guide so that a laparotomy can be planned to optimize pediatric surgical patient outcome. MATERIALS AND METHODS This is a prospective study conducted in a government tertiary teaching institution over a period of 24 months. All children in the age group of 5-10 years presenting in the emergency department with Pediatric Risk of Mortality III score ≤8, undergoing emergency laparotomy in emergency operation theater, were included. OBSERVATIONS AND RESULTS In all, 213 children were included in the study. The mean time from presentation to shifting to the operating room was 3.7 h. The mean operative duration was 108 min. The mean operative time in survived patients was 102 min as compared to 135 min in expired patients (P < 0.05). The 30-day in-hospital mortality rate was 17.4%. After application of binary logistic regression analysis, it was found that time to laparotomy and operative duration were significant risk factors (<0.05) predicting post-operative mortality. Kaplan-Meier survival curve showed a decrease at a mean weighted operative duration of approximately 100 min. Receiver operating characteristic curve analysis yielded operative duration of 123.5 min at which Youden's index maximized. CONCLUSION This 100-min duration of laparotomy might appear a long duration but in casualty setup of a government hospital with limited resources, there are so many hurdles for optimal working that completion of an emergency laparotomy in children in 100 min can be considered a realistic target for improving post-operative outcome. At an operative duration of <123.50 min, mortality rates within acceptable limits can be achieved.
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Affiliation(s)
- SM Kaushal-Deep
- Department of Pediatric Surgery, Jawaharlal Nehru Medical College and Hospital, Aligarh Muslim University, Aligarh, Uttar Pradesh, India
| | - R Ahmad
- Department of Pediatric Surgery, Jawaharlal Nehru Medical College and Hospital, Aligarh Muslim University, Aligarh, Uttar Pradesh, India
| | - M Lodhi
- Department of Anesthesia, Jawaharlal Nehru Medical College and Hospital, Aligarh Muslim University, Aligarh, Uttar Pradesh, India
| | - RS Chana
- Department of Pediatric Surgery, Jawaharlal Nehru Medical College and Hospital, Aligarh Muslim University, Aligarh, Uttar Pradesh, India
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465
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Tung A. Anesthesia Advanced Cardiac Life Support: A Guideline Validated? Anesth Analg 2018; 126:746-747. [PMID: 29461322 DOI: 10.1213/ane.0000000000002730] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Avery Tung
- From the Department of Anesthesia and Critical Care, University of Chicago, Chicago, Illinois
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466
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Comparison of rocuronium requirement in children with continuous infusion versus intermittent bolus: A randomised controlled trial. Eur J Anaesthesiol 2018; 36:194-199. [PMID: 30540640 DOI: 10.1097/eja.0000000000000934] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND Minimising rocuronium administration during paediatric surgery helps to reduce the incidence of residual muscular blockade. OBJECTIVE To determine whether intermittent bolus injection (Bolus group) or continuous infusion (group) requires the lesser amount of rocuronium. DESIGN A randomised, single-blind controlled trial. SETTING A single university hospital from March to June 2017. PATIENTS Sixty-six children undergoing general anaesthesia. INTERVENTIONS Dose of rocuronium for maintenance of muscle relaxation in either Bolus or continuous infusion group. Train-of-four (TOF) count of two was maintained during surgery. When TOF count reached three, 0.1 mg kg of rocuronium was administered in Bolus group or infused at an increased rate of 0.1 mg kg h in continuous infusion group. MAIN OUTCOME MEASURES Primary outcome was the dose of rocuronium given (μg kg min). The recovery time from the TOF count four to TOF 0.7 (RT0.7), and 0.9 (RT0.9) were recorded. All adverse events were recorded up to 30 min after extubation. RESULTS Mean (SD) rocuronium dose in the Bolus group was 6.1 (0.9), [95% confidence interval (95% CI) 5.7 to 6.4] μg kg min and 4.9 (1.0), (95% CI 4.6 to 5.3) μg kg min in the continuous infusion group (P = 0.001). RT0.7 was 24.0 (13.7), 95% CI 19.3 to 28.7) min in the Bolus group, and 25.7 (16.0), (95% CI 20.2 to 31.2) min in the continuous infusion group (P = 0.73). RT0.9 was 30.7 (17.1), (95% CI 24.9 to 36.5) min in the Bolus group, and 30.0 (17.6), (95% CI 24.0 to 36.0) min in the continuous infusion group (P = 0.91). The incidence of adverse events was not significantly different between two groups. CONCLUSION In children undergoing general anaesthesia, the dose of rocuronium given by continuous administration was less than that with intermittent bolus. TRIAL REGISTRATION ClinicalTrials.gov (identifier: NCT03060707).
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467
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Seet E, Kumar CM, Eke T, Joshi GP. Starving Patients Before Cataract Surgery Under Regional Anesthesia. Anesth Analg 2018; 127:1448-1451. [DOI: 10.1213/ane.0000000000003504] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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468
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Buhrman WC, Lyman WB, Kirks RC, Passeri M, Vrochides D. Current State of Enhanced Recovery After Surgery in Hepatopancreatobiliary Surgery. J Laparoendosc Adv Surg Tech A 2018; 28:1471-1475. [DOI: 10.1089/lap.2018.0314] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Affiliation(s)
- William C. Buhrman
- Department of Anesthesiology, Carolinas Medical Center, Charlotte, North Carolina
| | - William B. Lyman
- Department of Surgery, Carolinas Medical Center, Charlotte, North Carolina
| | - Russell C. Kirks
- Department of Surgery, Carolinas Medical Center, Charlotte, North Carolina
| | - Michael Passeri
- Division of HPB Surgery, Department of Surgery, Carolinas Medical Center, Charlotte, North Carolina
| | - Dionisios Vrochides
- Division of HPB Surgery, Department of Surgery, Carolinas Medical Center, Charlotte, North Carolina
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469
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Presta MV, Bhavani SS, Abdelmalak BB. Nil per os guidelines: what is changing, what is not, and what should? Minerva Anestesiol 2018; 84:1413-1419. [DOI: 10.23736/s0375-9393.18.13042-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
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470
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Ohashi Y, Farzi S, Siddiqui N. The use of lumbar spine and gastric ultrasound in perioperative obstetric anesthesia. HYPERTENSION RESEARCH IN PREGNANCY 2018. [DOI: 10.14390/jsshp.hrp2018-008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Yayoi Ohashi
- Department of Anaesthesia and Pain Medicine, Fiona Stanley Fremantle Hospitals Group
| | - Sahar Farzi
- Department of Anesthesia and Pain Management, Mount Sinai Hospital, University of Toronto
| | - Naveed Siddiqui
- Department of Anesthesia and Pain Management, Mount Sinai Hospital, University of Toronto, Clinician Scientist, Lunenfeld-Tanenbaum Research Institute
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471
