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Pillinger NL, Robson JL, Kam P. Nutritional prehabilitation: physiological basis and clinical evidence. Anaesth Intensive Care 2018; 46:453-462. [PMID: 30189818 DOI: 10.1177/0310057x1804600505] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
In this narrative review, we describe the physiological basis for nutritional prehabilitation and evaluate the clinical evidence for its current roles in the perioperative period. Surgical stress and fasting induce insulin resistance as a result of altered mitochondrial function. Insulin resistance in the perioperative period leads to increased morbidity in a dose-dependent fashion, while preoperative carbohydrate loading attenuates insulin resistance, minimises protein loss and improves postoperative muscle function. Carbohydrate loading is an established practice in many countries and a key component of enhanced recovery after surgery (ERAS) programs, yet its independent effects on clinical outcomes remain unclear. Amino acid supplements may confer additional positive effects on a number of markers of clinical outcomes in the perioperative period, but their current role is also poorly defined. Clinical studies evaluating nutritional interventions have been marred by conflicting data, which may be due to small sample sizes, as well as heterogeneity of patients and surgical procedures. At present, it is known that carbohydrate loading is safe and improves patients' wellbeing, but does not appear to influence length of hospital stay or rate of postoperative complications. This should be appreciated before its routine inclusion in ERAS programs.
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Affiliation(s)
- N L Pillinger
- Department of Anaesthetics, Royal Prince Alfred Hospital; Clinical Lecturer, University of Sydney; Sydney, New South Wales
| | | | - Pca Kam
- Nuffield Professor of Anaesthetics, University of Sydney; Department of Anaesthetics, Royal Prince Alfred Hospital; Sydney, New South Wales
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Carter-Brooks CM, Du AL, Ruppert KM, Romanova AL, Zyczynski HM. Implementation of a urogynecology-specific enhanced recovery after surgery (ERAS) pathway. Am J Obstet Gynecol 2018; 219:495.e1-495.e10. [PMID: 29913175 DOI: 10.1016/j.ajog.2018.06.009] [Citation(s) in RCA: 82] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2017] [Revised: 06/05/2018] [Accepted: 06/09/2018] [Indexed: 12/29/2022]
Abstract
OBJECTIVE Enhanced recovery after surgery protocols were developed for colorectal surgery to hasten postoperative recovery. Variations of the protocol are being adopted for gynecological procedures despite limited population and procedure-specific outcome data. Our objective was to evaluate whether implementation of an enhanced recovery after surgery pathway would facilitate reduced length of admission in a urogynecology population. MATERIALS AND METHODS In this retrospective analysis of patients undergoing pelvic floor reconstructive surgery by 7 female pelvic medicine and reconstructive surgeons, we compared same-day discharge, length of admission and postoperative complications before and after implementation of an enhanced recovery after surgery pathway at a tertiary care hospital. Groups were compared using χ2 and Student t tests. Candidate variables that could have an impact on patient outcomes with P < .2 were included in multivariable logistic regression models. Satisfaction with surgical experience was assessed using a phone-administered questionnaire the day after discharge. RESULTS Mean age and body mass index of 258 women (137 before enhanced recovery after surgery and 121 enhanced recovery after surgery) were 65.5 ± 11.3 years and 28.2 ± 5.0 kg/m2. The most common diagnosis was pelvic organ prolapse (n = 242, 93.8%) including stage III pelvic organ prolapse (n = 61, 65.1%). Apical suspension procedures included 58 transvaginal (25.1%), 112 laparoscopic/robotic (48.8%), and 61 obliterative (26.4%). Hysterectomy was performed in 57.4% of women. Demographic and surgical procedures were similar in both groups. Compared with before enhanced recovery after surgery, the enhanced recovery after surgery group had a higher proportion of same-day discharge (25.9% vs 91.7%, P < .001) and a 13.8 hour shorter duration of stay (25.9 ± 13.5 vs 12.1 ± 11.2 hours, P <.001). Operative and postsurgical recovery room times were similar (2.6 ± 0.8 vs 2.6 ± 0.9 hours, P =.955; 3.7 ± 2.1 vs 3.6 ± 2.2 hours, P = .879). Women in the enhanced recovery after surgery group were more likely to be discharged using a urethral catheter (57.9% enhanced recovery after surgery vs 25.4% before enhanced recovery after surgery, P = .005). There were no group differences in total 30 day postoperative complications overall and for the following categories: urinary tract infections, emergency room visits, unanticipated office visits, and return to the operating room. However, enhanced recovery after surgery patients had higher 30 day hospital readmission rates (n = 8, 6.7% vs n = 2, 1.5%, P = .048). Patients before enhanced recovery after surgery were readmitted for myocardial infarction and chest pain. Enhanced recovery after surgery patients were admitted for weakness, chest pain, hyponatremia, wound complications, nausea/ileus, and ureteral obstruction. Three enhanced recovery after surgery patients returned to the operating room for ureteral obstruction (n = 1), incisional hernia (n = 1), and vaginal cuff bleeding (n = 1). Enhanced recovery after surgery patients also had more postoperative nursing phone notes (2.6 ± 1.7 vs 2.1 ± 1.4, P = .030). On multivariable logistic regressions adjusting for age and operative time, same-day discharge was more likely in the enhanced recovery after surgery group (odds ratio, 32.73, 95% confidence interval [15.23-70.12]), while the odds of postoperative complications and emergency room visits were no different. After adjusting for age, operative time, and type of prolapse surgery, readmission was more likely in the enhanced recovery after surgery group (odds ratio, 32.5, 95% confidence interval [1.1-28.1]). In the enhanced recovery after surgery group, patient satisfaction (n = 77 of 121) was reported as very good or excellent by 86.7% for pain control, 89.6% for surgery preparedness, and 93.5% for overall surgical experience; 89.6% did not recall any postoperative nausea during recovery. CONCLUSION Enhanced recovery after surgery implementation in a urogynecology population resulted in a greater proportion of same-day discharge and high patient satisfaction but with slightly increased hospital readmissions within 30 days.
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Affiliation(s)
- Charelle M Carter-Brooks
- Department of Obstetrics, Gynecology and Reproductive Sciences of the University of Pittsburgh, Division of Urogynecology and Pelvic Reconstructive Surgery, Magee-Womens Hospital of the University of Pittsburgh Medical Center, Pittsburgh, PA.
| | - Angela L Du
- University of Pittsburgh School of Medicine, Pittsburgh, PA
| | | | - Anna L Romanova
- Department of Obstetrics, Gynecology and Reproductive Sciences of the University of Pittsburgh, Division of Urogynecology and Pelvic Reconstructive Surgery, Magee-Womens Hospital of the University of Pittsburgh Medical Center, Pittsburgh, PA
| | - Halina M Zyczynski
- Department of Obstetrics, Gynecology and Reproductive Sciences of the University of Pittsburgh, Division of Urogynecology and Pelvic Reconstructive Surgery, Magee-Womens Hospital of the University of Pittsburgh Medical Center, Pittsburgh, PA
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Wang H, Geng Y, Zheng W, Fang W, Gu E, Liu X, Li W. Phantom limb syndrome induced by combined spinal and epidural anesthesia in patients undergoing elective open gynecological surgery. Medicine (Baltimore) 2018; 97:e12708. [PMID: 30313067 PMCID: PMC6203534 DOI: 10.1097/md.0000000000012708] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND During regional anesthesia, including combined spinal and epidural anesthesia (CSEA), patients may develop a perceptual alteration of limb position known as phantom limb syndrome (PLS). We aimed to identify factors that influence the PLS onset, to explore whether PLS predisposes to other postoperative symptoms, and to document the relationship between PLS and sensorimotor impairment during recovery. METHODS Psychological questionnaires for anxiety and depression were completed beforehand, then multimodal tests of sensory and motor function, especially tests of proprioception, were performed regularly afterward. Two hundred participants undergoing elective gynecological surgery under CSEA reported their experiences of PLS and other symptoms using Likert rating scales. RESULTS Prolonged preoperative fasting (odds ratio (OR) 2.34; 95% confidence intervals (CI) 1.21-4.52), and surgical history (OR 2.56; 95% CI 1.16-5.62) predisposed to PLS, but patients with more extensive anesthetic histories may be at lower risk (OR 0.57; 95% CI 0.31-1.08). Furthermore, significant correlations were observed between the recovery from PLS and the perception of joint movement within the deafferented area (R = 0.82, P < .01) and motor functions (R = 0.68). PLS increases the chance of experiencing postoperative fatigue, physical discomfort, and emotional upset. CONCLUSION This study is the first to have identified the risk factors for PLS, assessed the relationship between PLS and postoperative sensorimotor impairment, and its influence on postoperative complications.
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Affiliation(s)
- Huan Wang
- Department of Anesthesiology, the First Affiliated Hospital of Anhui Medical University, Hefei, Anhui
| | - Yingjie Geng
- Department of Anesthesiology, the Second Affiliated Hospital of Haerbin Medical University, Haerbin, Heilongjiang, P.R. China
| | - Weijian Zheng
- Department of Anesthesiology, the First Affiliated Hospital of Anhui Medical University, Hefei, Anhui
| | - Weiping Fang
- Department of Anesthesiology, the First Affiliated Hospital of Anhui Medical University, Hefei, Anhui
| | - Erwei Gu
- Department of Anesthesiology, the First Affiliated Hospital of Anhui Medical University, Hefei, Anhui
| | - Xuesheng Liu
- Department of Anesthesiology, the First Affiliated Hospital of Anhui Medical University, Hefei, Anhui
| | - Wenzhi Li
- Department of Anesthesiology, the Second Affiliated Hospital of Haerbin Medical University, Haerbin, Heilongjiang, P.R. China
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Soffin EM, YaDeau JT. Enhanced recovery after surgery for primary hip and knee arthroplasty: a review of the evidence. Br J Anaesth 2018; 117:iii62-iii72. [PMID: 27940457 DOI: 10.1093/bja/aew362] [Citation(s) in RCA: 174] [Impact Index Per Article: 29.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Enhanced recovery after surgery (ERAS) protocols produce significant clinical and economic benefits in a range of surgical subspecialties. There is a long tradition of applying clinical pathways to the perioperative care of joint arthroplasty patients. Enhanced recovery after surgery represents the next step in the evolution of standardized care. To date, reports of full ERAS pathways for hip or knee arthroplasty are lacking. In this narrative review, we present the evidence base that can be usefully applied to constructing ERAS pathways for hip or knee arthroplasty. The history and rationale for applying ERAS to joint arthroplasty are explained. Evidence demonstrates improved outcomes after joint arthroplasty when a standardized approach to care is implemented. The efficacy of individual ERAS components in hip or knee replacement is considered, including preoperative education, intraoperative anaesthetic techniques, postoperative analgesia, and early mobilization after joint arthroplasty. Interventions lacking high-quality evidence are identified, together with recommendations for future research. Based on currently available evidence, we present a model ERAS pathway that can be applied to perioperative care of patients undergoing hip or knee arthroplasty.
