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Lobmeyr E, Amrein K. Continuation of enteral nutrition until extubation in critically ill patients. THE LANCET. RESPIRATORY MEDICINE 2023; 11:298-299. [PMID: 36693398 DOI: 10.1016/s2213-2600(22)00481-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Accepted: 11/17/2022] [Indexed: 01/23/2023]
Affiliation(s)
- Elisabeth Lobmeyr
- Department of Medicine I, Intensive Care Unit 13i2, Center of Excellence in Medical Intensive Care, Medical University of Vienna, Vienna 1090, Austria.
| | - Karin Amrein
- Division of Endocrinology and Diabetology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
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152
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Charlene Kwa XW, Mathew C, Tan TK. ERAS journey: an abridged account for the busy practitioner. Singapore Med J 2023; 0:367495. [PMID: 36695279 DOI: 10.4103/singaporemedj.smj-2020-513] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Affiliation(s)
| | | | - Tong Khee Tan
- Department of Anaesthesiology, Singapore General Hospital, Singapore
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153
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Guidelines for Perioperative Care for Liver Surgery: Enhanced Recovery After Surgery (ERAS) Society Recommendations 2022. World J Surg 2023; 47:11-34. [PMID: 36310325 PMCID: PMC9726826 DOI: 10.1007/s00268-022-06732-5] [Citation(s) in RCA: 58] [Impact Index Per Article: 58.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/29/2022] [Indexed: 12/14/2022]
Abstract
BACKGROUND Enhanced Recovery After Surgery (ERAS) has been widely applied in liver surgery since the publication of the first ERAS guidelines in 2016. The aim of the present article was to update the ERAS guidelines in liver surgery using a modified Delphi method based on a systematic review of the literature. METHODS A systematic literature review was performed using MEDLINE/PubMed, Embase, and the Cochrane Library. A modified Delphi method including 15 international experts was used. Consensus was judged to be reached when >80% of the experts agreed on the recommended items. Recommendations were based on the Grading of Recommendations, Assessment, Development and Evaluations system. RESULTS A total of 7541 manuscripts were screened, and 240 articles were finally included. Twenty-five recommendation items were elaborated. All of them obtained consensus (>80% agreement) after 3 Delphi rounds. Nine items (36%) had a high level of evidence and 16 (64%) a strong recommendation grade. Compared to the first ERAS guidelines published, 3 novel items were introduced: prehabilitation in high-risk patients, preoperative biliary drainage in cholestatic liver, and preoperative smoking and alcohol cessation at least 4 weeks before hepatectomy. CONCLUSIONS These guidelines based on the best available evidence allow standardization of the perioperative management of patients undergoing liver surgery. Specific studies on hepatectomy in cirrhotic patients following an ERAS program are still needed.
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154
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Irani JL, Hedrick TL, Miller TE, Lee L, Steinhagen E, Shogan BD, Goldberg JE, Feingold DL, Lightner AL, Paquette IM. Clinical Practice Guidelines for Enhanced Recovery After Colon and Rectal Surgery From the American Society of Colon and Rectal Surgeons and the Society of American Gastrointestinal and Endoscopic Surgeons. Dis Colon Rectum 2023; 66:15-40. [PMID: 36515513 PMCID: PMC9746347 DOI: 10.1097/dcr.0000000000002650] [Citation(s) in RCA: 13] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Affiliation(s)
- Jennifer L. Irani
- Department of Surgery, Division of Colorectal Surgery, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
| | - Traci L. Hedrick
- Department of Surgery, University of Virginia Health System, Charlottesville, Virginia
| | - Timothy E. Miller
- Department of Anesthesiology, Duke University, Durham, North Carolina
| | - Lawrence Lee
- Department of Surgery, McGill University, Montreal, Quebec, Canada
| | - Emily Steinhagen
- Department of Surgery, University Hospital Cleveland Medical Center, Cleveland, Ohio