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Liu B, Wang Y, Liu S, Zhao T, Zhao B, Jiang X, Ye L, Zhao L, Lv W, Zhang Y, Zheng T, Xue Y, Chen L, Chen L, Wu Y, Li Z, Yan J, Wang S, Sun X, Gao G, Qu Y, He S. A randomized controlled study of preoperative oral carbohydrate loading versus fasting in patients undergoing elective craniotomy. Clin Nutr 2018; 38:2106-2112. [PMID: 30497695 DOI: 10.1016/j.clnu.2018.11.008] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2018] [Revised: 11/07/2018] [Accepted: 11/12/2018] [Indexed: 12/20/2022]
Abstract
OBJECT The aim of this study was to evaluate the effect of preoperative oral carbohydrate loading versus fasting on the outcomes of patients undergoing elective craniotomy. METHODS In a single-center randomized controlled study, 120 neurosurgical patients who were admitted for elective craniotomy were included and randomized into 2 groups: 58 patients received 400 mL of oral carbohydrate loading 2 h before surgery (intervention group), and 62 patients were fasting for 8 h prior to surgery as routine management (control group). The primary end point was glucose homeostasis. Secondary outcomes included handgrip strength, pulmonary function and postoperative complications. RESULTS Better glucose homeostasis (5.6 ± 1.0 mmol/L vs. 6.3 ± 1.2 mmol/L, P = 0.001) was achieved in patients who received preoperative oral carbohydrate loading compared to fasting. Furthermore, patients in the intervention group had better handgrip strength (25.3 ± 7.1 kg vs. 19.9 ± 7.5 kg, P < 0.0001) and pulmonary function (in terms of peak expiratory flow rate) (315.8 ± 91.5 L/min vs. 270.0 ± 102.7 L/min, P = 0.036) compared to the controls postoperatively. The rates of postoperative surgical and non-surgical complications did not differ between the groups. Both postoperative and total hospital length of stay (LOS) reduced significantly in the intervention group (-3d, P < 0.0001 and P = 0.004). CONCLUSIONS Oral carbohydrate loading given 2 h before surgery in patients undergoing elective craniotomy seems to improve glucose homeostasis, handgrip strength and pulmonary function as well as decrease LOS without increasing the risk of postoperative complications. Routine use of preoperative oral carbohydrate loading could be suggested in clinical settings, though further evaluation of its safety and efficacy is warranted.
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Affiliation(s)
- Bolin Liu
- Department of Neurosurgery, Tangdu Hospital, Fourth Military Medical University, Xi'an, Shaanxi Province, China; Department of Neurosurgery, Xi'an International Medical Center, Xi'an, Shaanxi Province, China
| | - Yuan Wang
- Department of Neurosurgery, Tangdu Hospital, Fourth Military Medical University, Xi'an, Shaanxi Province, China
| | - Shujuan Liu
- Department of Obstetrics and Gynecology, Xijing Hospital, Fourth Military Medical University, Xi'an, Shaanxi Province, China
| | - Tianzhi Zhao
- Department of Neurosurgery, Tangdu Hospital, Fourth Military Medical University, Xi'an, Shaanxi Province, China
| | - Binfang Zhao
- Department of Neurosurgery, Tangdu Hospital, Fourth Military Medical University, Xi'an, Shaanxi Province, China
| | - Xue Jiang
- Department of Neurosurgery, Tangdu Hospital, Fourth Military Medical University, Xi'an, Shaanxi Province, China
| | - Lin Ye
- Department of Nutrition, Tangdu Hospital, Fourth Military Medical University, Xi'an, Shaanxi Province, China
| | - Lanfu Zhao
- Department of Neurosurgery, Tangdu Hospital, Fourth Military Medical University, Xi'an, Shaanxi Province, China
| | - Wenhai Lv
- Department of Neurosurgery, Tangdu Hospital, Fourth Military Medical University, Xi'an, Shaanxi Province, China
| | - Yufu Zhang
- Department of Neurosurgery, Tangdu Hospital, Fourth Military Medical University, Xi'an, Shaanxi Province, China
| | - Tao Zheng
- Department of Neurosurgery, Tangdu Hospital, Fourth Military Medical University, Xi'an, Shaanxi Province, China
| | - Yafei Xue
- Department of Neurosurgery, Tangdu Hospital, Fourth Military Medical University, Xi'an, Shaanxi Province, China
| | - Lei Chen
- Department of Neurosurgery, Tangdu Hospital, Fourth Military Medical University, Xi'an, Shaanxi Province, China
| | - Long Chen
- Department of Neurosurgery, Tangdu Hospital, Fourth Military Medical University, Xi'an, Shaanxi Province, China
| | - Yingxi Wu
- Department of Neurosurgery, Tangdu Hospital, Fourth Military Medical University, Xi'an, Shaanxi Province, China
| | - Zhengmin Li
- Department of Anesthesiology, Tangdu Hospital, Fourth Military Medical University, Xi'an, Shaanxi Province, China
| | - Jing Yan
- Department of Nutrition, Tangdu Hospital, Fourth Military Medical University, Xi'an, Shaanxi Province, China
| | - Shasha Wang
- Department of Nutrition, Tangdu Hospital, Fourth Military Medical University, Xi'an, Shaanxi Province, China
| | - Xude Sun
- Department of Anesthesiology, Tangdu Hospital, Fourth Military Medical University, Xi'an, Shaanxi Province, China
| | - Guodong Gao
- Department of Neurosurgery, Tangdu Hospital, Fourth Military Medical University, Xi'an, Shaanxi Province, China
| | - Yan Qu
- Department of Neurosurgery, Tangdu Hospital, Fourth Military Medical University, Xi'an, Shaanxi Province, China
| | - Shiming He
- Department of Neurosurgery, Tangdu Hospital, Fourth Military Medical University, Xi'an, Shaanxi Province, China; Department of Neurosurgery, Xi'an International Medical Center, Xi'an, Shaanxi Province, China.
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472
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Davies A, Pang WS, Fowler T, Dewi F, Wright T. Preoperative fasting in the department of plastic surgery. BMJ Open Qual 2018; 7:e000161. [PMID: 30515463 PMCID: PMC6231091 DOI: 10.1136/bmjoq-2017-000161] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2017] [Revised: 07/21/2018] [Accepted: 08/21/2018] [Indexed: 11/07/2022] Open
Abstract
Preoperative fasting is necessary to reduce the risk of regurgitation of gastric contents and pulmonary aspiration in patients undergoing general anaesthetic and procedural sedation. Excessive fasting is associated with metabolic, cardiovascular and gastrointestinal complications and patient discomfort. We aimed to reduce the fasting time for patients on the plastic surgery trauma list. Adult inpatients awaiting surgery were asked to complete a preoperative assessment sheet. Questions included the length of preoperative fasting, clarity of instructions and wellness scores. Three cycles of data collection were performed over a 12-month period, patients who declined to participate or were unable to consent were excluded. The first cycle revealed the need for significant improvement. Interventions included staff education, patient information sheets, preoperative drinks, greater availability of ward snacks and improved communication between the ward staff and surgical team through our electronic trauma database. The initial audit of 15 patients revealed a mean fasting time of 16.3 hours for fluid (range 10–22) and a mean of 19.3 hours for solid food (range 10–24). The mean wellness score was 6/10 (10 being very well), 67% of patients felt they were given clear information. The final cycle demonstrated clear improvement in all domains. The mean fasting time declined to 5.1 hours for fluid (range 3–10 hours) and 13 hours for solid food (range 7.5–17 hours). The mean wellness score (10=very well) increased from 6 to 8, the mean thirst score declined from 6.1 to 5.1 and 100% patients felt they had been given clear information. Removal of the traditional ‘NBM from midnight’, patient education, a clear fasting routine with preoperative drinks and improved communication between the full multidisciplinary team has led to a reduction in the fasting times on our trauma list.