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Affiliation(s)
- E M Soffin
- Department of Anesthesiology, Hospital for Special Surgery, Weill Cornell Medical College, 535 East 70th Street, New York, NY 10021, USA
| | - J T YaDeau
- Department of Anesthesiology, Hospital for Special Surgery, Weill Cornell Medical College, 535 East 70th Street, New York, NY 10021, USA
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van Noort HHJ, Ettema RGA, Vermeulen H, Huisman-de Waal G. Outpatient preoperative oral nutritional support for undernourished surgical patients: A systematic review. J Clin Nurs 2018; 28:7-19. [PMID: 30039517 DOI: 10.1111/jocn.14629] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2018] [Accepted: 07/15/2018] [Indexed: 11/29/2022]
Abstract
AIMS AND OBJECTIVES To evaluate the effects of preoperative nutritional support using a regular diet for undernourished surgical patients at the outpatient clinic. BACKGROUND Undernutrition (or malnutrition) in surgical patients has severe consequences, that is, more complications, longer hospital stay and decreased quality of life. While systematic reviews show the effects of oral nutritional supplements (ONS), enteral and parenteral nutrition in surgical patients, the effects of normal foods and regular diets remain unclear. DESIGN A systematic review. METHODS PubMed, CINAHL, Web of Science, PsycINFO, Cochrane Library and EMBASE were searched up to July 24, 2017. Studies on undernourished patients receiving nutritional support using regular or therapeutic diet, performed preoperatively at the outpatient clinic, were considered eligible. Risk of bias was assessed using the Cochrane Risk of Bias tool. Two reviewers independently performed study selection, quality assessment and data extraction. RESULTS Six studies with moderate risk of bias were included. Interventions were preoperatively performed in mainly oncological outpatients by dieticians and aimed to reach nutrient requirements. Interventions included consults for counselling and advice, follow-up meetings and encouragements, and ONS. Nutritional status, nutrient intake and quality of life improved in supported patients. Improvements were better in counselled patients compared to patients using supplements. Unsupported patients experienced worse outcomes. CONCLUSION Frequent consults with counselling and advice as nutritional support for undernourished patients before surgery result in improvements to nutritional status, intake and quality of life. This statement is supported by weak evidence due to few studies and inadequate methods. RELEVANCE TO CLINICAL PRACTICE Nutritional support should be provided to all undernourished surgical patients during preoperative course. Nurses are in key position to provide nutritional support during outpatient preoperative evaluations.
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Affiliation(s)
- Harm H J van Noort
- Department of Innovation of Care, Gelderse Vallei Hospital, Ede, The Netherlands.,Radboud University Medical Centre, Radboud Institute for Health Sciences, IQ healthcare, Nijmegen, The Netherlands
| | - Roelof G A Ettema
- Julius Center for Health Sciences and Primary Care, University Utrecht, Utrecht, The Netherlands.,Research Center Health and Sustainable Living, Utrecht University of Applied Sciences, Utrecht, The Netherlands
| | - Hester Vermeulen
- Radboud University Medical Centre, Radboud Institute for Health Sciences, IQ healthcare, Nijmegen, The Netherlands
| | - Getty Huisman-de Waal
- Radboud University Medical Centre, Radboud Institute for Health Sciences, IQ healthcare, Nijmegen, The Netherlands
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Tsukamoto M, Hitosugi T, Yokoyama T. Influence of Fasting Duration on Body Fluid and Hemodynamics. Anesth Prog 2018; 64:226-229. [PMID: 29200368 DOI: 10.2344/anpr-65-01-01] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Fasting before general anesthesia aims to reduce the volume and acidity of stomach contents, which reduces the risk of regurgitation and aspiration. Prolonged fasting for many hours prior to surgery could lead to unstable hemodynamics, however. Therefore, preoperative oral intake of clear fluids 2 hours prior to surgery is recommended to decrease dehydration without an increase in aspiration risk. In this study, we investigated the body fluid composition and hemodynamics of patients undergoing general anesthesia as the first case of the day versus the second subsequent case. We retrospectively reviewed the general anesthesia records of patients over 20 years old who underwent oral maxillofacial surgery. We investigated patient demographics, preoperative fasting time, anesthetic time, urine output, infusion volume, and opioid and vasopressor use. With respect to body fluid and hemodynamics, we extracted the data from the induction of anesthesia through 2 hours of anesthesia time. Thirty patients were suitable for this study. Patients were divided into 2 groups: patients who underwent surgery as the first case of the day (am group: n = 15) and patients who underwent surgery as the second case (pm group: n = 15). There were no significant differences between the 2 groups in patient demographics. In the pm group, fasting time for a light meal (832 minutes) was significantly longer than for the am group (685 minutes), p = .005. In the pm group, fasting time for clear fluids (216 minutes) was also significantly longer than for the am group (194 minutes), p = .005. Body fluid composition was not significantly different between the 2 groups. In addition, cardiac parameters intraoperatively were stable. In the pm group, vasopressors were used in 4 patients at the induction of anesthesia (p = .01). There were not statistically significant changes in cardiac function or body fluid composition between patients treated as the first case of the day vs patients who underwent surgery with general anesthesia as the second case of the day.
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Affiliation(s)
- Masanori Tsukamoto
- Department of Dental Anesthesiology, Kyushu University Hospital, Fukuoka, Japan
| | - Takashi Hitosugi
- Department of Dental Anesthesiology, Faculty of Dental Science, Kyushu University, Fukuoka, Japan
| | - Takeshi Yokoyama
- Department of Dental Anesthesiology, Faculty of Dental Science, Kyushu University, Fukuoka, Japan
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What Is the Role of Nutritional Supplements in Support of Total Hip Replacement and Total Knee Replacement Surgeries? A Systematic Review. Nutrients 2018; 10:nu10070820. [PMID: 29941852 PMCID: PMC6073268 DOI: 10.3390/nu10070820] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2018] [Revised: 06/20/2018] [Accepted: 06/21/2018] [Indexed: 11/16/2022] Open
Abstract
Nutritional supplements can influence outcomes for individuals undergoing major surgery, particularly in older persons whose functional reserve is limited. Accelerating recovery from total hip replacement (THR) and total knee replacement (TKR) may offer significant benefits. Therefore, we explored the role of nutritional supplements in improving recovery following THR and TKR. A systematic review was conducted to source randomized clinical trials that tested nutritional supplements in cohorts of THR or TKR patients. Our search yielded nine relevant trials. Intake of a carbohydrate-containing fluid is reported to improve insulin-like growth factor levels, reduce hunger, nausea, and length of stay, and attenuate the decrease in whole-body insulin sensitivity and endogenous glucose release. Amino acid supplementation is reported to reduce muscle atrophy and accelerate return of functional mobility. One paper reported a suppressive effect of beta-hydroxy beta-methylbutyrate, L-arginine, and L-glutamine supplementation on muscle strength loss following TKR. There is limited evidence for nutritional supplementation in THR and TKR pathways; however, the low risk profile and potential benefits to adjunctive treatment methods, such as exercise programs, suggest nutritional supplements may have a role. Optimizing nutritional status pre-operatively may help manage the surgical stress response, with a particular benefit for undernourished, frail, or elderly individuals.
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Kang C, Kim SB, Heo YM, Won YG, Oh BH, Jun JB, Lee GS. Comparison of Time to Operation and Efficacies of Ultrasound-Guided Nerve Block and General Anesthesia in Emergency External Fixation of Lower Leg Fractures (AO 42, 43, 44). J Foot Ankle Surg 2018; 56:1019-1024. [PMID: 28842086 DOI: 10.1053/j.jfas.2017.04.027] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2016] [Indexed: 02/03/2023]
Abstract
The present randomized controlled trial evaluated the usefulness of ultrasound (US)-guided nerve block (NB) for emergency external fixation of lower leg fractures, by investigating the time required before surgery and the clinical results stratified by the anesthesia method (US-guided NB or general anesthesia [GA]). From June 2014 to April 2016, 40 patients who had undergone emergency surgery for external fixator application were enrolled in the present study. We measured the lead time before the start of surgery after the decision to perform emergency surgery in both groups. The US-guided NB group included 17 males (85%) and 3 females (15%), with a mean age of 55.6 (range 33 to 77) years. Of these 20 patients, 12 (60%) had comorbidities such as diabetes mellitus, hypertension, and kidney-related disease. Fracture type 42, 43, and 44 in the AO classification were observed in 3 (15%), 12 (60%), and 5 (25%) cases, respectively. The mean interval before emergency surgery was 4.3 (range 2 to 6.25) hours in the US-guided NB group. In the GA group (n = 20 patients), the mean interval before emergency surgery was 9.4 (range 3 to 14) hours, and this difference was statistically significant (p < .001). In the US-guided NB group, no cases of anesthesia failure or unstable vital signs occurred during surgery. Also, no postoperative complications related to the anesthesia method, such as aggravation of the general condition, developed. In contrast, 1 case of postoperative atelectasis occurred in the GA group. Emergency external fixation with US-guided NB in patients with lower extremity trauma can be implemented in less time, regardless of the preoperative preparation, which is a requirement for GA.
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Affiliation(s)
- Chan Kang
- Professor, Department of Orthopaedic Surgery, Chungnam National University School of Medicine, Daejon, Korea
| | - Sang-Bum Kim
- Professor, Department of Orthopedic Surgery, Konyang University College of Medicine, Daejon, Korea
| | - Youn-Moo Heo
- Professor, Department of Orthopedic Surgery, Konyang University College of Medicine, Daejon, Korea
| | - You-Gun Won
- Assistant Professor, Department of Orthopedic Surgery, Konyang University College of Medicine, Daejon, Korea
| | - Byung-Hak Oh
- Assistant Professor, Department of Orthopedic Surgery, Konyang University College of Medicine, Daejon, Korea
| | - June-Bum Jun
- Orthopedist, Department of Orthopedic Surgery, Konyang University College of Medicine, Daejon, Korea
| | - Gi-Soo Lee
- Assistant Professor, Department of Orthopedic Surgery, Konyang University College of Medicine, Daejon, Korea.
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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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Doo AR, Hwang H, Ki MJ, Lee JR, Kim DC. Effects of preoperative oral carbohydrate administration on patient well-being and satisfaction in thyroid surgery. Korean J Anesthesiol 2018; 71:394-400. [PMID: 29684984 PMCID: PMC6193600 DOI: 10.4097/kja.d.18.27143] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2017] [Accepted: 08/22/2017] [Indexed: 12/16/2022] Open
Abstract
Background Although the positive effects of preoperative oral carbohydrate administration on clinical outcomes followingmajor surgery have been reported continuously, there are few investigations of them in minor surgical patients. Thepresent study was designed to examine the effects of preoperative oral carbohydrate administration on patient well-beingand satisfaction in patients undergoing thyroidectomy. Methods Fifty adults aged 20–65 years and scheduled for elective thyroidectomy in first schedule in the morning wereallocated to one of two groups. The Control group (n = 25) was requested to obey traditional preoperative fasting aftermidnight prior to the day of surgery. The Carbohydrate group (n = 25) also fasted overnight but drank 400 ml of carbohydrate-richdrink 2 hours before induction of anesthesia. Patient well-being (thirst, hunger, mouth dryness, nauseaand vomiting, fatigue, anxiety and sleep quality) and satisfaction were assessed just before the operating room admission(preoperative) and 6 hours following surgery (postoperative). Other secondary outcomes including oral Schirmer’s testand plasma glucose concentrations were also evaluated. Results The two groups were homogenous in patient characteristics. Seven parameters representing patient well-beingevaluated on NRS (0–10) and patient satisfaction scored on a 5-point scale were not statistically different between thetwo groups preoperatively and postoperatively. There were no statistically significant differences in secondary outcomes. Conclusions Preoperative oral carbohydrate administration does not appear to improve patient well-being and satisfactioncompared with midnight fasting in patients undergoing thyroidectomy in first schedule in the morning.