| | - Benjamin D. Shogan
- Department of Surgery, University of Chicago Pritzker School of Medicine, Chicago, Illinois
| | - Joel E. Goldberg
- Department of Surgery, Division of Colorectal Surgery, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
| | - Daniel L. Feingold
- Department of Surgery, Section of Colorectal Surgery, Rutgers University, New Brunswick, New Jersey
| | - Amy L. Lightner
- Department of Colorectal Surgery, Cleveland Clinic Foundation, Cleveland Clinic
| | - Ian M. Paquette
- Division of Colon and Rectal Surgery, University of Cincinnati College of Medicine, Cincinnati, Ohio
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155
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Irani JL, Hedrick TL, Miller TE, Lee L, Steinhagen E, Shogan BD, Goldberg JE, Feingold DL, Lightner AL, Paquette IM. Clinical practice guidelines for enhanced recovery after colon and rectal surgery from the American Society of Colon and Rectal Surgeons and the Society of American Gastrointestinal and Endoscopic Surgeons. Surg Endosc 2023; 37:5-30. [PMID: 36515747 PMCID: PMC9839829 DOI: 10.1007/s00464-022-09758-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/04/2022] [Indexed: 12/15/2022]
Abstract
The American Society of Colon and Rectal Surgeons (ASCRS) and the Society of American Gastrointestinal and Endoscopic Surgeons (SAGES) are dedicated to ensuring high-quality innovative patient care for surgical patients by advancing the science, prevention, and management of disorders and diseases of the colon, rectum, and anus as well as minimally invasive surgery. The ASCRS and SAGES society members involved in the creation of these guidelines were chosen because they have demonstrated expertise in the specialty of colon and rectal surgery and enhanced recovery. This consensus document was created to lead international efforts in defining quality care for conditions related to the colon, rectum, and anus and develop clinical practice guidelines based on the best available evidence. While not proscriptive, these guidelines provide information on which decisions can be made and do not dictate a specific form of treatment. These guidelines are intended for the use of all practitioners, healthcare workers, and patients who desire information about the management of the conditions addressed by the topics covered in these guidelines. These guidelines should not be deemed inclusive of all proper methods of care nor exclusive of methods of care reasonably directed toward obtaining the same results. The ultimate judgment regarding the propriety of any specific procedure must be made by the physician in light of all the circumstances presented by the individual patient. This clinical practice guideline represents a collaborative effort between the American Society of Colon and Rectal Surgeons (ASCRS) and the Society of American Gastrointestinal and Endoscopic Surgeons (SAGES) and was approved by both societies.
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Affiliation(s)
- Jennifer L Irani
- Department of Surgery, Division of Colorectal Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Traci L Hedrick
- Department of Surgery, University of Virginia Health System, Charlottesville, VA, USA
| | - Timothy E Miller
- Duke University Medical Center Library, Duke University School of Medicine, Durham, NC, USA
| | - Lawrence Lee
- Department of Surgery, McGill University, Montreal, QC, Canada
| | - Emily Steinhagen
- Department of Surgery, University Hospital Cleveland Medical Center, Cleveland, OH, USA
| | - Benjamin D Shogan
- Department of Surgery, University of Chicago Pritzker School of Medicine, Chicago, IL, USA
| | - Joel E Goldberg
- Department of Surgery, Division of Colorectal Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Daniel L Feingold
- Section of Colorectal Surgery, Rutgers University, New Brunswick, NJ, USA
| | - Amy L Lightner
- Department of Colorectal Surgery, Cleveland Clinic Foundation, Cleveland Clinic, Cleveland, USA
| | - Ian M Paquette
- Division of Colon and Rectal Surgery, University of Cincinnati College of Medicine Surgery (Colon and Rectal), 222 Piedmont #7000, Cincinnati, OH, 45219, USA.