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Affiliation(s)
- Andrew Davies
- Department of Orthopaedics, North Bristol NHS Trust, Bristol, UK
| | | | - Timothy Fowler
- Department of Plastic Surgery, North Bristol NHS Trust, Bristol, UK
| | - Ffion Dewi
- Department of Plastic Surgery, North Bristol NHS Trust, Bristol, UK
| | - Thomas Wright
- Department of Plastic Surgery, North Bristol NHS Trust, Bristol, UK
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473
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Ultrasound dynamics of gastric content volumes after the ingestion of coconut water or a meat sandwich. A randomized controlled crossover study in healthy volunteers. BRAZILIAN JOURNAL OF ANESTHESIOLOGY (ENGLISH EDITION) 2018. [PMID: 30195629 PMCID: PMC9391824 DOI: 10.1016/j.bjane.2018.06.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Background Adequate preoperative fasting is critical in preventing pulmonary aspiration of gastric content. We proposed to study the sonographic gastric content dynamics after the ingestion of liquid or solid food in healthy volunteers and confront it with current guidelines for preoperative fasting times. Methods We performed a prospective, crossover, evaluator-blinded study involving 17 healthy volunteers of both sexes. Each participant fasted for 10 h and was subjected to a baseline gastric ultrasound, intake of 400 mL of coconut water or a 145 g, 355 kcal meat sandwich, and sonographic gastric evaluations after 10 min and every hour until the stomach was completely empty. Results At baseline, all subjects had an empty stomach. At 10 min, gastric content [mean + standard deviation (SD)] was 240.4 + 69.3 and 248.2 + 119.2 mL for liquid and solid foods, respectively (p > 0.05). Mean + SD gastric emptying times were 2.5 + 0.7 and 4.5 + 0.9 h for liquid and solid foods, respectively (p < 0.001). For the drink, the stomach was completely empty in 59% and 100% of the subjects after two and four hours, and for the sandwich, 65% and 100% of the subjects after four and seven hours, respectively. Conclusions Sonographic gastric dynamics for coconut water and a meat sandwich resulted in complete gastric emptying times higher and lower, respectively, than those suggested by current guidelines for preoperative fasting.
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474
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Ohashi Y, Walker JC, Zhang F, Prindiville FE, Hanrahan JP, Mendelson R, Corcoran T. Preoperative Gastric Residual Volumes in Fasted Patients Measured by Bedside Ultrasound: A Prospective Observational Study. Anaesth Intensive Care 2018; 46:608-613. [DOI: 10.1177/0310057x1804600612] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
The purpose of this prospective observational study was to measure gastric volumes in fasted patients using bedside gastric ultrasound. Patients presenting for non-emergency surgery underwent a gastric antrum assessment, using the two-diameter and free-trace methods to determine antral cross-sectional area. Gastric residual volume (GRV) was calculated using a validated formula. Univariate and multivariable analyses were performed to examine any potential relationships between ‘at risk’ GRVs (>100 ml) and patient factors. Two hundred and twenty-two successful scans were performed; of these 110 patients (49.5%) had an empty stomach, nine patients (4.1%) had a GRV >100 ml, and a further six patients (2.7%) had a GRV >1.5 ml/kg. There was no significant relationship between ‘at risk’ GRV and obesity, diabetes mellitus, gastro-oesophageal reflux disease or opioid use, although our study had insufficient power to exclude an influence of one or more of these factors. Our results indicate that despite compliance with fasting guidelines, a small percentage of patients still have GRVs that pose a pulmonary aspiration risk. Anaesthetists should consider this background incidence when choosing anaesthesia techniques for their patients. While future observational studies are required to determine the role of preoperative bedside gastric ultrasound, it is possible that this technique may assist anaesthetists in identifying patients with ‘at risk’ GRVs.
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Affiliation(s)
- Y. Ohashi
- Department of Anaesthesia and Pain Medicine, Fiona Stanley Fremantle Hospitals Group, Perth, Western Australia
| | - J. C. Walker
- Consultant Anaesthetist, Anaesthetic Department, Royal Bournemouth Hospital, Bournemouth, United Kingdom
| | - F. Zhang
- Department of Radiology, Sir Charles Gairdner Hospital, Perth, Western Australia
| | - F. E. Prindiville
- Sonographer, Department of Imaging Services, Royal Perth Hospital, Perth, Western Australia
| | - J. P. Hanrahan
- General Practitioner, Queens Park Medical Centre, Perth, Western Australia
| | - R. Mendelson
- Emeritus Consultant Radiologist, Department of Diagnostic and Interventional Radiology, Royal Perth Hospital; Clinical Professor, University of Western Australia; Adjunct Professor, Notre Dame University; Perth, Western Australia
| | - T. Corcoran
- Director of Research, Department of Anaesthesia and Pain Medicine, Royal Perth Hospital; Clinical Professor, School of Medicine and Pharmacology, University of Western Australia; Raine Clinical Research Fellow, Raine Foundation/WA Health Department; Adjunct Clinical Professor, School of Public Health and Preventive Medicine, Monash University Australia; Perth, Western Australia
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475
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A Clinical Nurse Specialist-Led Initiative to Reduce Deficits in Tube Feeding Administration for the Surgical and Trauma Populations. CLIN NURSE SPEC 2018; 32:299-306. [PMID: 30299332 DOI: 10.1097/nur.0000000000000405] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE/OBJECTIVES The purpose of this clinical nurse specialist-led initiative was to redefine the standard of care to reduce the deficit that exists between the daily amount of tube feedings prescribed versus received by patients in a surgical-trauma intensive care unit. DESCRIPTION OF THE PROJECT Nutrition plays a vital role in health and wellness. Although nutritional recommendations are not always met by individuals on a daily basis-the presence of in-hospital malnutrition presents greater risks and complications after a surgery or traumatic event. An evidence-based algorithm for initiating and maintaining tube feedings was developed and incorporated into morning bedside report. A preintervention and postintervention chart analysis was done to calculate the amount of tube feedings received by patients during their first 5 days of admission. OUTCOMES Preintervention data revealed that 29 patients received a mean 49.8% (SD, 21.6%) of tube feedings prescribed, and postintervention data showed 31 patients received 60.4% (SD, 18.5%) of tube feedings prescribed (P = .04). CONCLUSION Through the implementation of a tube feeding algorithm, there was a reduction of tube feed interruptions and volume deficits during the first 5 days of admission.