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Affiliation(s)
- A Ram Doo
- Department of Anesthesiology and Pain Medicine, Chonbuk National University Medical School and Hospital, Jeonju, Korea
| | - Hyunsup Hwang
- Department of Anesthesiology and Pain Medicine, Chonbuk National University Medical School and Hospital, Jeonju, Korea
| | - Min-Jong Ki
- Department of Anesthesiology and Pain Medicine, Chonbuk National University Medical School and Hospital, Jeonju, Korea
| | - Jun-Rae Lee
- Department of Anesthesiology and Pain Medicine, Chonbuk National University Medical School and Hospital, Jeonju, Korea
| | - Dong-Chan Kim
- Department of Anesthesiology and Pain Medicine, Chonbuk National University Medical School and Hospital, Jeonju, Korea
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Perioperative hyperglycemia: an unmet need within a surgical site infection bundle. Tech Coloproctol 2018; 22:201-207. [PMID: 29512047 DOI: 10.1007/s10151-018-1769-2] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2017] [Accepted: 01/21/2018] [Indexed: 10/17/2022]
Abstract
BACKGROUND The aim of this study was to determine whether perioperative stress hyperglycemia is correlated with surgical site infection (SSI) rates in non-diabetes mellitus (DM) patients undergoing elective colorectal resections within an SSI bundle. METHODS American College of Surgeons National Surgical Quality Improvement Program data of patients treated at a single institution in 2006-2012 were supplemented by institutional review board-approved chart review. A multifactorial SSI bundle was implemented in 2009 without changing the preoperative 8-h nil per os, and in the absence of either a carbohydrate loading strategy or hyperglycemic management protocol. Hyperglycemia was defined as blood glucose level > 140 mg/dL. The primary endpoint was SSI defined by the Centers for Disease Control National Nosocomial Infections Surveillance. RESULTS Of 690 patients included, 112 (16.2%) had pre-existing DM. Overall SSI rates were significantly higher in DM patients as compared to non-DM patients (28.7 vs. 22.3%, p = 0.042). Postoperative hyperglycemia was more frequently seen in non-DM patients (46 vs. 42.9%). The SSI bundle reduced SSI rates (17 vs. 29.3%, p < 0.001), but the rate of hyperglycemia remained unchanged for DM or non-DM patients (pre-bundle 59%; post-bundle 62%, p = 0.527). Organ/space SSI rates were higher in patients with pre- and postoperative hyperglycemia (12.6%) (p = 0.017). Overall SSI rates were higher in DM patients with hyperglycemia as compared to non-DM patients with hyperglycemia (35.6 vs. 20.8%, p = 0.002). At multivariate analysis DM, chronic steroid use, chemotherapy and SSI bundle were predictive factors for SSI. CONCLUSIONS This study showed that non-DM patients have a postoperative hyperglycemia rate as high as 46% in spite of the SSI bundle. A positive correlation was found between stress hyperglycemia and organ/space SSI rates regardless of the DM status. These data support the need for a strategy to prevent stress hyperglycemia in non-DM patients undergoing colorectal resections.
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Gonfiotti A, Viggiano D, Bongiolatti S, Bertolaccini L, Solli P, Bertani A, Voltolini L, Crisci R, Droghetti A. Enhanced Recovery After Surgery (ERAS®) in thoracic surgical oncology. Future Oncol 2018; 14:33-40. [DOI: 10.2217/fon-2017-0471] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Enhanced recovery after surgery (ERAS®) is a strategy that seeks to reduce patients’ perioperative stress response, thereby reducing potential complications, decreasing hospital length of stay and enabling patients to return more quickly to their baseline functional status. The concept was introduced in the late 1990s and was first adopted for use with patients undergoing open colorectal surgery. Since that time, the concept of ERAS has spread to multiple surgical specialties. This article explores the key elements for patient care using an ERAS protocol applied to minimally invasive thoracic surgery.
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Affiliation(s)
| | - Domenico Viggiano
- Thoracic Surgery Unit, Careggi University Hospital, Florence 50134, Italy
| | | | - Luca Bertolaccini
- Thoracic Surgery Unit – AUSL Romagna Teaching Hospital, Ravenna 48121, Italy
| | - Piergiorgio Solli
- Thoracic Surgery Unit – AUSL Romagna Teaching Hospital, Ravenna 48121, Italy
| | - Alessandro Bertani
- Department of Thoracic Surgery, IRCCS ISMETT-UPMC, University of Pittsburgh, Palermo 90145, Italy
| | - Luca Voltolini
- Thoracic Surgery Unit, Careggi University Hospital, Florence 50134, Italy
| | - Roberto Crisci
- Department of Thoracic Surgery, University of L'Aquila, L'Aquila 67100, Italy
| | - Andrea Droghetti
- Department of Thoracic Surgery, ASST Mantova, Mantova 46100, Italy
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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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Enhanced Recovery After Minimally Invasive Surgery (ERAmiS) for Gynecology. CURRENT OBSTETRICS AND GYNECOLOGY REPORTS 2018. [DOI: 10.1007/s13669-018-0234-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
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65
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Albalawi Z, Laffin M, Gramlich L, Senior P, McAlister FA. Enhanced Recovery After Surgery (ERAS ®) in Individuals with Diabetes: A Systematic Review. World J Surg 2018; 41:1927-1934. [PMID: 28321553 DOI: 10.1007/s00268-017-3982-y] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND Prevalence of diabetes in surgical patients is 10-40%. It is well recognized that they have higher rates of complications, and longer stays in hospital compared to patients without diabetes. Enhanced recovery after surgery (ERAS) is an evidence-based multimodal surgical care pathway that improves postoperative complications and length of stay in patients without diabetes. This review evaluates the evidence on whether individuals with diabetes would benefit from ERAS implementation. METHODS MEDLINE, Cochrane Central Register of Controlled Trials (CENTRAL) and EMBASE searched with no language restrictions applied. Conference proceedings and bibliographies were reviewed. Experts in the field were contacted, and www.clinicaltrials.gov searched for ongoing trials. SELECTION CRITERIA Randomized controlled trials (RCT) looking at individuals with diabetes undergoing surgery randomized to ERAS® or conventional care. Non-randomized controlled trials, controlled before-after studies, interrupted time series, and cohort studies with concurrent controls were also considered. Two authors independently screened studies. RESULTS The electronic search yielded 437 references. After removing duplicates, 376 were screened for eligibility. Conference proceedings and bibliographies identified additional references. Searching www.clinicaltrials.gov yielded 59 references. Contacting experts in the field identified no further studies. Fourteen full articles were assessed and subsequently excluded for the following reasons: used an intervention other than ERAS®, did not include patients with diabetes, or used an uncontrolled observational design. CONCLUSIONS To date, the effects of ERAS® on patients with diabetes have not been rigorously evaluated. This review highlights the lack of evidence in this area and provides guidance on design for future studies.
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Affiliation(s)
- Zaina Albalawi
- Department of Medicine, University of Alberta, Edmonton, Canada. .,Endocrinology and Metabolism, Alberta Health Services, Edmonton, Canada.
| | - Michael Laffin
- Department of Surgery, University of Alberta, Edmonton, Canada
| | - Leah Gramlich
- Department of Medicine, University of Alberta, Edmonton, Canada.,Gastroenterology, University of Alberta, Edmonton, Canada
| | - Peter Senior
- Department of Medicine, University of Alberta, Edmonton, Canada.,Endocrinology and Metabolism, University of Alberta, Edmonton, Canada
| | - Finlay A McAlister
- Department of Medicine, University of Alberta, Edmonton, Canada.,General Internal Medicine, University of Alberta, Edmonton, Canada
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Arzola C, Perlas A, Siddiqui NT, Downey K, Ye XY, Carvalho JCA. Gastric ultrasound in the third trimester of pregnancy: a randomised controlled trial to develop a predictive model of volume assessment. Anaesthesia 2017; 73:295-303. [DOI: 10.1111/anae.14131] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/09/2017] [Indexed: 01/02/2023]
Affiliation(s)
- C. Arzola
- Department of Anesthesia, Department of Obstetrics and Gynecology; University of Toronto and Mount Sinai Hospital; Toronto Canada
| | - A. Perlas
- Department of Anesthesia; University of Toronto and Toronto Western Hospital-UHN; Toronto Canada
| | - N. T. Siddiqui
- Department of Anesthesia, Department of Obstetrics and Gynecology; University of Toronto and Mount Sinai Hospital; Toronto Canada
| | - K. Downey
- Department of Anesthesia; Maternal-Infant Care Research Center; Mount Sinai Hospital; Toronto Canada
| | - X. Y. Ye
- Maternal-Infant Care Research Center; Mount Sinai Hospital; Toronto Canada
| | - J. C. A. Carvalho
- Department of Anesthesia and Department of Obstetrics and Gynecology; University of Toronto and Mount Sinai Hospital; Toronto Canada
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Abstract
BACKGROUND Enhanced recovery pathways, also known as fast-track protocols, have been adopted since the early 2000s by various surgical specialties with the goal of improving patient outcomes and reducing the cost burden of major surgery on the health care system. OBJECTIVE To review the scientific literature on the origin of enhanced recovery pathways, track the contemporary utilization of such practices for patients undergoing radical cystectomy, and analyze the available data regarding their effect on morbidity, mortality, and treatment cost. METHODS A literature search of multiple electronic databases was undertaken. Manuscripts including patients undergoing radical cystectomy were chosen based on predefined criteria with an emphasis on randomized controlled trials and cohort studies. Strength of evidence for each study that met inclusion criteria was assessed based on the risk of bias, consistency, directness, and precision. RESULTS Database searches resulted in 1,236 potentially relevant articles. A total of 485 articles were selected for full-text dual review and 106 studies in 52 publications met the inclusion criteria. CONCLUSION The utilization of enhanced recovery pathways with the goal of improving overall patient morbidity and mortality is well supported in the literature, however standardization of implementation and adherence across institutions is lacking, and their direct efficacy on reducing preventable treatment related expenditures is unconfirmed.
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Affiliation(s)
- Ian Maloney
- Department of Urology, The University of Oklahoma Health Sciences Center and The Stephenson Cancer Center, Oklahoma City, OK, USA
| | - Daniel C. Parker
- Department of Urology, The University of Oklahoma Health Sciences Center and The Stephenson Cancer Center, Oklahoma City, OK, USA
| | - Michael S. Cookson
- Department of Urology, The University of Oklahoma Health Sciences Center and The Stephenson Cancer Center, Oklahoma City, OK, USA
| | - Sanjay Patel
- Department of Urology, The University of Oklahoma Health Sciences Center and The Stephenson Cancer Center, Oklahoma City, OK, USA
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68
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Zhang HW, Sun L, Yang XW, Feng F, Li GC. Safety of total gastrectomy without nasogastric and nutritional intubation. Mol Clin Oncol 2017; 7:421-426. [PMID: 28894580 DOI: 10.3892/mco.2017.1331] [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: 07/22/2016] [Accepted: 04/03/2017] [Indexed: 02/04/2023] Open
Abstract
The aim of the present study was to evaluate the safety of gastrectomy without nasogastric and nutritional intubations. Between January 2010 and August 2015, 74 patients with gastric cancer received total gastric resection and esophagogastric anastomosis without nasogastric and nutritional intubations at the First Department of Digestive Surgery of the XiJing Hospital of Digestive Diseases (Xi'an, China), of whom 42 were also received earlier oral feeding within 48 h. The data were retrospectively analyzed. An additional 301 cases who underwent traditional postoperative intubation were used for comparison. In patients without intubation compared with those managed traditionally with intubation, the mean operative time was decreased (190.97±38.18 vs. 216.12±59.52 min, respectively; P=0.026). In addition, the postoperative activity was resumed earlier (1.16±0.47 vs. 1.36±0.84 days, respectively; P=0.009), oral food intake was started earlier (4.28±1.79 vs. 5.71±2.66 days, respectively; P=0.009), the incidence of fever was lower (12.16 vs. 29.23%, respectively; P=0.003), and the incidence of total complications was not statistically significantly different between the two groups (9.41 vs. 6.31%, respectively; P=0.317). There were no significant differences regarding complications of the anastomotic port (1.37 vs. 1.69%, respectively; P=0.849). Compared with traditional postoperative management, earlier oral feeding did not increase the incidence of complications (7.21 vs. 4.76%, respectively; P=0.557). Our results suggest that total gastric resection without nasogastric and nutritional intubation is a safe and feasible option for patients undergoing total gastrectomy.