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156
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Retained Food During Esophagogastroduodenoscopy Is a Risk Factor for Gastric-to-Pulmonary Aspiration. Dig Dis Sci 2023; 68:164-172. [PMID: 35596820 DOI: 10.1007/s10620-022-07536-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Accepted: 04/21/2022] [Indexed: 02/01/2023]
Abstract
BACKGROUND Residual food (RF) during esophagogastroduodenoscopy (EGD) is thought, but not proven, to be a risk factor for gastric-to-pulmonary aspiration. AIMS The aims of this study were to determine the prevalence of RF during EGD, to investigate whether RF was associated with an increased risk of aspiration, especially when monitored anesthesia care (MAC) or general anesthesia (GA) were administered, and to determine whether aspiration associated with RF led to a more severe clinical outcome. METHODS Patients undergoing EGD between October 2012 and September 2018 were identified. Patient age, sex, aspiration events, RF, sedation type, structural foregut abnormalities, and diagnoses associated with impaired esophageal or gastric motility were noted. The clinical course after an aspiration event was evaluated. RESULTS RF was identified during 4% of 81,367 EGDs. Aspiration events occurred during 41 (5/10,000) procedures. Aspiration was more likely to occur in patients with RF (odds ratio [OR] 15.1) or those receiving MAC or GA (OR 9.6 and 16.8 relative to conscious sedation, respectively). RF and MAC/GA were synergistically associated with increased odds of aspiration. In a multivariate nominal logistic regression model, older age (OR 2.6), MAC (OR 3.8), GA (OR 4.4), vagotomy (OR 5.2), achalasia (OR 3.8), and RF (OR 10.0) were risk factors for aspiration. Aspiration events in the presence or absence of RF led to similar clinical outcomes. CONCLUSIONS While aspiration events are rare in patients undergoing EGD, RF and the use of MAC or GA were associated with substantially increased odds of aspiration.
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157
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Chen YX, Lin J, Ye XH, Zhao XD, Yan QX. Analysis of anesthetic effect of dexmedetomidine in femoral shaft fracture surgery. Medicine (Baltimore) 2022; 101:e32388. [PMID: 36596048 PMCID: PMC9803518 DOI: 10.1097/md.0000000000032388] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
To investigate the effect of dexmedetomidine (DEX) on hemodynamics and recovery period after femoral shaft fracture surgery. Fifty-two patients, aged 3 to 7 years, who underwent femoral shaft fracture reduction surgery in our hospital in 2019 were randomly divided into the experimental group (n = 26) and the control group (n = 26). Both groups were given routine propofol combined with remifentanil by intravenous anesthesia. The experimental group was continuously pumped with DEX after induction of anesthesia, while the control group was continuously pumped with the same volume of normal saline. The mean arterial pressure (MAP) and heart rate (HR) were recorded before anesthesia induction (T0), when laryngeal mask was inserted (T1), when skin was cut (T2), when intramedullary needle was inserted (T3), and when laryngeal mask was removed (T4). Extubation time after anesthesia withdrawal was recorded in the 2 groups. According to the Pediatric Anesthesia Emergence Delirium score, the agitation and the incidence of agitation were recorded immediately after extubation (T5), 10 minutes after entering the recovery room (T6) and 30 minutes after entering the recovery room (T7). There was no significant difference in MAP and HR between the 2 groups at T0 and T1 time points (P > .05). The MAP and HR of the experimental group at T2 to T4 were significantly lower than those of the control group (P < .05). The extubation time of the experimental group was longer than that of the control group (P < .05), but the Pediatric Anesthesia Emergence Delirium score and the incidence of agitation in the recovery period of the experimental group were lower than those of the control group (P < .05). In femoral shaft fracture surgery, intravenous anesthesia combined with continuous pumping DEX can effectively stabilize the hemodynamics of patients, and the incidence of postoperative agitation during anesthesia recovery is low.