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476
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Evaluation of preoperative oral carbohydrate administration on insulin resistance in off-pump coronary artery bypass patients: A randomised trial. Eur J Anaesthesiol 2018; 34:740-747. [PMID: 28437263 DOI: 10.1097/eja.0000000000000637] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
BACKGROUND In fasting cardiac surgery patients, preoperative carbohydrate (CHO) drink intake attenuated insulin resistance and improved cardiac metabolism, although its beneficial effects were not evident after cardiac surgery possibly due to cardiopulmonary bypass-related extreme systemic inflammation. OBJECTIVE We aimed to evaluate whether preoperative CHO intake affected insulin resistance and free-fatty acid (FFA) concentrations in off-pump coronary revascularisation. DESIGN A randomised controlled trial. SETTING Primary care in a university hospital in Korea from January 2015 to July 2016. PATIENTS Sixty patients who underwent elective multi-vessel off-pump coronary revascularisation were randomised into two groups. Three patients were excluded from analysis and 57 patients completed study. INTERVENTION The CHO group received oral CHO (400 ml) the prior evening and 2 to 3 h before surgery, and the control group was fasted from food and water according to standard protocol. MAIN OUTCOME MEASURES Insulin resistance was assessed twice, after anaesthetic induction and after surgery via short insulin tolerance test. FFA, C-reactive protein and creatine kinase-myocardial band concentrations were determined serially for 48 h after surgery. RESULTS Insulin sensitivity was greater (P = 0.002) and plasma FFA concentrations were lower (P = 0.001) after anaesthetic induction in the CHO group compared with the Control group, although there were no intergroup differences after surgery. The postoperative peak creatine kinase-myocardial band concentration was significantly lower in the CHO group compared with the Control group [8.8 (5.4 to 18.2) vs. 6.4 (3.5 to 9.7) ng ml, P = 0.031]. CONCLUSION A preoperative CHO supplement significantly reduced insulin resistance and FFA concentrations compared with fasting at the beginning of the surgery, but these benefits were lost after off-pump coronary revascularisation. Despite their transient nature, these beneficial effects resulted in less myocardial injury, mandating further studies focused on the impact of preoperative CHO on myocardial ischaemia and cardiac function after coronary revascularisation. TRIAL REGISTRATION Clinicaltrials.gov identifier: NCT 02330263.
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477
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Feng JE, Novikov D, Anoushiravani AA, Wasterlain AS, Lofton HF, Oswald W, Nazemzadeh M, Weiser S, Berger JS, Iorio R. Team Approach: Perioperative Optimization for Total Joint Arthroplasty. JBJS Rev 2018; 6:e4. [DOI: 10.2106/jbjs.rvw.17.00147] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
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478
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Umesh G, Tejesh CA. Probing the future - Can gastric ultrasound herald a change in perioperative fasting guidelines? Indian J Anaesth 2018; 62:735-737. [PMID: 30443053 PMCID: PMC6190412 DOI: 10.4103/ija.ija_669_18] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Affiliation(s)
- Goneppanavar Umesh
- Department of Anaesthesiology, Dharwad Institute of Mental Health and Neurosciences, Dharwad, Karnataka, India. E-mail:
| | - C A Tejesh
- Department of Anaesthesiology, MS Ramaiah Medical College and Hospitals, Bengaluru, Karnataka, India
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479
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Sheckter CC, Rochlin DH, Moshrefi S, Schenone M, Vargas V, Sproul J, Karanas YL. Volume- vs. rate-based tube feeding in burn patients: A case-control study. BURNS OPEN 2018. [DOI: 10.1016/j.burnso.2018.10.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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480
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Bouvet L, Bellier N, Gagey-Riegel AC, Desgranges FP, Chassard D, De Queiroz Siqueira M. Ultrasound assessment of the prevalence of increased gastric contents and volume in elective pediatric patients: A prospective cohort study. Paediatr Anaesth 2018; 28:906-913. [PMID: 30207013 DOI: 10.1111/pan.13472] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2018] [Revised: 07/24/2018] [Accepted: 07/30/2018] [Indexed: 12/20/2022]
Abstract
BACKGROUND Though pulmonary aspiration of gastric contents occurs mainly in the setting of emergency surgery, it may also occur in children scheduled for elective surgery without any obvious clinical risk factor. Increased gastric content volume is one the predisposing factors for pulmonary aspiration that could affect such children and may be identified using ultrasound examination of the gastric antrum. AIMS We aimed to assess the prevalence of "at-risk stomach" defined by ultrasound visualization of any solid content in the antrum and/or by calculated gastric fluid volume > 1.25 mL/kg, in children scheduled for elective surgery. METHODS Children scheduled for elective surgery were consecutively included into this prospective cohort study. Preoperative ultrasound examination of the antrum was performed in both the supine and the right lateral decubitus positions. Gastric fluid content was assessed using a 0-2 qualitative grading scale. The antral cross-sectional area was also measured in both the supine and the right lateral decubitus positions, allowing the calculation of the gastric fluid volume according to a formula previously described. RESULTS We analyzed 200 elective children. Median duration of fasting was 4 hours for liquids and >13 hours for solids. None of the children included in this study had evidence of solid content. Six (3%) children had a Grade 2 antrum (fluid content seen in both the supine and the right lateral decubitus positions). Two children had a gastric fluid volume >1.25 mL/kg. The prevalence of "at-risk stomach" was 1% (95% confidence interval: 0.2%-3.9%). CONCLUSION According to our results, only 1% of elective children had potentially increased risk for pulmonary aspiration. Further studies should be performed in order to define the target population of elective children for which ultrasound assessment of gastric content should be performed prior to general anesthesia.