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Affiliation(s)
- Hong-Wei Zhang
- First Department of Digestive Surgery, Xijing Hospital of Digestive Diseases, Fourth Military Medical University, Xi'an, Shaanxi 710032, P.R. China
| | - Li Sun
- First Department of Digestive Surgery, Xijing Hospital of Digestive Diseases, Fourth Military Medical University, Xi'an, Shaanxi 710032, P.R. China
| | - Xue-Wen Yang
- First Department of Digestive Surgery, Xijing Hospital of Digestive Diseases, Fourth Military Medical University, Xi'an, Shaanxi 710032, P.R. China
| | - Fan Feng
- First Department of Digestive Surgery, Xijing Hospital of Digestive Diseases, Fourth Military Medical University, Xi'an, Shaanxi 710032, P.R. China
| | - Guo-Cai Li
- First Department of Digestive Surgery, Xijing Hospital of Digestive Diseases, Fourth Military Medical University, Xi'an, Shaanxi 710032, P.R. China
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69
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Sarin A, Chen LL, Wick EC. Enhanced recovery after surgery-Preoperative fasting and glucose loading-A review. J Surg Oncol 2017; 116:578-582. [PMID: 28846137 DOI: 10.1002/jso.24810] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2017] [Accepted: 06/19/2017] [Indexed: 02/04/2023]
Abstract
In this review, we explore the rationale and history behind the practice of preoperative fasting in elective surgery including the gradual move toward longer fasting and the more recent change in direction of practice. Gastric emptying physiology and the metabolic effects of prolonged fasting and carbohydrate loading are examined. Most recent guidelines related to these topics are discussed and practical recommendations for implementing these guidelines are suggested.
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Affiliation(s)
- Ankit Sarin
- Department of Surgery, University of California-San Francisco, San Francisco, California
| | - Lee-Lynn Chen
- Department of Anesthesia and Perioperative Care, University of California-San Francisco, San Francisco, California
| | - Elizabeth C Wick
- Department of Surgery, University of California-San Francisco, San Francisco, California
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70
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Douglas MJ, Ciraulo D. Variability in Perioperative Fasting Practices Negatively Impacts Nutritional Support of Critically Ill Intubated Patients. Am Surg 2017. [DOI: 10.1177/000313481708300843] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
The aim of the study was to quantify nutritional losses related to pre- and postoperative fasts in critically ill intubated patients and to explore whether shorter fasts are safe and appropriate in this population. A retrospective review of mechanically ventilated adults undergoing surgery more than 24 hours after admission to a Level I trauma center over 15 months was done, which yielded 132 procedures and 81 unique patients. Ninety per cent of preoperative periods and 43 per cent of postoperative periods were affected by nonmedical barriers to feeding. Eighty-two per cent of gastrically fed nonemergent cases were fasted for longer than the 6-hour American Society of Anesthesiologists guideline, whereas 91 per cent of emergent cases had shorter fasts. There were no anesthetic complications, placing an upper limit of 6 per cent on the rate of aspiration for fasts shorter than six hours (95% confidence). Forty-three per cent of cases did not resume tube feeds within 90 minutes postoperatively, and only 37 per cent had a documented justification for delay. Intubated patients were frequently fasted preoperatively for longer than recommended and postoperatively for longer than medically indicated. No complications were observed with shorter-than-guideline fasts. This strengthens the evidence that “standard” preoperative fasting is unnecessary and deleterious in many critically ill intubated patients. New protocols and national guidelines are needed to ensure adequate nutrition.
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71
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Li L, Jin J, Min S, Liu D, Liu L. Compliance with the enhanced recovery after surgery protocol and prognosis after colorectal cancer surgery: A prospective cohort study. Oncotarget 2017; 8:53531-53541. [PMID: 28881829 PMCID: PMC5581128 DOI: 10.18632/oncotarget.18602] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2017] [Accepted: 05/23/2017] [Indexed: 12/13/2022] Open
Abstract
We explored the effects of different levels of compliance with an enhanced recovery after surgery (ERAS) protocol on the short-term prognosis of patients who underwent colorectal cancer surgery. We conducted a single-center prospective cohort study in which 254 patients who received surgical treatment in a teaching tertiary care hospital were enrolled from March 2016 to November 2016. The patients were divided into four groups (I, II, III, and IV) based on individual compliance rates; the corresponding range of compliance rates was 0-60%, 60-70%, 70-80%, and 80-100%, and the number of patients in each group was 66, 63, 53, and 72, respectively. In the four groups from low to high compliance with ERAS (group I, II, III, and IV), the incidence of surgical site infections was 24.2%, 20.6%, 9.4%, and 6.9% (P < 0.05); the overall incidence of postoperative complications was 41.3%, 33.3%, 26.4%, and 16.7% (P < 0.05); the median length of postoperative hospital stay (in days) was 12.5, 10, 9, 8 (P < 0.05); and the median total hospital cost (Chinese Yuan) was 71,733, 73,632, 65,861, and 63,289 (P < 0.05), respectively. These results suggest that higher compliance with the ERAS protocol was associated with a lower incidence of surgical site infections, lower overall postoperative complication rate, shorter postoperative hospital stays, and lower total hospital costs.
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Affiliation(s)
- Liang Li
- Department of Anesthesiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Juying Jin
- Department of Anesthesiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Su Min
- Department of Anesthesiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Dan Liu
- Department of Anesthesiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Ling Liu
- Department of Anesthesiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
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Stoppe C, Goetzenich A, Whitman G, Ohkuma R, Brown T, Hatzakorzian R, Kristof A, Meybohm P, Mechanick J, Evans A, Yeh D, McDonald B, Chourdakis M, Jones P, Barton R, Tripathi R, Elke G, Liakopoulos O, Agarwala R, Lomivorotov V, Nesterova E, Marx G, Benstoem C, Lemieux M, Heyland DK. Role of nutrition support in adult cardiac surgery: a consensus statement from an International Multidisciplinary Expert Group on Nutrition in Cardiac Surgery. CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2017; 21:131. [PMID: 28583157 PMCID: PMC5460477 DOI: 10.1186/s13054-017-1690-5] [Citation(s) in RCA: 69] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/22/2016] [Accepted: 05/02/2017] [Indexed: 12/25/2022]
Abstract
Nutrition support is a necessary therapy for critically ill cardiac surgery patients. However, conclusive evidence for this population, consisting of well-conducted clinical trials is lacking. To clarify optimal strategies to improve outcomes, an international multidisciplinary group of 25 experts from different clinical specialties from Germany, Canada, Greece, USA and Russia discussed potential approaches to identify patients who may benefit from nutrition support, when best to initiate nutrition support, and the potential use of pharmaco-nutrition to modulate the inflammatory response to cardiopulmonary bypass. Despite conspicuous knowledge and evidence gaps, a rational nutritional support therapy is presented to benefit patients undergoing cardiac surgery.
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Affiliation(s)
- Christian Stoppe
- Department of Intensive Care Medicine, University Hospital of the RWTH Aachen, Pauwelsstraße 30, 52074, Aachen, Germany.
| | - Andreas Goetzenich
- Department of Thoracic, Cardiac and Vascular Surgery, University Hospital, RWTH Aachen, Pauwelsstraße 30, 52074, Aachen, Germany.
| | - Glenn Whitman
- Cardiac Surgical Intensive Care, Johns Hopkins Hospital Baltimore, Blalock 618, 600 N. Wolfe Street, Baltimore, MD, 21287, USA
| | - Rika Ohkuma
- Cardiac Surgical Intensive Care, Johns Hopkins Hospital Baltimore, Blalock 618, 600 N. Wolfe Street, Baltimore, MD, 21287, USA
| | - Trish Brown
- Cardiac Surgical Intensive Care, Johns Hopkins Hospital Baltimore, Blalock 618, 600 N. Wolfe Street, Baltimore, MD, 21287, USA
| | - Roupen Hatzakorzian
- Department of Anesthesia, Royal Victoria Hospital, McGill University Health Centre, Montreal, Canada
| | - Arnold Kristof
- Department of Microbiology and Immunology, McGill University Health Centre, Montreal, Canada
| | - Patrick Meybohm
- Department of Anaesthesiology, Intensive Care Medicine and Pain Therapy, University Hospital Frankfurt, Theodor-Stern-Kai 7, 60590, Frankfurt am Main, Germany
| | - Jefferey Mechanick
- Division of Endocrinology, Diabetes, and Bone Disease, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Adam Evans
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Daniel Yeh
- Department of Surgery, Division of Trauma, Emergency Surgery and Surgical Critical Care, Massachusetts General Hospital, Boston, MA, USA
| | - Bernard McDonald
- Division of Cardiac Anesthesiology and Critical Care Medicine, University of Ottawa Heart Institute, Ruskin Street H2410, Ottawa, ON, K1Y 4W7, Canada
| | - Michael Chourdakis
- Department of Medicine, Aristotle University of Thessaloniki, University Campus, Thessaloniki, 54124, Greece
| | - Philip Jones
- Departments of Anesthesia & Perioperative Medicine and Epidemiology & Biostatistics, University of Western Ontario, London, Canada
| | - Richard Barton
- Department of Surgery, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Ravi Tripathi
- Department of Anesthesiology, The Ohio State University College of Medicine, Columbus, OH, USA
| | - Gunnar Elke
- Department of Anesthesiology and Intensive Care Medicine, University Medical Center Schleswig-Holstein, Campus Kiel, Arnold-Heller-Str. 3 Haus 12, 24105, Kiel, Germany
| | - Oliver Liakopoulos
- Department of Cardiothoracic Surgery, Heart Center, University of Cologne, Cologne, Germany
| | - Ravi Agarwala
- Department of Anesthesiology, Section on Critical Care Medicine, Wake Forest School of Medicine, Medical Center Boulevard, Winston-Salem, NC, 27157, USA
| | - Vladimir Lomivorotov
- Department of Anesthesiology and Intensive Care, Research Institute of Circulation Pathology, Novosibirsk, Russia
| | - Ekaterina Nesterova
- Department of Anesthesiology and Intensive Care Medicine, National Pirogov Surgical Medical Center, Moscow, Russia
| | - Gernot Marx
- Department of Intensive Care Medicine, University Hospital of the RWTH Aachen, Pauwelsstraße 30, 52074, Aachen, Germany
| | - Carina Benstoem
- Department of Thoracic, Cardiac and Vascular Surgery, University Hospital, RWTH Aachen, Pauwelsstraße 30, 52074, Aachen, Germany
| | - Margot Lemieux
- Department of Critical Care Medicine, Queen's University and Clinical Evaluation Research Unit, Angada 4, Kingston General Hospital, Kingston, ON, K7L 2V7, Canada
| | - Daren K Heyland
- Department of Critical Care Medicine, Queen's University and Clinical Evaluation Research Unit, Angada 4, Kingston General Hospital, Kingston, ON, K7L 2V7, Canada
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Sasuga M, Yamamoto H, Abe S, Misumi M, Watanabe H, Hikawa Y. Gastric fluid volume and acidity 2 h after intake of clear fluids in patients undergoing upper GI, lower GI, and non-GI surgery. Clin Nutr ESPEN 2017. [DOI: 10.1016/j.clnesp.2017.01.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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74
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Preoperative Fasting among Adult Patients for Elective Surgery in a Kenyan Referral Hospital. INTERNATIONAL SCHOLARLY RESEARCH NOTICES 2017; 2017:2159606. [PMID: 28487877 PMCID: PMC5405382 DOI: 10.1155/2017/2159606] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/04/2017] [Revised: 03/24/2017] [Accepted: 04/02/2017] [Indexed: 12/13/2022]
Abstract
Background. Preoperative fasting (POF) is physiologically and precautionary important during anesthesia and surgery. POF from midnight has been practiced despite the recommended shorter practice. Objective. Assessing preoperative fasting among adult patients scheduled for elective surgery at Kenyatta National Hospital (KNH). Methods. A descriptive cross-sectional study involving 65 surgical patients. A questionnaire of mixed questions on demographics, reasons, source of instructions, opinion on instructions, time, premedication practices, outcome, and complains on NPO was used. Analysis was quantitatively done with SPSS v. 22. Ethical approval was obtained from KNH-UoN ERC. Results. Of the respondents 93.8% lacked knowledge on the correct reasons for POF and felt that the instructions were unclear and less important <50%. POF instructions were administered by nurses 80%, anesthetists 15%, and surgeons 5%. Most of respondents (73.8%) fasted > 15 hours. The POF outcomes were rated moderately challenging as follows: prolonged wait for surgery 44.6%, thirst 43.1%, hunger 36.9%, and anxiety 29.2%. Conclusion. Nurses are critical in providing POF instructions and care, and patient knowledge level is a mirror reflection of the quality of interventions. This underscores the need to build capacity for nurses and strengthen the health system to offer individualized preoperative interventions as well as monitoring and clinical auditing of fasting practices.