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Affiliation(s)
- Yin-Xiao Chen
- Department of Anesthesiology, The First People’s Hospital of Wenling, Taizhou, Zhejiang Province, China
| | - Jie Lin
- Department of Anesthesiology, The First People’s Hospital of Wenling, Taizhou, Zhejiang Province, China
| | - Xian-Hua Ye
- Department of Anesthesiology, The First People’s Hospital of Wenling, Taizhou, Zhejiang Province, China
| | - Xian-Da Zhao
- Department of Anesthesiology, The First People’s Hospital of Wenling, Taizhou, Zhejiang Province, China
| | - Qun-Xin Yan
- Department of Anesthesiology, The First People’s Hospital of Wenling, Taizhou, Zhejiang Province, China
- * Correspondence: Qun-Xin Yan, Department of Anesthesiology, The First People’s Hospital of Wenling, Taizhou 317500, Zhejiang Province, China (e-mail: )
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158
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Seyhan Ak E, Türkmen A, Sinmaz T, Biçer ÖS. Evaluation of Thirst in the Early Postoperative Period in Patients Undergoing Orthopedic Surgery. J Perianesth Nurs 2022; 38:448-453. [PMID: 36586782 DOI: 10.1016/j.jopan.2022.08.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Revised: 07/27/2022] [Accepted: 08/10/2022] [Indexed: 12/31/2022]
Abstract
BACKGROUND Thirst, is a subjective symptom that has a high incidence in the early postoperative period and causes patients to experience intense discomfort. PURPOSE The aim of this study is to determine thirst and the factors affecting thirst in the early postoperative period in patients undergoing orthopedic surgery. DESIGN The research was carried out as a descriptive-cross sectional study with 177 patients between September 2021 and January 2022. METHODS Data were collected using the "Descriptive and clinical features form," "Thirst and Symptoms Associated with Thirst Evaluation Form." For descriptive analysis, frequency, percentage distribution, mean, and minimum-maximum values were analyzed. The Chi-square test was used to compare the data according to the groups. Before starting the research, necessary ethics committee and institutional permission were obtained. FINDINGS The mean perioperative thirst time of the patients was 15.25 ± 3.61 hours and the mean anesthesia time was 2.32 ± 1.13 hours. When the perioperative thirst duration was compared with the type of surgery, duration of operation, type of anesthesia, duration of anesthesia, duration of fasting, intubation and duration of stay in PACU, there was a statistical significance between them (P > .05). CONCLUSION The most common symptoms in patients undergoing orthopedic surgery were thirst and dry mouth. Surgery type, operation duration, anesthesia type, anesthesia duration, fasting duration, intubation status and duration of stay in PACU were the factors affecting the perioperative thirst status of the patients.
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Affiliation(s)
- Ezgi Seyhan Ak
- Istanbul University-Cerrahpasa, Florence Nightingale Faculty of Nursing, Surgical Nursing Department, Istanbul, Turkey
| | - Açelya Türkmen
- Çukurova University, Faculty of Health Sciences, Surgical Nursing Department, Adana, Turkey.
| | - Tuba Sinmaz
- Istanbul University-Cerrahpasa, Florence Nightingale Faculty of Nursing, Surgical Nursing Department, Istanbul, Turkey
| | - Ömer Sunkar Biçer
- Çukurova University, Faculty of Medicine, Department of Orthopedics and Traumatology, Adana, Turkey
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159
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Relationship between Fasting Times and Emergence Delirium in Children Undergoing Magnetic Resonance Imaging under Sedation. MEDICINA (KAUNAS, LITHUANIA) 2022; 58:medicina58121861. [PMID: 36557062 PMCID: PMC9786080 DOI: 10.3390/medicina58121861] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Revised: 12/09/2022] [Accepted: 12/15/2022] [Indexed: 12/24/2022]
Abstract
Background and Objectives: This study aimed to determine whether there is a relationship between preoperative fasting time, fasting blood glucose (FBG), and postoperative emergence delirium (ED) in pediatric patients undergoing MRI under sedation. Materials and Methods: 110 pediatric patients were included in the study. Preoperative fasting (solid-fluid) time and FBG were recorded. The development of ED in the patients who underwent MRI under sedation was evaluated with the pediatric anesthesia emergence delirium (PAED) value for 30 min every 5 min in the recovery room. PAED score of ≥10 was grouped as having ED, and a PAED score of <10 as without ED at any time. The PAED scores were compared with other variables, ASA, age, weight, MRI examination time, and FBG level and fasting times. The risk factors affecting the occurrence of ED were examined. Results: Mean age was 3.94 ± 1.53 years, mean FBG was 106.97 ± 12.53 mg/dL, fasting time was 10.75 ± 2.61 h, solid food fasting time was 11.92 ± 2.33 h, and thirst time was 10.74 ± 2.58 h. FBG was never associated with PAED measurement at any time (p > 0.05). There was a weak positive correlation between the fasting time and the 0th, 5th, and 10th minute PAED score (r = 0.225; p = 0.018, r = 0.195; p = 0.041, r = 0.195; p = 0.041). There was a weak positive correlation between the solid food fasting time and the PAED score at the 0th, 5th, 10th, 15th, and 20th minutes (r = 0.382; p < 0.001, r = 0.357; p < 0.001, r = 0.345; p < 0.001, r = 0.360; p < 0.001, r = 0.240; p < 0.001). There was a weak positive correlation between thirst time and the PAED score at the 0th, 5th, and 10th minutes (r = 0.222; p = 0.020. r = 0.192; p = 0.045, r = 0.199; p = 0.037). The incidence of ED at any time was 34.5%. Conclusions: Prolonged fasting time, solid food fasting time and thirst time are risk factors for developing postoperative ED in children undergoing MRI under sedation.