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Affiliation(s)
- Lionel Bouvet
- Department of Anesthesia and Intensive Care, Hospices Civils de Lyon, Femme Mère Enfant Hospital, Bron, France.,INSERM, LabTAU UMR1032, University of Lyon, Université Claude Bernard Lyon 1, Centre Léon Bérard, Lyon, France
| | - Nicolas Bellier
- Department of Anesthesia and Intensive Care, Hospices Civils de Lyon, Femme Mère Enfant Hospital, Bron, France
| | - Anne-Charlotte Gagey-Riegel
- Department of Anesthesia and Intensive Care, Hospices Civils de Lyon, Femme Mère Enfant Hospital, Bron, France
| | - François-Pierrick Desgranges
- Department of Anesthesia and Intensive Care, Hospices Civils de Lyon, Femme Mère Enfant Hospital, Bron, France.,University of Lyon, Université Claude Bernard Lyon 1, Villeurbanne, France
| | - Dominique Chassard
- Department of Anesthesia and Intensive Care, Hospices Civils de Lyon, Femme Mère Enfant Hospital, Bron, France.,University of Lyon, Université Claude Bernard Lyon 1, Villeurbanne, France
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481
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Carmona BM, Almeida CCA, Vieira WDB, Fascio MDNC, Carvalho LRD, Vane LA, Barbosa FT, do Nascimento Junior P, Módolo NSP. [Ultrasound dynamics of gastric content volumes after the ingestion of coconut water or a meat sandwich. A randomized controlled crossover study in healthy volunteers]. Rev Bras Anestesiol 2018; 68:584-590. [PMID: 30195629 DOI: 10.1016/j.bjan.2018.06.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2018] [Revised: 06/08/2018] [Accepted: 06/15/2018] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Adequate preoperative fasting is critical in preventing pulmonary aspiration of gastric content. We proposed to study the sonographic gastric content dynamics after the ingestion of liquid or solid food in healthy volunteers and confront it with current guidelines for preoperative fasting times. METHODS We performed a prospective, crossover, evaluator-blinded study involving 17 healthy volunteers of both sexes. Each participant fasted for 10h and was subjected to a baseline gastric ultrasound, intake of 400mL of coconut water or a 145g, 355kcal meat sandwich, and sonographic gastric evaluations after 10min and every hour until the stomach was completely empty. RESULTS At baseline, all subjects had an empty stomach. At 10min, gastric content [mean + standard deviation (SD)] was 240.4 + 69.3 and 248.2 + 119.2mL for liquid and solid foods, respectively (p>0.05). Mean + SD gastric emptying times were 2.5 + 0.7 and 4.5 + 0.9h for liquid and solid foods, respectively (p<0.001). For the drink, the stomach was completely empty in 59% and 100% of the subjects after two and four hours, and for the sandwich, 65% and 100% of the subjects after four and seven hours, respectively. CONCLUSIONS Sonographic gastric dynamics for coconut water and a meat sandwich resulted in complete gastric emptying times higher and lower, respectively, than those suggested by current guidelines for preoperative fasting.
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Affiliation(s)
| | | | - Waldônio de Brito Vieira
- Fundação Santa Casa de Misericórdia do Pará, Departamento de Radiologia e Imagem de Diagnóstico, Belém, PA, Brasil
| | | | | | - Luiz Antonio Vane
- Universidade Estadual Paulista (Unesp), Faculdade de Medicina, Botucatu, SP, Brasil
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482
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Connolly K. Intravenous Fluid Administration: Improving Patient Outcomes With Evidence-based Care. J Nurse Pract 2018. [DOI: 10.1016/j.nurpra.2018.06.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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483
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Schmidt A, Buehler K, Both C, Wiener R, Klaghofer R, Hersberger M, Weiss M, Schmitz A. Liberal fluid fasting: impact on gastric pH and residual volume in healthy children undergoing general anaesthesia for elective surgery. Br J Anaesth 2018; 121:647-655. [DOI: 10.1016/j.bja.2018.02.065] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2017] [Revised: 02/07/2018] [Accepted: 03/07/2018] [Indexed: 12/31/2022] Open
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484
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Perier F, Chateauneuf AL, Jacq G, Holleville M, Schnell D, Merceron S, Cavelot S, Richard O, Legriel S. Comparison of etomidate and sodium thiopental for induction during rapid sequence intubation in convulsive status epilepticus: A retrospective single-center study. Seizure 2018; 61:170-176. [PMID: 30176574 DOI: 10.1016/j.seizure.2018.08.022] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2018] [Revised: 08/07/2018] [Accepted: 08/27/2018] [Indexed: 10/28/2022] Open
Abstract
PURPOSE Few outcome data are available about morbidity associated with endotracheal intubation modalities in critically ill patients with convulsive status epilepticus. We compared etomidate versus sodium thiopental for emergency rapid sequence intubation in patients with out-of-hospital convulsive status epilepticus. METHODS Patients admitted to our intensive care unit in 2006-2015 were studied retrospectively. The main outcome measure was seizure and/or status epilepticus recurrence within 12 h after rapid sequence intubation. RESULTS We included 97 patients (60% male; median age, 59 years [IQR, 48-70]). Median time from seizure onset to first antiepileptic drug was 60 min [IQR, 35-90]. Reasons for intubation were coma in 95 (98%), acute respiratory distress in 18 (19%), refractory convulsive status epilepticus in 9 (9%), and shock in 6 (6%) patients; 50 (52%) patients had more than one reason. The hypnotic drugs used were etomidate in 54 (56%) and sodium thiopental in 43 (44%) patients. Seizure and/or status epilepticus recurred in 13 (56%) patients in the etomidate group and 11 patients (44%) in the sodium thiopental group (adjusted common odds ratio [aOR], 0.98; 95%CI, 0.36-2.63; P = 0.97). The two groups were not significantly different for proportions of patients with hemodynamic instability after intubation (aOR, 0.60; 95%CI, 0.23-1.58; P = 0.30) or with difficult endotracheal intubation (OR, 1.28; 95% CI 0.23 to 7.21; P=0.77). CONCLUSIONS Our findings argue against a difference in seizure and/or status epilepticus recurrences rates between critically ill patients with convulsive status epilepticus given etomidate vs. sodium thiopental as the induction agent for emergency intubation.
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Affiliation(s)
- François Perier
- Intensive Care Unit, Centre Hospitalier de Versailles - Site André Mignot, 177 rue de Versailles, 78150 Le Chesnay Cedex, France
| | - Anne-Laure Chateauneuf
- Intensive Care Unit, Centre Hospitalier de Versailles - Site André Mignot, 177 rue de Versailles, 78150 Le Chesnay Cedex, France
| | - Gwenaëlle Jacq
- Intensive Care Unit, Centre Hospitalier de Versailles - Site André Mignot, 177 rue de Versailles, 78150 Le Chesnay Cedex, France
| | - Mathilde Holleville
- Intensive Care Unit, Centre Hospitalier de Versailles - Site André Mignot, 177 rue de Versailles, 78150 Le Chesnay Cedex, France
| | - David Schnell
- Intensive Care Unit, Centre Hospitalier d'Angoulême, Rond point de Girac, 16959 Angoulême, France
| | - Sybille Merceron
- Intensive Care Unit, Centre Hospitalier de Versailles - Site André Mignot, 177 rue de Versailles, 78150 Le Chesnay Cedex, France
| | - Sébastien Cavelot
- Intensive Care Unit, Centre Hospitalier de Versailles - Site André Mignot, 177 rue de Versailles, 78150 Le Chesnay Cedex, France
| | - Olivier Richard
- SAMU 78, Centre Hospitalier de Versailles - Site André Mignot, 177 rue de Versailles, 78150 Le Chesnay Cedex, France
| | - Stéphane Legriel
- Intensive Care Unit, Centre Hospitalier de Versailles - Site André Mignot, 177 rue de Versailles, 78150 Le Chesnay Cedex, France; Paris Descartes University, Sorbonne Paris Cité-Medical School, Paris, France; INSERM U970, Paris Cardiovascular Research Center, Paris, France.