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75
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Shiraishi T, Kurosaki D, Nakamura M, Yazaki T, Kobinata S, Seki Y, Kasama K, Taniguchi H. Gastric Fluid Volume Change After Oral Rehydration Solution Intake in Morbidly Obese and Normal Controls. Anesth Analg 2017; 124:1174-1178. [DOI: 10.1213/ane.0000000000001886] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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76
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Abela G. The potential benefits and harms of early feeding post-surgery: a literature review. Int Wound J 2017; 14:870-873. [PMID: 28371381 DOI: 10.1111/iwj.12750] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2017] [Accepted: 03/04/2017] [Indexed: 12/20/2022] Open
Abstract
The effect of nutrition on wound healing is widely recognized, with many studies highlighting the detrimental effect poor nutrition can have on wound healing. In addition, fasting pre-, peri- and postoperatively can contribute to further protein catabolism, leading to morbidity and mortality. By reviewing the current literature, this work evaluates the potential benefits and harms from early feeding (EF) during the early stages postsurgery. Current randomised control trials suggest that the early introduction of nutrients post-surgery may be beneficial for wound healing and recovery from surgery. Additionally, this approach does not seem to impose any increased complications post-operatively. Conversely, although there is ongoing research supporting EF and evidence showing that malnutrition can delay wound healing and recovery, healthcare professionals remain sceptical with a slow uptake in adopting EF protocols.
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Affiliation(s)
- Genevieve Abela
- Cardiff University, School of Medicine, Centre for Medical Education, Cardiff, UK
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77
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Effect of Hypoglycemia on the Incidence of Revision in Total Knee Arthroplasty. J Arthroplasty 2017; 32:499-502. [PMID: 27554778 DOI: 10.1016/j.arth.2016.07.014] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2016] [Revised: 06/09/2016] [Accepted: 07/11/2016] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND It is well established that diabetic patients undergoing total knee arthroplasty (TKA) are more susceptible to infection, problematic wound healing, and overall higher complication rates. However, a paucity in current literature exists. The purpose of this study was to determine the effect of hypoglycemia on TKA revision (rTKA) incidence by analyzing a national private payer database for procedures performed between 2007 and 2015 Q1 Q2. METHODS A retrospective review of a national private payer database within the PearlDiver Supercomputer application for patients undergoing TKA with blood glucose levels from 20 to 219 mg/mL, in 10-mg/mL increments, was conducted. Patients who underwent TKA were identified by Current Procedural Terminology (CPT) and International Classification of Disease (ICD) codes. Glucose ranges were identified by filtering for Logical Observation Identifiers Names and Codes within the PearlDiver database. Patients with diagnosed diabetes mellitus type I or II were excluded by using ICD-9 codes 250.00-250.03, 250.10-250.13, and 250.20-250.21. rTKA causes including mechanical loosening, failure/break, periprosthetic fracture, osteolysis, infection, pain, arthrofibrosis, instability, and trauma were identified with CPT and ICD-9 codes. Statistical analysis was primarily descriptive. RESULTS Our query returned 264,824 TKAs, of which 12,852 (4.9%) were revised. Most TKAs were performed with a glucose of 70-99 mg/mL (26.1%), followed by 100-109 mg/mL (18.5%). Patients with TKAs performed with glucose 20-29 mg/mL had the highest rate of revision (17.2%; P < .001). Infection was the most common cause of revision among all glucose ranges (P < .001). CONCLUSION Infection remains one of the most common causes of rTKA irrespective of glucose level. Our results suggest that hypoglycemia may increase revision rates among TKA patients. Tight glycemic control before and during surgery may be warranted.
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78
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Çakar E, Yilmaz E, Çakar E, Baydur H. The Effect of Preoperative Oral Carbohydrate Solution Intake on Patient Comfort: A Randomized Controlled Study. J Perianesth Nurs 2017; 32:589-599. [PMID: 29157765 DOI: 10.1016/j.jopan.2016.03.008] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2015] [Revised: 02/16/2016] [Accepted: 03/06/2016] [Indexed: 11/24/2022]
Abstract
PURPOSE The study was conducted to investigate the effect of preoperative oral carbohydrate loading on the preoperative discomforts and postoperative complications of patients undergoing elective thyroidectomy. DESIGN A randomized controlled clinical trial. METHODS Ninety patients scheduled for thyroidectomy were divided into three groups: (1) those receiving a carbohydrate-rich drink (CHD), (2) those receiving an overnight 5% glucose intravenous infusion, and (3) those fasting from midnight. The preoperative discomforts and postoperative complications of patients were evaluated using the Visual Analog Scale (VAS). The patients' vital signs and blood glucose levels were measured perioperatively. FINDINGS In the preoperative assessment, hunger, thirst, mouth dryness, chill, and headache adjusted for age, gender, body mass index, and duration of the operation were all found to be significantly higher in the glucose and fasting groups than the CHD group (P < .01). In the postoperative period, the fasting group experienced more vomiting and pain compared with the CHD group (P < .05). A significant difference was found between the groups in terms of diastolic blood pressure and pulse rate in the preoperative and intraoperative periods (P < .05). CONCLUSIONS The CHD treatment before thyroidectomy increases patient comfort by reducing preoperative discomfort (such as hunger, thirst, dry mouth, fatigue and headache) and early postoperative complications (vomiting and pain).
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79
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ŞAVLUK ÖF, KUŞÇU MA, GÜZELMERİÇ F, GÜRCÜ ME, ERKILINÇ A, ÇEVİRME D, OĞUŞ H, KOÇAK T. Do preoperative oral carbohydrates improve postoperative outcomesin patients undergoing coronary artery bypass grafts? Turk J Med Sci 2017; 47:1681-1686. [DOI: 10.3906/sag-1703-19] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
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80
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Affiliation(s)
- Olle Ljungqvist
- Centre for Gastrointestinal Disease, Ersta Hospital, and Department of Surgery, Centre for Surgical Sciences, Karolinska University Hospital, Huddinge, Stockholm, Sweden
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81
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The Trend of Perioperative Care of Gastrectomy in Kanagawa, Japan. Int Surg 2016. [DOI: 10.9738/intsurg-d-16-00128.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Comprehensive surveys on perioperative care in Japan, including that in community or private hospitals, have not been reported, and current trends remain unclear. The present survey was designed to investigate current routines for perioperative care in patients who undergo surgery for gastric cancer in Kanagawa, Japan. A questionnaire was designed specifically to obtain information on perioperative routines in patients with gastric cancer throughout Kanagawa. A total of 55 hospitals in Kanagawa responded. Most hospitals perform antimicrobial prophylaxis every 3 hours intraoperatively, use a postoperative drainage tube, use a urinary catheter for only 2 days after surgery, administer epidural anesthesia, and encourage early mobilization. Liquid intake until 3 hours before surgery is not allowed in most hospitals. Most hospitals do not routinely provide preoperative nutrition support, perform bowel mechanical preparation, administer prophylaxis against thromboembolism, place a postoperative nasogastric tube, attempt to maintain normovolemia, or administer planned nonsteroidal anti-inflammatory drugs. The day of restarting drinking or eating varies considerably. Many elements of perioperative management, especially postoperative oral nutrition, have yet to be standardized for patients with gastric cancer in Japan. There are great gaps between clinical practice and evidence-based practice in fluid management and drain usage.
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82
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Savvas I, Raptopoulos D, Rallis T. A “Light Meal” Three Hours Preoperatively Decreases the Incidence of Gastro-Esophageal Reflux in Dogs. J Am Anim Hosp Assoc 2016; 52:357-363. [DOI: 10.5326/jaaha-ms-6399] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
ABSTRACT
Emerging evidence from veterinary and medical clinical research shows that reducing preoperative fasting time may reduce the incidence of gastro-esophageal reflux (GER) intraoperatively. In order to evaluate the effect of two different preoperative fasting times on the incidence of GER during general anesthesia, 120 dogs were randomly assigned to two groups: administration of canned food 3 h before premedication (group C3, n = 60) and administration of canned food 10 h before premedication (group C10, n = 60). The animals were premedicated with propionyl-promazine. Anesthesia was induced with thiopental sodium and maintained with halothane. A pH electrode was introduced into the esophagus, and the esophageal pH was constantly monitored. Esophageal pH of less than 4 or greater than 7.5 was taken as an indication of GER. Three of the 60 dogs of group C3 and 12 of the 60 dogs of group C10 experienced a GER episode, the difference being statistically significant (P = .025). Feeding the dog 3 h before anesthesia at a half daily rate reduces significantly the incidence of GER during anesthesia, compared to the administration of the same amount and type of food 10 h before anesthesia. The administration of a half daily dose of an ordinary canine diet may be useful in clinical practice.
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Affiliation(s)
- Ioannis Savvas
- From the School of Veterinary Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Dimitrios Raptopoulos
- From the School of Veterinary Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Timoleon Rallis
- From the School of Veterinary Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
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83
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Lambert E, Carey S. Practice Guideline Recommendations on Perioperative Fasting. JPEN J Parenter Enteral Nutr 2016; 40:1158-1165. [DOI: 10.1177/0148607114567713] [Citation(s) in RCA: 78] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2014] [Accepted: 12/14/2014] [Indexed: 12/22/2022]
Affiliation(s)
| | - Sharon Carey
- University of Sydney, Sydney, Australia
- Department of Nutrition and Dietetics, Royal Prince Alfred Hospital, Sydney, Australia
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84
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Brunet-Wood K, Simons M, Evasiuk A, Mazurak V, Dicken B, Ridley D, Larsen B. Surgical fasting guidelines in children: Are we putting them into practice? J Pediatr Surg 2016; 51:1298-302. [PMID: 27166876 DOI: 10.1016/j.jpedsurg.2016.04.006] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2015] [Revised: 04/07/2016] [Accepted: 04/11/2016] [Indexed: 02/04/2023]
Abstract
BACKGROUND Patients are traditionally kept fasting (NPO) from midnight prior to surgery, to prevent aspiration during anesthesia. NPO time is continued postoperatively, out of concern for ileus. Prolonged periods of NPO place the pediatric population at risk for under-nutrition. Published guidelines for preoperative NPO times have been shown to be safe. The aim of this study was to investigate current pre- and postoperative feeding practices of children at a pediatric tertiary care hospital. METHODS Medical charts were used to extract data prospectively from 53 patients undergoing general, neurosurgical, or urological procedures. Date and time of NPO periods were recorded as well as the physician's postoperative diet orders and diet progression. Surgical procedures were classified as complex or noncomplex by the surgeons. Data were summarized and compared to published recommendations. RESULTS Preoperative NPO times were greater than recommended in 70% of patients studied (n=37). Median time spent NPO preoperatively was not significantly different between complex (11.5h) and noncomplex groups (10.8h). Postoperative NPO time was significantly greater for complex procedures than for noncomplex. Most patients received some postoperative NPO time, even when it was not included in the physician diet order. CONCLUSION Observed preoperative NPO time exceeded current recommendations in this study.