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160
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Fasting practices of enteral nutrition delivery for airway procedures in critically ill adult patients: A scoping review. J Crit Care 2022; 72:154144. [PMID: 36115335 DOI: 10.1016/j.jcrc.2022.154144] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Revised: 08/09/2022] [Accepted: 08/25/2022] [Indexed: 12/15/2022]
Abstract
BACKGROUND There is limited understanding of fasting practices and reported safety concerns for airway procedures in critically ill adults. OBJECTIVE To describe fasting practices including safety concerns for airway procedures in critically ill adult patients in the reported literature. INCLUSION CRITERIA Studies conducted in adult critically ill patients receiving enteral nutrition (EN) and undergoing an airway procedure (endotracheal intubation, endotracheal extubation, and tracheostomy) were included if EN fasting practices and/or prespecified nutrition and clinical outcomes were reported. METHODS A scoping review using the Joanna Briggs Institute methodology was conducted. MEDLINE, Embase, and CINAHL were searched from 2000 to January 19, 2022. Results are presented via narrative synthesis. RESULTS Fourteen studies were included, with only one randomised control trial (RCT). Twelve studies reported on fasting practices with varied EN fasting durations (0-34 h) and two reported data on nutrition adequacy. Three studies investigated continued EN in one study arm and four studies minimised fasting duration by including gastric suctioning prior to the airway procedure. Safety concerns primarily related to aspiration events (61%) were reported in nine studies. CONCLUSION In the reported literature, there is wide variation in EN fasting practices for airway procedures in critically ill patients with limited evidence to inform practice.
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161
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Rüggeberg A, Nickel EA. Unrestricted drinking before surgery: an iterative quality improvement study. Anaesthesia 2022; 77:1386-1394. [PMID: 36130830 DOI: 10.1111/anae.15855] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/16/2022] [Indexed: 01/11/2023]
Abstract
Average pre-operative fasting times for clear liquids are many times longer than those specified in national and international guidelines. We sought to decrease fasting times by applying a quality management tool aimed at continuous improvement. Through the application of iterative 'plan-do-study-act' cycles, tools to reduce pre-operative liquid fasting times were developed and applied, the effects measured, analysed and interpreted and the conclusions used to inform the next plan-do-study-act cycle. The first step was the introduction of unrestricted drinking until the patient was called to the operating theatre, with training of anaesthetic staff, adaption of local standard procedures and verbal information for patients. This did not result in short liquid fasting times, median (IQR [range]) 12.0 (9.5-14.0 [0.8-23.5]) h. In the second cycle, fasting cards were introduced as a subliminal written training tool for staff, patients and their relatives. This enabled short liquid fasting times to be achieved for outpatients (2.6 (0.8-5.1 [0.3-16]) h) and pre-admission patients (3.4 (1.8-9.4 [0.2-17.2]) h), but not for inpatients (6.5 (2.0-11.7 [0.2-16.2]) h). The third cycle included lectures for ward staff, putting up information posters throughout the hospital, revision of all written materials and provision of screencasts on the homepage for staff and patients. This decreased median liquid fasting time to 2.1 (1.2-3.8 [0.4-18.8]; p < 0.0001) h, with inpatients having the shortest fasting time of 1.4 (1.1-3.8 [0.4-18.8]) h. Repeated quality improvement cycles, adapted to local context, can support sustained reductions in pre-operative liquid fasting times.