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485
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Abstract
Enhanced recovery after surgery (ERAS) pathways target specific areas within perioperative patient care in a multidisciplinary and evidence-based manner. Because of the subsequent positive outcomes associated with its use, ERAS has expanded to most surgical subspecialties, including hepatopancreatobiliary surgery. Although certain concepts are universal to all ERAS protocols, there are unique areas of emphasis pertaining to the hepatopancreatobiliary specialties, which will be highlighted throughout this article. In addition, some of the less frequently discussed aspects of enhanced recovery, including patient-reported outcomes, recovery assessment, cost, and auditing, will be addressed.
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Affiliation(s)
- Heather A Lillemoe
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Thomas A Aloia
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
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486
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Parikh RP, Myckatyn TM. Paravertebral blocks and enhanced recovery after surgery protocols in breast reconstructive surgery: patient selection and perspectives. J Pain Res 2018; 11:1567-1581. [PMID: 30197532 PMCID: PMC6112815 DOI: 10.2147/jpr.s148544] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
The management of postoperative pain is of critical importance for women undergoing breast reconstruction after surgical treatment for breast cancer. Mitigating postoperative pain can improve health-related quality of life, reduce health care resource utilization and costs, and minimize perioperative opiate use. Multimodal analgesia pain management strategies with nonopioid analgesics have improved the value of surgical care in patients undergoing various operations but have only recently been reported in reconstructive breast surgery. Regional anesthesia techniques, with paravertebral blocks (PVBs) and transversus abdominis plane (TAP) blocks, and enhanced recovery after surgery (ERAS) pathways have been increasingly utilized in opioid-sparing multimodal analgesia protocols for women undergoing breast reconstruction. The objectives of this review are to 1) comprehensively review regional anesthesia techniques in breast reconstruction, 2) outline important components of ERAS protocols in breast reconstruction, and 3) provide evidence-based recommendations regarding each intervention included in these protocols. The authors searched across six databases to identify relevant articles. For each perioperative intervention included in the ERAS protocols, the literature was exhaustively reviewed and evidence-based recommendations were generated using the Grading of Recommendations, Assessment, Development, and Evaluation system methodology. This study provides a comprehensive evidence-based review of interventions to optimize perioperative care and postoperative pain control in breast reconstruction. Incorporating evidence-based interventions into future ERAS protocols is essential to ensure high value care in breast reconstruction.
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Affiliation(s)
- Rajiv P Parikh
- Department of Surgery, Division of Plastic and Reconstructive Surgery, Washington University School of Medicine, St Louis, MO, USA,
| | - Terence M Myckatyn
- Department of Surgery, Division of Plastic and Reconstructive Surgery, Washington University School of Medicine, St Louis, MO, USA,
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487
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Ito S, Inagawa G. Pocket-Size Ultrasound Examination. A A Pract 2018; 11:85. [DOI: 10.1213/xaa.0000000000000749] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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488
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Kang SH, Lee Y, Min SH, Park YS, Ahn SH, Park DJ, Kim HH. Multimodal Enhanced Recovery After Surgery (ERAS) Program is the Optimal Perioperative Care in Patients Undergoing Totally Laparoscopic Distal Gastrectomy for Gastric Cancer: A Prospective, Randomized, Clinical Trial. Ann Surg Oncol 2018; 25:3231-3238. [PMID: 30051365 DOI: 10.1245/s10434-018-6625-0] [Citation(s) in RCA: 59] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2018] [Indexed: 12/14/2022]
Abstract
BACKGROUND The application of ERAS protocol has widely gained acceptance after gastrointestinal surgery. Well-designed, randomized, control trials are needed to evaluate fully its safety and efficacy in the field of gastric cancer. This study aims to compare the enhanced recovery after surgery (ERAS) protocol and the conventional perioperative care program after totally laparoscopic distal gastrectomy (TLDG) in gastric cancer. METHODS Patients with gastric cancer indicated for TLDG were randomly assigned to either the ERAS group or the conventional group. The ERAS protocol included short fasting time, fluid restriction, early oral feeding, immediate mobilization, and use of epidural patient-controlled analgesia. Primary endpoint was recovery time, which was defined with the criteria of tolerable diet, safe ambulation, no requirement of additional analgesics, and afebrile state. Hospital stay, pain score, complications, and readmission rate were secondary endpoints. RESULTS A total of 97 patients who underwent TLDG from October 2012 to August 2014 were enrolled (ERAS = 46, conventional = 51). The ERAS group had faster recovery time (111.6 ± 34.3 vs. 126.7 ± 30.7 h; p = 0.026) and significantly less pain through postoperative days 1-4. Possible hospital stay also was faster in the ERAS group (5.0 ± 1.9 vs. 5.7 ± 1.6 days, p = 0.038), but there was no difference in actual hospital stay. No difference was found in complication, and there was no mortality or readmission in both groups. CONCLUSIONS ERAS is safe and enhances postoperative recovery after TLDG in gastric cancer. TRIAL REGISTRATION The trial was registered in ClinicalTrials.gov (NCT01938313).
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Affiliation(s)
- So Hyun Kang
- Department of Surgery, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Yoontaek Lee
- Department of Surgery, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Sa-Hong Min
- Department of Surgery, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Young Suk Park
- Department of Surgery, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Sang-Hoon Ahn
- Department of Surgery, Seoul National University Bundang Hospital, Seongnam, Korea. .,Department of Surgery, Seoul National University College of Medicine, Seoul, Korea.
| | - Do Joong Park
- Department of Surgery, Seoul National University Bundang Hospital, Seongnam, Korea.,Department of Surgery, Seoul National University College of Medicine, Seoul, Korea
| | - Hyung-Ho Kim
- Department of Surgery, Seoul National University Bundang Hospital, Seongnam, Korea.,Department of Surgery, Seoul National University College of Medicine, Seoul, Korea
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489
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Perianesthetic Implications and Considerations for Myasthenia Gravis. J Perianesth Nurs 2018; 34:4-15. [PMID: 29980408 DOI: 10.1016/j.jopan.2018.03.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2018] [Revised: 03/25/2018] [Accepted: 03/30/2018] [Indexed: 11/21/2022]
Abstract
Myasthenia gravis (MG) is a chronic autoimmune neuromuscular disease in which antibodies against the post-nicotinic acetylcholine receptor at the neuromuscular junction develop. Although the exact cause of MG remains unknown, the thymus is a common factor in many cases. Patients with underlying junctional disease, such as MG, have greater anesthesia-related risks because of their known predisposition toward prolonged muscle weakness. Medications given in the perioperative period, such as anesthetic agents, antibiotics, cardiovascular drugs, and corticosteroids, affect neuromuscular transmission that contributes to muscle weakness. Judicious use of neuromuscular blocking agents for patients with MG must be considered. This patient population is at high risk for respiratory failure, and therefore must be carefully assessed throughout the perioperative period to ensure that a regular spontaneous respiratory pattern is sufficient to provide adequate oxygenation. Perianesthesia providers must consider anesthetic, ventilatory, and pharmacologic implications when proposing, providing, and recovering anesthesia for the patient with MG.