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Affiliation(s)
| | - Mariska Simons
- Department of Agricultural, Life, and Environmental Sciences, University of Alberta.
| | - Amanda Evasiuk
- Department of Agricultural, Life, and Environmental Sciences, University of Alberta.
| | - Vera Mazurak
- Department of Agricultural, Life, and Environmental Sciences, University of Alberta.
| | - Bryan Dicken
- Department of Pediatrics, University of Alberta.
| | | | - Bodil Larsen
- Nutrition Services, Alberta Health Services; Department of Agricultural, Life, and Environmental Sciences, University of Alberta; Department of Pediatrics, University of Alberta.
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85
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Pecorelli N, Nobile S, Partelli S, Cardinali L, Crippa S, Balzano G, Beretta L, Falconi M. Enhanced recovery pathways in pancreatic surgery: State of the art. World J Gastroenterol 2016; 22:6456-6468. [PMID: 27605881 PMCID: PMC4968126 DOI: 10.3748/wjg.v22.i28.6456] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2016] [Revised: 05/21/2016] [Accepted: 06/13/2016] [Indexed: 02/06/2023] Open
Abstract
Pancreatic surgery is being offered to an increasing number of patients every year. Although postoperative outcomes have significantly improved in the last decades, even in high-volume centers patients still experience significant postoperative morbidity and full recovery after surgery takes longer than we think. In recent years, enhanced recovery pathways incorporating a large number of evidence-based perioperative interventions have proved to be beneficial in terms of improved postoperative outcomes, and accelerated patient recovery in the context of gastrointestinal, genitourinary and orthopedic surgery. The role of these pathways for pancreatic surgery is still unclear as high-quality randomized controlled trials are lacking. To date, non-randomized studies have shown that care pathways for pancreaticoduodenectomy and distal pancreatectomy are safe with no difference in postoperative morbidity, leading to early discharge and no increase in hospital readmissions. Hospital costs are reduced due to better organization of care and resource utilization. However, further research is needed to clarify the effect of enhanced recovery pathways on patient recovery and post-discharge outcomes following pancreatic resection. Future studies should be prospective and follow recent recommendations for the design and reporting of enhanced recovery pathways.
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86
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Abstract
Enhanced recovery after surgery is the natural evolution of what were previously referred to as fast track programs and seeks to implement a series of interventions to improve and enhance recovery after major surgical procedures. Two important preoperative aspects are nutrition and prehabilitation. Identifying nutritionally deficient patients allows preoperative intervention to optimize their nutritional status. The contribution of cardiopulmonary exercise testing to the evaluation of perioperative risk, subsequent development of a training program, and the use of indices to risk stratify and measure improvement after a training program allow a personalized preoperative program to be developed for each patient.
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Affiliation(s)
- Ruchir Gupta
- Department of Anesthesiology, Health Science Center, Stony Brook University School of Medicine, L4-060, Stony Brook, NY 11794, USA
| | - Tong J Gan
- Department of Anesthesiology, Health Science Center, Stony Brook University School of Medicine, L4-060, Stony Brook, NY 11794, USA.
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87
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Abdelbaki TN, Bekheit M, Katri K. A sleeve gastrectomy blast: how long should the bariatric patient fast? Surg Obes Relat Dis 2016; 12:707-710. [PMID: 26922164 DOI: 10.1016/j.soard.2015.10.079] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2015] [Revised: 10/17/2015] [Accepted: 10/20/2015] [Indexed: 02/08/2023]
Affiliation(s)
- Tamer N Abdelbaki
- General Surgery Department, Alexandria University, Alexandria, Egypt.
| | - Mohamed Bekheit
- General Surgery Department, Alexandria University, Alexandria, Egypt
| | - Khaled Katri
- General Surgery Department, Alexandria University, Alexandria, Egypt
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88
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Zatevakhin II, Pasechnik IN, Gubaidullin RR, Reshetnikov EA, Berezenko MN. [Accelerated postoperative rehabilitation: multidisciplinary issue (Part 1)]. Khirurgiia (Mosk) 2016:4-8. [PMID: 26762072 DOI: 10.17116/hirurgia201594-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
AIM To discuss the main aspects of multimodal method of accelerated postoperative rehabilitation (fast track surgery). MATERIAL AND METHODS The program of accelerated rehabilitation consists of minimization of surgical treatment's stressful influence on patient's organism in perioperative period. The method implies use of efficient preoperative management, minimally invasive operations, regional anesthesia and short-acting anesthetics, early postoperative rehabilitation. RESULTS The program improves the results of surgical treatment, reduces number of complications and cost of treatment, improves the "quality" of hospital stay.
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Affiliation(s)
| | - I N Pasechnik
- Teaching and Research Medical Center of the Presidential Administration of the Russian Federation
| | - R R Gubaidullin
- Teaching and Research Medical Center of the Presidential Administration of the Russian Federation; Clinical Hospital of the Presidential Administration of the Russian Federation
| | - E A Reshetnikov
- Central Clinical Hospital and Polyclinic of the Presidential Administration of the Russian Federation, Moscow
| | - M N Berezenko
- Clinical Hospital of the Presidential Administration of the Russian Federation
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89
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Nutrition before and during Surgery and the Inflammatory Response of the Heart: A Randomized Controlled Trial. J Nutr Metab 2015; 2015:123158. [PMID: 26294967 PMCID: PMC4532862 DOI: 10.1155/2015/123158] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2015] [Revised: 05/12/2015] [Accepted: 05/31/2015] [Indexed: 11/23/2022] Open
Abstract
Major surgery induces a long fasting time and provokes an inflammatory response which increases the risk of infections. Nutrition given before and during surgery can avoid fasting and has been shown to increase the arginine/asymmetric dimetlhylarginine ratio, a marker of nitric oxide availability, in cardiac tissue and increased concentrations of branched chain amino acids in blood plasma. However, the effect of this new nutritional strategy on organ inflammatory response is unknown. Therefore, we studied the effect of nutrition before and during cardiac surgery on myocardial inflammatory response.
In this trial, 32 patients were randomised between enteral, parenteral, and no nutrition supplementation (control) from 2 days before, during, up to 2 days after coronary artery bypass grafting. Both solutions included proteins or amino acids, glucose, vitamins, and minerals. Myocardial atrial tissue was sampled before and after revascularization and was analysed immunohistochemically, subdivided into cardiomyocytic, fatty, and fibrotic areas. Inflammatory cells, especially leukocytes, were present in cardiac tissue in all study groups. No significant differences were found in the myocardial inflammatory response between the enteral, parenteral, and control groups. In conclusion, nutrition given before and during surgery neither stimulates nor diminishes the myocardial inflammatory response in patients undergoing coronary artery bypass grafting. The trial was registered in Netherlands Trial Register (NTR): NTR2183.
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90
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Affiliation(s)
- Cassandra Pogatschnik
- Center for Human Nutrition & Center for Gut Rehabilitation and Transplantation, Department of General Surgery and Digestive Disease Institute, Cleveland Clinic, Cleveland, Ohio
| | - Ezra Steiger
- Center for Human Nutrition & Center for Gut Rehabilitation and Transplantation, Department of General Surgery and Digestive Disease Institute, Cleveland Clinic, Cleveland, Ohio
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91
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Southern Hospitality: How We Changed the NPO Practice in the Emergency Department. J Emerg Nurs 2015; 41:317-22. [PMID: 25940843 DOI: 10.1016/j.jen.2014.12.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2014] [Revised: 11/24/2014] [Accepted: 12/01/2014] [Indexed: 11/24/2022]
Abstract
PROBLEM In the Vanderbilt Medical Center adult emergency department, the practice has been to keep patients on "nothing by mouth" (NPO) status throughout their assessment, diagnostic, and treatment phases. As a result, most patients have NPO status for a period of several hours to days. The consequences are patient discomfort, hunger, thirst, dehydration, interruptions in routine medication schedules, poor glucose control, and compromised acid/base balance. The purpose of this project was to modify the NPO practice in the adult emergency department. METHODS A survey of nursing staff perceptions demonstrated both staff and patient dissatisfaction with the NPO practice. Responses to postdischarge satisfaction surveys demonstrated that patients experienced some discomfort because of hunger or thirst. A search of the literature revealed that the American Society of Anesthesiologists (ASA) adopted guidelines in 1999 that patients should fast 6 hours from solids and 2 hours from liquids preoperatively. These guidelines were implemented in the adult emergency department using the Standard Rollout Process. Physician order sets for the emergency department and the ED chest pain unit were modified to reflect the ASA guidelines. RESULTS After implementation of the ASA guidelines, a follow-up survey of nursing staff showed increased staff and patient satisfaction. After implementation, the patient satisfaction survey demonstrated an increase in patients who reported "no discomfort" because of hunger or thirst. No adverse outcomes or delays were reported in relation to the change in NPO standards. This change in practice resulted in improved satisfaction for patents and staff. IMPLICATIONS FOR PRACTICE The ASA guidelines have been in existence for more than a decade. They are evidence based. The role of the nurse is to advocate for the patient. Nurses need to be proactive in determining the timing of procedures and asking physicians to give diet orders that are in accordance with the ASA guidelines.
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92
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Chauhan G, Madan D, Gupta K, Kashyap C, Maan P, Nayar P. Effect of intraoperative intravenous crystalloid infusion on post-operative nausea and vomiting after diagnostic gynaecological laparoscopy: Comparison of 30 ml/kg and 10 ml/kg and to report the effect of the menstrual cycle on the incidence of post-operative nausea and vomiting. Anesth Essays Res 2015; 7:100-4. [PMID: 25885729 PMCID: PMC4173502 DOI: 10.4103/0259-1162.114013] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Aim: Primary To compare effect of 30 ml/kg and 10 ml/kg crystalloid infusion on post-operative nausea and vomiting after diagnostic gynaecological laparoscopy. Secondary To correlate incidence of post-operative nausea and vomiting associated with different phases of menstrual cycle. Study Design: This prospective, randomized, double blinded study was conducted in 200 patients [Group I - 10 ml.kg-1 crystalloid infusion (n = 100) and Group II - 30 ml.kg-1 crystalloid infusion (n = 100)] of ASA grades I/II, of either sex in the age group 20-40 years undergoing ambulatory gynaecological laparoscopic surgery. Both groups were compared with respect to post-operative nausea vomiting, hemodynamic parameters and incidence of post-operative nausea and vomiting associated with different phases of menstrual cycle. Statistical Analysis: Data for categorical variables and continuous variables are presented as proportions and percentages and mean ± SD, respectively. For normally distributed continuous data, the Student t test was used to compare different groups. Categorical data were tested with the Fisher exact test. Pearson or Spearman correlation coefficients for data normally distributed and not normally distributed, respectively, were used to evaluate the relation between 2 variables. P values < 0.05 were considered statistically significant. Results: In the first 4 h after anaesthesia, the cumulative incidence of nausea and vomiting in Group I was 66% as compared to 40% in Group II (P value = 0.036, *S). Anti-emetic use was less in the group II as compared to Group I (13% vs. 20%, P = 0.04). Female patients in the menstrual phase experienced nausea and vomiting in 89.48% of cases as compared to 58.33% and 24.24% during proliferative and secretory phases of menstrual cycle, respectively.