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Affiliation(s)
- A Rüggeberg
- Department of Anaesthesiology and Pain Therapy, Helios Klinikum Emil von Behring, Berlin, Germany
| | - E A Nickel
- Department of Anaesthesiology and Pain Therapy, Helios Klinikum Emil von Behring, Berlin, Germany
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162
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Somnuke P, Kitisin N, Chumklud P, Kunavuttitagool P, Deepinta P, Wadrod A, Prachayakul W, Amornyotin S, Raykateeraroj N. Hard-Candy Consumption Does Not Have an Effect on Volume and pH of Gastric Content in Patients Undergoing Elective Gastrointestinal Endoscopic Procedures: A Randomized Controlled Trial. Ther Clin Risk Manag 2022; 18:1049-1057. [PMID: 36467617 PMCID: PMC9716931 DOI: 10.2147/tcrm.s377421] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Accepted: 11/22/2022] [Indexed: 08/03/2023] Open
Abstract
Purpose This study aimed to determine the effect of hard candies on gastric content volume and pH in patients undergoing elective esophagogastroduodenoscopy and colonoscopy. Additionally, the study evaluated the difficulty of the procedure, complications, and satisfaction levels of the endoscopist and patient. Patients and Methods A randomized controlled study equally recruited 108 outpatients to candy and control groups. The patients in the candy group could consume sugar-free candies within 2 hours before anesthesia, while the controls remained fasted. The endoscopic procedure began under topical pharyngeal anesthesia and intravenous sedation. A blinded endoscopist suctioned the gastric volume through an endoscope. A blinded anesthesia provider tested the gastric pH with a pH meter. The primary outcome variables were gastric volume and pH. The secondary outcome variables were complications, the difficulty of the procedure, and endoscopist and patient satisfaction. Results The characteristics of both patient groups were comparable. The mean gastric volume of the candy group (0.43 [0.27-0.67] mL/kg) was not significantly different from that of the control group (0.32 [0.19-0.55] mL/kg). The gastric pH of both groups was similar: 1.40 (1.10-1.70) for the candy group and 1.40 (1.20-1.90) for the control group. The procedure-difficulty score of the candy group was higher than that of the control group. The satisfaction scores rated by the endoscopist and the patients in both groups were comparable. In addition, most endoscopists and patients in the candy and control groups reported being "very satisfied". No complications were observed in either group. Conclusion Hard candies did not affect gastric volume or pH. Elective gastrointestinal endoscopic procedures in adult patients who preoperatively consume candies could proceed to prevent delays and disruption of workflows.
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Affiliation(s)
- Pawit Somnuke
- Department of Anesthesiology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, 10700, Thailand
| | - Nuanprae Kitisin
- Department of Anesthesiology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, 10700, Thailand
| | - Phornprasurt Chumklud
- Department of Anesthesiology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, 10700, Thailand
| | - Pishsinee Kunavuttitagool
- Department of Anesthesiology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, 10700, Thailand
| | - Penpuk Deepinta
- Department of Anesthesiology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, 10700, Thailand
| | - Araya Wadrod
- Department of Nursing, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, 10700, Thailand
| | - Warayu Prachayakul
- Division of Gastroenterology, Department of Internal Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, 10700, Thailand
| | - Somchai Amornyotin
- Department of Anesthesiology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, 10700, Thailand
| | - Nattaya Raykateeraroj
- Department of Anesthesiology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, 10700, Thailand
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163
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Tong E, Chen Y, Ren Y, Zhou Y, Di C, Zhou Y, Shao S, Qiu S, Hong Y, Yang L, Tan X. Effects of preoperative carbohydrate loading on recovery after elective surgery: A systematic review and Bayesian network meta-analysis of randomized controlled trials. Front Nutr 2022; 9:951676. [PMID: 36505254 PMCID: PMC9726728 DOI: 10.3389/fnut.2022.951676] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Accepted: 10/31/2022] [Indexed: 11/24/2022] Open