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490
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Perioperative Management and Implementation of Enhanced Recovery Programs in Gynecologic Surgery for Benign Indications. Obstet Gynecol 2018; 132:137-146. [DOI: 10.1097/aog.0000000000002696] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
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491
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492
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Association between preoperative hydration status and acute kidney injury in patients managed surgically for kidney tumours. Int Urol Nephrol 2018; 50:1211-1217. [DOI: 10.1007/s11255-018-1901-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2018] [Accepted: 05/23/2018] [Indexed: 12/18/2022]
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493
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494
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Hegde HV, Bandi J, Mudakanagoudar MS, Honnannavar KA. Evaluation of performance of Streamlined Liner of the Pharynx Airway™, Laryngeal Mask Airway-ProSeal and endotracheal tube in prone position: A prospective, randomised study. Indian J Anaesth 2018; 62:173-181. [PMID: 29643550 PMCID: PMC5881318 DOI: 10.4103/ija.ija_691_17] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Background and Aims: Airway used in prone position should be efficacious and safe. The Streamlined Liner of the Pharynx Airway (SLIPA™) and Laryngeal Mask Airway-ProSeal (PLMA) provide better airway seal and protection against aspiration. We planned to evaluate the performance of SLIPA™, PLMA and endotracheal tube (ETT) in prone position. Methods: 114 adult patients undergoing elective surgery in prone position under general anaesthesia were randomised into Group-T (ETT), Group-S (SLIPA™) and Group-P (PLMA). Airways were inserted in supine position and patients turned prone subsequently. Airway characteristics, ventilatory parameters and complications were noted. One-way analysis of variance, Mann–Whitney U-test and Chi-square or Fisher's exact test were used. Results: Tidal volumes, peak airway pressure and compliance were comparable at all times. Leak pressure was significantly higher (P < 0.001) in Group-T (mean leak pressure = 40 cmH2O) when compared to Group-S and Group-P at all the times of recording, and there was no significant difference between Group-S and Group-P. The number of patients requiring airway/neck manipulation in prone position was significantly higher (P < 0.001) in Group-S (19 [55.9%]) when the three groups were compared (none in Group-T) and in comparison with Group-P (5 [14.7%], P < 0.001). On airway removal, the incidence of complications and airway reaction was significantly higher in Group-T. Group-S had a significantly higher incidence of dysphagia at 2 h postoperatively. Conclusion: ETT was most efficacious. SLIPA™ and PLMA were efficacious, safe and less stimulating to the airway during removal. More patients required SLIPA™ airway/neck manipulation.
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Affiliation(s)
- Harihar Vishwanath Hegde
- Department of Anaesthesiology, SDM College of Medical Sciences and Hospital, Dharwad, Karnataka, India
| | - Joshiraj Bandi
- Department of Anaesthesiology, SDM College of Medical Sciences and Hospital, Dharwad, Karnataka, India
| | | | - Kiran A Honnannavar
- Department of Anaesthesiology, SDM College of Medical Sciences and Hospital, Dharwad, Karnataka, India
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495
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Galvis-Navarrete SH, Bonilla-Ramírez AJ, Cubillos-Salcedo JE, Quesada-Montealegre DA, Valbuena-Pábon JC. Point-of-care gastric ultrasound in trichobezoar. COLOMBIAN JOURNAL OF ANESTHESIOLOGY 2018. [DOI: 10.1097/cj9.0000000000000030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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496
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Dudaryk R, Epstein RH, Varon AJ. Nil Per Os Consideration for Emergency Procedures: Cornerstone of Safety or an Obstacle to Patient Care? Anesth Analg 2018. [PMID: 29533257 DOI: 10.1213/ane.0000000000003331] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Affiliation(s)
- Roman Dudaryk
- From the Department of Anesthesiology, University of Miami Miller School of Medicine, Miami, Florida
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497
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Mohan S, Chakravarthy M, George A, Devanahalli A, Kumar J. Knowledge of Nurses About Preoperative Fasting in a Corporate Hospital. J Contin Educ Nurs 2018; 49:127-131. [PMID: 29498400 DOI: 10.3928/00220124-20180219-07] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2017] [Accepted: 12/20/2017] [Indexed: 11/20/2022]
Abstract
BACKGROUND Preoperative fasting is a requirement to be made by anesthesiologists, but they generally depend on nurses to ensure it is carried out by patients. Lack of updated knowledge among nurses may cause complications. METHOD The objective of this study was to understand the knowledge of nurses about preoperative fasting. The multi-unit study was conducted in the units of our hospitals using an Internet-based survey. The responders were anonymous to the authors. RESULTS The survey was sent to approximately 5,000 nurses, with more than 600 responding to the survey. Most of the respondents were aware of the preoperative fasting guidelines. The understanding regarding preoperative fasting appeared to be insufficient among nurses. The nurses appreciated the concern of the anesthesiologists about fasting. The nurses opined that additional training regarding preoperative fasting might benefit them. CONCLUSION This survey conveyed to the authors that the nurses of our hospitals were knowledgeable but required further training to update them. J Contin Educ Nurs. 2018;49(3):127-131.