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Affiliation(s)
- Gaurav Chauhan
- Department of Anaesthesia and Intensive Care, Safdarjang Hospital, New Delhi, India
| | - Deepika Madan
- Department of Anaesthesia and Intensive Care, Safdarjang Hospital, New Delhi, India
| | - Kapil Gupta
- Department of Anaesthesia and Intensive Care, Safdarjang Hospital, New Delhi, India
| | - Chandni Kashyap
- Department of Anaesthesia and Intensive Care, Safdarjang Hospital, New Delhi, India
| | - Prashant Maan
- Department of Anaesthesia and Intensive Care, Safdarjang Hospital, New Delhi, India
| | - Pavan Nayar
- Department of Anaesthesia and Intensive Care, Safdarjang Hospital, New Delhi, India
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93
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Shelygin YA, Achkasov SI, Lukashevich IV. [Optimization of postoperative period in patients after colon resection]. Khirurgiia (Mosk) 2015:76-81. [PMID: 26103648 DOI: 10.17116/hirurgia2015476-81] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Affiliation(s)
- Yu A Shelygin
- State Scientific Coloproctology Center of Russian Medical Academy of Postgraduate Education
| | - S I Achkasov
- State Scientific Coloproctology Center, Health Ministry of the Russian Federation, Moscow
| | - I V Lukashevich
- State Scientific Coloproctology Center, Health Ministry of the Russian Federation, Moscow
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94
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Wang Z, Liu Y, Li Q, Ruan C, Wu B, Wang Q, Hu Z, Qin H. Preoperative oral carbohydrate improved postoperative insulin resistance in rats through the PI3K/AKT/mTOR pathway. Med Sci Monit 2015; 21:9-17. [PMID: 25553410 PMCID: PMC4288420 DOI: 10.12659/msm.891063] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
Background Preoperative oral carbohydrate (OCH) improves postoperative insulin resistance (PIR) and insulin sensitivity. However, the exact mechanisms involved in the improvement of PIR with respect to preoperative OCH are still not clear. The aim of this study was to investigate the involvement of preoperative OCH and PI3K/AKT/mTOR pathway in reducing PIR in rats. Material/Methods Forty male Sprague-Dawley rats were randomly assigned to PreOp, glucose, saline, and fasting groups. Rats in the PreOp, glucose, and saline groups received OCH, 5% glucose solution, and saline, respectively. Rats in the fasting group did not receive anything but were fasted 3 h before surgery. Blood glucose, insulin and leucine levels, and insulin resistance, secretion, and sensitivity indexes were measured before and after surgery. mRNA and protein (total and phosphorylated) levels of mTOR, IRS-1, PI3K, PKB/AKT, and GlUT4 were measured using real-time polymerase chain reaction and Western blot in skeletal muscles. Results In the PIR experiment, blood glucose, serum insulin, insulin resistance, and serum leucine levels were all significantly lower in the PreOp group than in the other 3 groups (P<0.05) after surgery. HOMA-ISI were higher in the PreOp group vs the other 3 groups after surgery (P<0.05), and HOMA-β in the PreOp group was higher than that in the other 3 groups at 30 and 120 min after surgery. Additionally, post-operative phosphorylated IRS-1, PI3K, and AKT protein levels were significantly higher in the PreOp group than in the other 3 groups (P<0.05), but no significant differences were observed in their respective protein levels (P>0.05). Conclusions OCH decreases postoperative insulin resistance and improves postoperative insulin sensitivity in skeletal muscles through the PI3K/AKT/mTOR pathway.
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Affiliation(s)
- Zhiguo Wang
- Department of General Surgery, Shanghai Chang Zheng Hospital, Second Military Medical University, Shanghai, China (mainland)
| | - Yiqing Liu
- Library, Second Military Medical University, Shanghai, China (mainland)
| | - Qi Li
- Department of General Surgery, Shanghai Chang Zheng Hospital, Second Military Medical University, Shanghai, China (mainland)
| | - Canping Ruan
- Department of General Surgery, Shanghai Chang Zheng Hospital, Second Military Medical University, Shanghai, China (mainland)
| | - Bin Wu
- Department of Thoracic Surgery, Shanghai Chang Zheng Hospital, Second Military Medical University, Shanghai, China (mainland)
| | - Qiang Wang
- Department of General Surgery, Shanghai Zhabei Central Hospital, Shanghai, China (mainland)
| | - Zhiqian Hu
- Department of General Surgery, Shanghai Chang Zheng Hospital, Second Military Medical University, Shanghai, China (mainland)
| | - Huanlong Qin
- Department of General Surgery, Tenth People's Hospital of Tongji University, Shanghai, China (mainland)
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Wang LH, Fang F, Lu CM, Wang DR, Li P, Fu P. Safety of fast-track rehabilitation after gastrointestinal surgery: Systematic review and meta-analysis. World J Gastroenterol 2014; 20:15423-15439. [PMID: 25386092 PMCID: PMC4223277 DOI: 10.3748/wjg.v20.i41.15423] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2013] [Revised: 03/27/2014] [Accepted: 07/22/2014] [Indexed: 02/06/2023] Open
Abstract
AIM: To compare the safety of fast-track rehabilitation protocols (FT) and conventional care strategies (CC), or FT and laparoscopic surgery (LFT) and FT and open surgery (OFT) after gastrointestinal surgery.
METHODS: We searched MEDLINE, WHO International Trial Register, Embase and The Cochrane Central Register of Controlled Trials up to 2014 for randomized controlled trials (RCTs) comparing FT and CC or comparing LFT and OFT, with 10 or more randomized participants and about 30 d follow-up. Two reviewers independently extracted data on complications, anastomotic leak, obstruction, wound infection, re-admission between FT and CC or LFT and OFT after gastrointestinal surgery.
RESULTS: Twenty-four RCTs of FT vs CC or LFT vs OFT were included. Compared with CC, FT reduced overall complications and wound infection. However, anastomotic leak, obstruction and re-admission were not significantly reduced. The pooled risk ratio (RR) of 0.69 (95%CI: 0.60-0.78; P < 0.001), pooled RR of 0.71 (95%CI: 0.57-0.88; P < 0.001), pooled RR of 0.93 (95%CI: 0.68-1.25; P > 0.05), a pooled RR of 0.87 (95%CI: 0.67-1.15; P > 0.05) and pooled RR of 0.94 (95%CI: 0.73-1.22; P > 0.05) respectively. Compared with OFT, LFT reduced complications, with a pooled RR of 0.66 (95%CI: 0.54-0.81; P < 0.001).
CONCLUSION: FTs are safe after gastrointestinal surgery. Additional large, prospective RCTs should be conducted to establish further the safety of this approach.
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96
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Sada F, Krasniqi A, Hamza A, Gecaj-Gashi A, Bicaj B, Kavaja F. A randomized trial of preoperative oral carbohydrates in abdominal surgery. BMC Anesthesiol 2014; 14:93. [PMID: 25364300 PMCID: PMC4216365 DOI: 10.1186/1471-2253-14-93] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2013] [Accepted: 09/24/2014] [Indexed: 11/13/2022] Open
Abstract
Background Carbohydrate-rich liquid drinks (CRLDs) have been recommended to attenuate insulin resistance by shortening the preoperative fasting interval. The aim of our study the effect of preoperative oral administration of CRLDs on the well-being and clinical status of patients. Methods A randomized, double blind, prospective study of patients undergoing open colorectal operations (CR) and open cholecyctectomy (CH) was conducted. Patients were divided into three groups: study, placebo, and control. Visual analogue scale (VAS) scores for seven parameters (thirst, hunger, anxiety, mouth dryness, nausea, weakness and sleep quality) were recorded and compared for two different time periods (up to 24 h postoperatively and from 36 to 48 h postoperatively). The Simplified Acute Physiology Score changes (SAPS)-II between the three groups were also studied. Results There were 142 patients American Society of Anesthesiology (ASA) I or II enrolled in the study (CR = 71 and CH = 71). There were no significant differences in postoperative SAPS-II scores or lengths of hospital stay (LOS) between the groups. However, in CR patients, the degree of thirst was partially improved by drinking CRLDs (P = 0.027). In CH patients, on the other hand, feelings of thirst, hunger, mouth dryness, nausea and weakness showed significant improvement (P < 0.05). Conclusion Oral administration of carbohydrate-rich liquid drinks (CRLDs) improves the well-being in patients undergoing CH, but the effect is less evident in patients undergoing CR. No significant improvements were seen in clinical status or in length of hospital stay in either group. Trial registration ANZCTR.org.au: ACTRN12614000995673 (registered on 16/09/2014). Electronic supplementary material The online version of this article (doi:10.1186/1471-2253-14-93) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Fatos Sada
- Clinic of Anesthesiology and Intensive Care, University Clinical Center of Kosovo, Rr. Hyzri Talla, hy 7/8, Bregu i Diellit, Zona e Lindjes, Prishtina, Kosovo
| | - Avdyl Krasniqi
- Clinic of Surgery, University Clinical Center of Kosovo, Prishtina, Kosovo
| | - Astrit Hamza
- Clinic of Surgery, University Clinical Center of Kosovo, Prishtina, Kosovo
| | - Agreta Gecaj-Gashi
- Clinic of Anesthesiology and Intensive Care, University Clinical Center of Kosovo, Rr. Hyzri Talla, hy 7/8, Bregu i Diellit, Zona e Lindjes, Prishtina, Kosovo
| | - Besnik Bicaj
- Clinic of Surgery, University Clinical Center of Kosovo, Prishtina, Kosovo
| | - Floren Kavaja
- Clinic of Surgery, University Clinical Center of Kosovo, Prishtina, Kosovo
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97
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Welchman S, Hiotis P, Pengelly S, Hughes G, Halford J, Christiansen P, Lewis S. Changes in taste preference after colorectal surgery: A longitudinal study. Clin Nutr 2014; 34:881-4. [PMID: 25300650 DOI: 10.1016/j.clnu.2014.09.017] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2014] [Revised: 09/09/2014] [Accepted: 09/15/2014] [Indexed: 12/20/2022]
Abstract
BACKGROUND & AIMS Nutrition is a key component of surgical enhanced recovery programmes. However, alterations in food preferences are often reported as reasons for patients not eating in the early postoperative period. We hypothesised that taste preferences are altered in the early postoperative period and this dysgeusia affects patients' food choices during this critical time. METHODS This is a longitudinal study looking at taste preferences of patients recovering from surgery. Patients undergoing colonic resections were recruited. Using visual analogue scales participants completed a questionnaire, taste tests and preference scoring of food images for the 6 groups of taste (bitter, salty, savoury, sour, spicy and sweet) preoperatively and on postoperative days 1-3. Patients were also offered snacks postoperatively, which represented foods from the six groups and consumption was measured. Differences from baseline were assessed using the Friedman's and Wilcoxon tests. RESULTS 31 patients were studied. In the immediate postoperative period participants reported deterioration in their sense of taste (p ≤ 0.001), increased nausea (p < 0.001) and hunger (p = 0.03). Sweet, savoury and spicy tastes were the most popular during the perioperative period. However, only palatability for salty taste increased (p = 0.001) following surgery. The highest rated images were for savoury food with only the ratings for salty food increasing after surgery (p < 0.05). These findings concurred with the sweet, savoury and salty snacks being the most consumed foods in the postoperative period. Bitter, sour and spicy foods were the least frequently consumed. DISCUSSION This is the first study to investigate postsurgical patients' food preferences. A consistent change in all the individual tastes with the exception of salty in the postoperative period was observed. The most desirable tastes were for savoury and sweet, reflecting patients' preoperative preferences. An improved understanding of taste may improve the resumption of eating after colonic surgery.