Abstract
Background Preoperative carbohydrate loading is an important element of the enhanced recovery after surgery (ERAS) paradigm in adult patients undergoing elective surgery. However, preoperative carbohydrate loading remains controversial in terms of improvement in postoperative outcomes and safety. We conducted a Bayesian network meta-analysis to evaluate the effects and safety of different doses of preoperative carbohydrates administrated in adult patients after elective surgery. Methods MEDLINE (PubMed), Web of Science, EMBASE, EBSCO, the Cochrane Central Register of Controlled Trials, and China National Knowledge Infrastructure (CNKI) were searched to identify eligible trials until 16 September 2022. Outcomes included postoperative insulin resistance, residual gastric volume (RGV) during the surgery, insulin sensitivity, fasting plasma glucose (FPG), fasting serum insulin (Fin) level, the serum levels of C-reactive protein (CRP), postoperative scores of pain, patients' satisfaction, thirst, hunger, anxiety, nausea and vomit, fatigue, and weakness within the first 24 h after surgery and the occurrences of postoperative infection. The effect sizes were estimated using posterior mean difference (continuous variables) or odds ratios (dichotomous variables) and 95 credible intervals (CrIs) with the change from baseline in a Bayesian network meta-analysis with random effect. Results Fifty-eight articles (N = 4936 patients) fulfilled the eligibility criteria and were included in the meta-analysis. Both preoperative oral low-dose carbohydrate loading (MD: -3.25, 95% CrI: -5.27 to -1.24) and oral high-dose carbohydrate loading (MD: -2.57, 95% CrI: -4.33 to -0.78) were associated with postoperative insulin resistance compared to placebo/water. When trials at high risk of bias were excluded, association with insulin resistance was found for oral low-dose carbohydrate loading compared with placebo/water (MD: -1.29, 95%CrI: -2.26 to -0.27) and overnight fasting (MD: -1.17, 95%CrI: -1.88 to -0.43). So, there was large uncertainty for all estimates vs. control groups. In terms of safety, oral low-dose carbohydrate administration was associated with the occurrences of postoperative infection compared with fasting by 0.42 (95%Crl: 0.20-0.81). In the other outcomes, there was no significant difference between the carbohydrate and control groups. Conclusion Although preoperative carbohydrate loading was associated with postoperative insulin resistance and the occurrences of postoperative infection, there is no evidence that preoperative carbohydrate administration alleviates patients' discomfort. Systematic review registration [https://www.crd.york.ac.uk/PROSPERO/], identifier [CRD42022312944].
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Affiliation(s)
- Enyu Tong
- School of Public Health, Hangzhou Normal University, Hangzhou, China
| | - Yiming Chen
- School of Public Health, Hangzhou Normal University, Hangzhou, China
| | - Yanli Ren
- School of Public Health, Hangzhou Normal University, Hangzhou, China
| | - Yuanyuan Zhou
- School of Public Health, Hangzhou Normal University, Hangzhou, China
| | - Chunhong Di
- The Affiliated Hospital of Hangzhou Normal University, Hangzhou Normal University, Hangzhou, China
| | - Ying Zhou
- School of Public Health, Hangzhou Normal University, Hangzhou, China
| | - Shihan Shao
- School of Public Health, Hangzhou Normal University, Hangzhou, China
| | - Shuting Qiu
- School of Public Health, Hangzhou Normal University, Hangzhou, China
| | - Yu Hong
- School of Public Health, Hangzhou Normal University, Hangzhou, China
| | - Lei Yang
- School of Public Health, Hangzhou Normal University, Hangzhou, China
| | - Xiaohua Tan
- School of Public Health, Hangzhou Normal University, Hangzhou, China