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498
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Peters EG, Smeets BJJ, Nors J, Back CM, Funder JA, Sommer T, Laurberg S, Løve US, Leclercq WKG, Slooter GD, de Vries Reilingh TS, Wegdam JA, Nieuwenhuijzen GAP, Hiligsmann M, Buise MP, Buurman WA, de Jonge WJ, Rutten HJT, Luyer MDP. Perioperative lipid-enriched enteral nutrition versus standard care in patients undergoing elective colorectal surgery (SANICS II): a multicentre, double-blind, randomised controlled trial. Lancet Gastroenterol Hepatol 2018; 3:242-251. [PMID: 29426699 DOI: 10.1016/s2468-1253(18)30031-1] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2017] [Revised: 12/17/2017] [Accepted: 12/18/2017] [Indexed: 12/21/2022]
Abstract
BACKGROUND Postoperative ileus and anastomotic leakage severely impair recovery after colorectal resection. We investigated the effect of perioperative lipid-enriched enteral nutrition versus standard care on the risk of postoperative ileus, anastomotic leakage, and other clinical outcomes. METHODS We did an international, multicentre, double-blind, randomised, controlled trial of patients (≥18 years) undergoing elective colorectal surgery with primary anastomosis at six clinical centres in the Netherlands and Denmark. Patients were randomly assigned (1:1), stratified by location (colonic and rectal) and type of surgery (laparoscopic and open), via online randomisation software, with block sizes of six, to receive either continuous lipid-enriched enteral tube feeding from 3 h before until 6 h after surgery (intervention) or no perioperative nutrition (control). Surgeons, patients, and researchers were masked to treatment allocation for the entire study period. The primary outcome was postoperative ileus. Secondary outcomes included anastomotic leakage, pneumonia, preoperative gastric volumes, time to functional recovery, length of hospital stay, the need for additional interventions, intensive care unit admission, postoperative inflammatory response, and surgical complications. Analyses were by intention to treat. This study is registered with ClinicalTrials.gov, number NCT02175979, and trialregister.nl, number NTR4670. FINDINGS Between July 28, 2014, and February 20, 2017, 280 patients were randomly assigned, 15 of whom were excluded after random allocation because they fulfilled one or more exclusion criteria. 265 patients received perioperative nutrition (n=132) or standard care (n=133) and were included in the analyses. A postoperative ileus occurred in 37 (28%) patients in the intervention group versus 29 (22%) in the control group (risk ratio [RR] 1·09, 95% CI 0·95-1·25; p=0·24). Anastomotic leakage occurred in 12 (9%) patients in the intervention group versus 11 (8%) in the control group (RR 1·01, 95% CI 0·94-1·09; p=0·81). Pneumonia occurred in ten (8%) patients in the intervention group versus three (2%) in the control group (RR 1·06, 95% CI 1·00-1·12; p=0·051). All other secondary outcomes were similar between groups (all p>0·05). INTERPRETATION Perioperative lipid-enriched enteral nutrition in patients undergoing elective colorectal surgery has no advantage over standard care in terms of postoperative complications. FUNDING Netherlands Organisation for Health Research and Development (ZonMW), Fonds NutsOhra, and Danone Research.
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Affiliation(s)
- Emmeline G Peters
- Department of Surgery, Catharina Hospital, Eindhoven, Netherlands; Tytgat Institute for Intestinal and Liver Research, Academic Medical Centre, Amsterdam, Netherlands
| | - Boudewijn J J Smeets
- Department of Surgery, Catharina Hospital, Eindhoven, Netherlands; GROW School of Oncology and Developmental Biology, Maastricht University, Maastricht, Netherlands
| | - Jesper Nors
- Department of Surgery, Aarhus University Hospital, Aarhus, Denmark; Department of Surgery, Regionshospitalet Randers, Randers, Denmark
| | - Christian M Back
- Department of Surgery, Regionshospitalet Viborg, Viborg, Denmark
| | - Jonas A Funder
- Department of Surgery, Aarhus University Hospital, Aarhus, Denmark
| | - Thorbjørn Sommer
- Department of Surgery, Regionshospitalet Randers, Randers, Denmark
| | - Søren Laurberg
- Department of Surgery, Aarhus University Hospital, Aarhus, Denmark
| | - Uffe S Løve
- Department of Surgery, Regionshospitalet Viborg, Viborg, Denmark
| | | | - Gerrit D Slooter
- Department of Surgery, Máxima Medical Centre, Veldhoven, Netherlands
| | | | | | | | - Mickaël Hiligsmann
- Department of Health Services Research, CAPHRI Care and Public Health Research Institute, Maastricht University, Maastricht, Netherlands
| | - Marc P Buise
- Department of Anaesthesiology, Catharina Hospital, Eindhoven, Netherlands
| | - Willem A Buurman
- School for Mental Health and Neuroscience, Maastricht University, Maastricht, Netherlands
| | - Wouter J de Jonge
- Tytgat Institute for Intestinal and Liver Research, Academic Medical Centre, Amsterdam, Netherlands
| | - Harm J T Rutten
- Department of Surgery, Catharina Hospital, Eindhoven, Netherlands; GROW School of Oncology and Developmental Biology, Maastricht University, Maastricht, Netherlands
| | - Misha D P Luyer
- Department of Surgery, Catharina Hospital, Eindhoven, Netherlands.
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499
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Maki Y, Toyoda D, Tomichi K, Onodera J, Kotake Y. Association of Oral Intake and Transient Mixed Venous Oxygen Desaturation in Patients Undergoing Fast-Track Postoperative Care After Open-Heart Surgery. J Cardiothorac Vasc Anesth 2018; 32:2236-2240. [PMID: 29395815 DOI: 10.1053/j.jvca.2017.12.028] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2017] [Indexed: 11/11/2022]
Abstract
OBJECTIVE The impact of early resumption of oral intake after cardiac surgery on hemodynamics has not been characterized. The authors examined the effects of early oral intake on the oxygen supply-demand relationship in patients undergoing on-pump cardiac surgery in an early recovery after surgery program. DESIGN Prospective data were collected in postcardiac surgical patients in a multidisciplinary intensive care unit (ICU) during an 18-month period. SETTING Single institution study. PARTICIPANTS Forty-three patients who underwent either mitral or aortic valve repair and were successfully liberated from ventilatory support within 10 hours after surgery. INTERVENTIONS Patients were either allowed to resume oral intake on the morning of the first postoperative day or not at the discretion of the surgical team after extubation. MEASUREMENTS AND MAIN RESULTS The oxygen supply-demand relationship was assessed continuously with cardiac index and mixed venous oxygen saturation (SvO2). Among the subjects, 22 patients were allowed to eat, and transient SvO2 decrease was noted in 13 patients. All transient SvO2 decreases occurred in the patients with early oral intake. The hemodynamic status and oxygen supply-demand relationship did not differ between the patients with and without transient SvO2 decrease. All the subjects were discharged successfully from the ICU on the first postoperative day, and the length of hospital stay was similar irrespective of SvO2 decrease after early oral intake. CONCLUSIONS Early oral intake shortly after extubation was associated with transient but significant SvO2 decrease in patients who underwent fast-track recovery after open-heart surgery. Because this phenomenon did not negatively affect the postoperative outcome, early oral intake may not be harmful.
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Affiliation(s)
- Yuichi Maki
- Department of Anesthesiology, Toho University Ohashi Medical Center, Meguro, Tokyo, Japan.
| | - Daisuke Toyoda
- Department of Anesthesiology, Toho University Ohashi Medical Center, Meguro, Tokyo, Japan
| | - Keiko Tomichi
- Department of Anesthesiology, Toho University Ohashi Medical Center, Meguro, Tokyo, Japan
| | - Jun Onodera
- Department of Anesthesiology, Toho University Ohashi Medical Center, Meguro, Tokyo, Japan
| | - Yoshifumi Kotake
- Department of Anesthesiology, Toho University Ohashi Medical Center, Meguro, Tokyo, Japan
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500
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