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Affiliation(s)
| | | | | | - Georgina Hughes
- Dept of Psychological Sciences, University of Liverpool, Merseyside, UK
| | - Jason Halford
- Dept of Psychological Sciences, University of Liverpool, Merseyside, UK
| | - Paul Christiansen
- Dept of Psychological Sciences, University of Liverpool, Merseyside, UK
| | - Stephen Lewis
- Dept Gastroenterology, Derriford Hospital, Plymouth, Devon, UK; National Institute of Health Research Bristol Biomedical Research Centre, UK.
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98
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TIAN X, XIANG Y, FAN Y, BU H, YANG H, MANYANDE A, GAO F, TIAN Y. Impact of malnutrition on propofol consumption and recovery time among patients undergoing laparoscopic gastrointestinal surgery. Acta Anaesthesiol Scand 2014; 58:942-7. [PMID: 25060045 DOI: 10.1111/aas.12373] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/26/2014] [Indexed: 12/17/2022]
Abstract
BACKGROUND Malnutrition is a major health problem, especially in hospitalized patients as it can be closely related to many post-operative complications. However, research on malnutrition and its effect on the outcome of general anesthesia have been largely neglected. Here we investigated malnutrition status on propofol consumption and recovery time among patients undergoing laparoscopic gastrointestinal surgery under general anesthesia. METHODS One hundred and one patients were recruited between January and June 2012 at Tongji Hospital and assigned into three groups according to Nutritional Risk Screening Tool 2002 score. A standard combined general anesthesia procedure was performed under regular monitoring. The dosage of propofol needed for induction, consumption during maintenance and recovery time were recorded. RESULTS When compared with normal nutritional status individuals, the propofol dosage at induction was significantly decreased about 4.3% in moderate malnutritional status patients (P < 0.01) and about 16.8% in severely malnutritional status patients (P < 0.01). The average consumption of propofol was also significantly lower in malnourished individuals; for moderate malnutritional, the decrease was about 20% (P < 0.01) while for the severely malnutritional, it was 30% (P < 0.01) when compared with normal nutritional status individuals. For the recovery time of propofol anesthesia, the patients with severe malnutritional status awoke average 6.8 min later than those normally nourished (P < 0.01), but those patients with moderate malnutrition status did not (P = 0.885). CONCLUSION The present results indicate that the dosage and recovery time of propofol does change in malnourished individuals. Therefore, malnutrition may somehow affect the outcome of general anesthesia.
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Affiliation(s)
- X. TIAN
- Department of Anesthesiology; Tongji Hospital; Tongji Medical College; Huazhong University of Science and Technology; Wuhan Hubei China
| | - Y. XIANG
- Department of Ophthalmology; Tongji Hospital; Tongji Medical College; Huazhong University of Science and Technology; Wuhan Hubei China
| | - Y. FAN
- Department of Nutrition and Food Hygiene; School of Public Health; Tongji Medical College; Huazhong University of Science and Technology; Wuhan Hubei China
| | - H. BU
- Department of Anesthesiology; Tongji Hospital; Tongji Medical College; Huazhong University of Science and Technology; Wuhan Hubei China
| | - H. YANG
- Department of Anesthesiology; Tongji Hospital; Tongji Medical College; Huazhong University of Science and Technology; Wuhan Hubei China
| | - A. MANYANDE
- School of Psychology; Social Work and Human Sciences; University of West London; London UK
| | - F. GAO
- Department of Anesthesiology; Tongji Hospital; Tongji Medical College; Huazhong University of Science and Technology; Wuhan Hubei China
| | - Y. TIAN
- Department of Anesthesiology; Tongji Hospital; Tongji Medical College; Huazhong University of Science and Technology; Wuhan Hubei China
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99
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Gebremedhn EG, Nagaratnam VB. Audit on preoperative fasting of elective surgical patients in an African academic medical center. World J Surg 2014; 38:2200-4. [PMID: 24748347 PMCID: PMC4124256 DOI: 10.1007/s00268-014-2582-3] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Preoperative fasting is a requisite before anesthesia. The main reason for preoperative fasting is to reduce gastric volume and acidity and thus decrease the risk of pulmonary aspiration. However, preoperative fasting is usually prolonged beyond the recommended time for various reasons. Despite the many adverse effects of prolonged fasting, patients sometimes fasted for a prolonged time when surgery was delayed for different reasons at the University of Gondar Hospital. The aim of this study was to assess the duration of preoperative fasting for elective surgery. METHODS A cross-sectional study was conducted from March 10 to April 10, 2013. Patients were interviewed 24 h after surgery. All 43 patients who were under anesthesia while operated on during the study period were included. RESULT Of the 43 patients included in the study, 35 were adults and 8 were children. The minimum, maximum, and mean fasting hours for food were 5, 96, and 19.60, respectively, and more than 50 % of the patients fasted from food twice as long as recommended. The minimum, maximum, and mean fasting hours for fluid were 5, 19, and 12.72, respectively. More than 95 % of the patients fasted from fluid longer than recommended. CONCLUSION Most patients fasted from both food (92 %) and fluid (95 %) longer than the fasting time recommended by the AAGBI, ASA, RCOA, and RCN fasting guidelines. Anesthetists, surgeons, and nurses need to revise operation lists every day in the operating theatres and resuscitate the patients when surgery is delayed for various reasons. A preoperative fasting guideline should be developed and implemented in the University of Gondar Hospital.
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Affiliation(s)
- Endale Gebreegziabher Gebremedhn
- Department of Anaesthesia, School of Medicine, College of Medicine and Health Sciences, University of Gondar, P.O. Box 196, Gonder, Ethiopia
| | - Vidhya Bates Nagaratnam
- Department of Anaesthesia, School of Medicine, College of Medicine and Health Sciences, University of Gondar, P.O. Box 196, Gonder, Ethiopia
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100
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Smith MD, McCall J, Plank L, Herbison GP, Soop M, Nygren J. Preoperative carbohydrate treatment for enhancing recovery after elective surgery. Cochrane Database Syst Rev 2014; 2014:CD009161. [PMID: 25121931 PMCID: PMC11060647 DOI: 10.1002/14651858.cd009161.pub2] [Citation(s) in RCA: 141] [Impact Index Per Article: 14.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
BACKGROUND Preoperative carbohydrate treatments have been widely adopted as part of enhanced recovery after surgery (ERAS) or fast-track surgery protocols. Although fast-track surgery protocols have been widely investigated and have been shown to be associated with improved postoperative outcomes, some individual constituents of these protocols, including preoperative carbohydrate treatment, have not been subject to such robust analysis. OBJECTIVES To assess the effects of preoperative carbohydrate treatment, compared with placebo or preoperative fasting, on postoperative recovery and insulin resistance in adult patients undergoing elective surgery. SEARCH METHODS We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (2014, Issue 3), MEDLINE (January 1946 to March 2014), EMBASE (January 1947 to March 2014), the Cumulative Index to Nursing and Allied Health Literature (CINAHL) (January 1980 to March 2014) and Web of Science (January 1900 to March 2014) databases. We did not apply language restrictions in the literature search. We searched reference lists of relevant articles and contacted known authors in the field to identify unpublished data. SELECTION CRITERIA We included all randomized controlled trials of preoperative carbohydrate treatment compared with placebo or traditional preoperative fasting in adult study participants undergoing elective surgery. Treatment groups needed to receive at least 45 g of carbohydrates within four hours before surgery or anaesthesia start time. DATA COLLECTION AND ANALYSIS Data were abstracted independently by at least two review authors, with discrepancies resolved by consensus. Data were abstracted and documented pro forma and were entered into RevMan 5.2 for analysis. Quality assessment was performed independently by two review authors according to the standard methodological procedures expected by The Cochrane Collaboration. When available data were insufficient for quality assessment or data analysis, trial authors were contacted to request needed information. We collected trial data on complication rates and aspiration pneumonitis. MAIN RESULTS We included 27 trials involving 1976 participants Trials were conducted in Europe, China, Brazil, Canada and New Zealand and involved patients undergoing elective abdominal surgery (18), orthopaedic surgery (4), cardiac surgery (4) and thyroidectomy (1). Twelve studies were limited to participants with an American Society of Anaesthesiologists grade of I-II or I-III.A total of 17 trials contained at least one domain judged to be at high risk of bias, and only two studies were judged to be at low risk of bias across all domains. Of greatest concern was the risk of bias associated with inadequate blinding, as most of the outcomes assessed by this review were subjective. Only six trials were judged to be at low risk of bias because of blinding.In 19 trials including 1351 participants, preoperative carbohydrate treatment was associated with shortened length of hospital stay compared with placebo or fasting (by 0.30 days; 95% confidence interval (CI) 0.56 to 0.04; very low-quality evidence). No significant effect on length of stay was noted when preoperative carbohydrate treatment was compared with placebo (14 trials including 867 participants; mean difference -0.13 days; 95% CI -0.38 to 0.12). Based on two trials including 86 participants, preoperative carbohydrate treatment was also associated with shortened time to passage of flatus when compared with placebo or fasting (by 0.39 days; 95% CI 0.70 to 0.07), as well as increased postoperative peripheral insulin sensitivity (three trials including 41 participants; mean increase in glucose infusion rate measured by hyperinsulinaemic euglycaemic clamp of 0.76 mg/kg/min; 95% CI 0.24 to 1.29; high-quality evidence).As reported by 14 trials involving 913 participants, preoperative carbohydrate treatment was not associated with an increase or a decrease in the risk of postoperative complications compared with placebo or fasting (risk ratio of complications 0.98, 95% CI 0.86 to 1.11; low-quality evidence). Aspiration pneumonitis was not reported in any patients, regardless of treatment group allocation. AUTHORS' CONCLUSIONS Preoperative carbohydrate treatment was associated with a small reduction in length of hospital stay when compared with placebo or fasting in adult patients undergoing elective surgery. It was found that preoperative carbohydrate treatment did not increase or decrease postoperative complication rates when compared with placebo or fasting. Lack of adequate blinding in many studies may have contributed to observed treatment effects for these subjective outcomes, which are subject to possible biases.
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Affiliation(s)
- Mark D Smith
- Southland HospitalDepartment of General SurgeryKew RoadInvercargillNew Zealand9840
| | - John McCall
- Dunedin School of Medicine, University of OtagoDepartment of Surgical SciencesPO Box 913DunedinNew Zealand9054
| | - Lindsay Plank
- University of AucklandDepartment of SurgeryPrivate Bag 92019AucklandNew Zealand1142
| | - G Peter Herbison
- Dunedin School of Medicine, University of OtagoDepartment of Preventive & Social MedicinePO Box 913DunedinNew Zealand9054
| | - Mattias Soop
- Salford Royal NHS Foundation TrustDepartment of SurgeryStott LaneSalfordUK
| | - Jonas Nygren
- Institution of Clinical Sciences at Danderyds HospitalCentre for Gastrointestinal Disease, Ersta Hospital and Karolinska InstitutetStockholmSweden
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