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Matrka AK, Smith HM, Amundson AW, Duncan CM, Rueter MJ, Andrijasevic S, Hannon CP, Couch CG, Sanchez-Sotelo J, Trousdale RT, Abdel MP. Orthopedic Surgery and Anesthesiology Surgical Improvement Strategies Project - Phase III Outcomes. J Arthroplasty 2022; 38:779-784. [PMID: 36403718 DOI: 10.1016/j.arth.2022.11.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Revised: 10/27/2022] [Accepted: 11/10/2022] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Our institution initiated the Orthopedic Surgery and Anesthesiology Surgical Improvement Strategies (OASIS) project in 2017 to improve the quality and efficiency for hip and knee arthroplasties. Phase III of this project aimed to: 1) increase same-day discharge (SDD) of primary total joint arthroplasties (TJAs) to 20%; 2) maintain or improve 30-day readmission rates; and 3) realize cost savings and revenue increases. METHODS All primary TJAs performed between 2021 and 2022 represented our study cohort, with those in 2019 (prepandemic) establishing the baseline cohort. A multidisciplinary team met weekly to track project tactics and metrics through the entire episode of care from preoperative surgical visit through 30 days postoperatively. RESULTS The SDD rate increased from 4% at baseline to 37%, with mean lengths of stay (LOS) decreasing from 1.5 to 0.9 days for all primary TJAs. The 30-day readmission rate decreased to 1.2 from 1.3%. Composite changes in surgical volume and cost reductions equaled $5 million. CONCLUSION Application of a multidisciplinary team with health systems engineering tools and methods allowed SDD to increase from 4 to 37% with a mean LOS <1 day, resulting in a $5 million incremental gain in profit at a major academic medical center. Importantly, patient safety was not compromised as 30-day readmission rates remained stable. LEVEL OF EVIDENCE III Therapeutic.
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Affiliation(s)
- Alexis K Matrka
- Mayo Clinic Department of Orthopedic Surgery, Rochester, Minnesota
| | - Hugh M Smith
- Mayo Clinic Department of Anesthesiology and Perioperative Medicine, Rochester, Minnesota
| | - Adam W Amundson
- Mayo Clinic Department of Anesthesiology and Perioperative Medicine, Rochester, Minnesota
| | - Christopher M Duncan
- Mayo Clinic Department of Anesthesiology and Perioperative Medicine, Rochester, Minnesota
| | - Matthew J Rueter
- Mayo Clinic Practice Optimization and Acceleration, Rochester, Minnesota
| | - Sasa Andrijasevic
- Mayo Clinic Practice Optimization and Acceleration, Rochester, Minnesota
| | - Charles P Hannon
- Mayo Clinic Department of Orthopedic Surgery, Rochester, Minnesota
| | - Cory G Couch
- Mayo Clinic Department of Orthopedic Surgery, Rochester, Minnesota
| | | | | | - Matthew P Abdel
- Mayo Clinic Department of Orthopedic Surgery, Rochester, Minnesota
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165
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Liddle C. Preoperative fasting: exploring guidelines and evidence to ensure consistent, high-quality care. Nurs Stand 2022; 37:77-82. [PMID: 36377391 DOI: 10.7748/ns.2022.e12033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/28/2022] [Indexed: 11/16/2022]
Abstract
Many nurses will still be familiar with the instruction 'nil by mouth from midnight' traditionally given to patients preparing to undergo surgery. National and international guidelines now promote much shorter preoperative fasting times, encapsulated in the '2-4-6 rule' - two hours for clear fluids, four hours for breast milk and six hours for solids. The latest evidence appears to show that these fasting times are in need of revision. Furthermore, there are inconsistencies in how guidelines are implemented. This article explores the guidelines and literature on preoperative fasting in adults and children to determine what the evidence is and what changes could be made to ensure consistent, high-quality patient care.
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166
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De Francesco V, Alicante S, Amato A, Frazzoni L, Lombardi G, Manfredi G, Monica F, Sferrazza S, Vassallo R, Germanà B, Pasquale L, Annibale B, Cadoni S. Quality performance measures in upper gastrointestinal endoscopy for lesion detection: Italian AIGO-SIED-SIGE joint position statement. Dig Liver Dis 2022; 54:1479-1485. [PMID: 35871984 DOI: 10.1016/j.dld.2022.06.028] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Revised: 06/27/2022] [Accepted: 06/30/2022] [Indexed: 12/29/2022]
Abstract
Esophagogastroduodenoscopy (EGD) plays a crucial role in the management of gastroduodenal diseases by allowing a direct and accurate evaluation of the mucosa and the execution of several operative maneuvers. Despite a constant development of new imaging tools and operative devices, the widespread use of EGD has not resulted in a significant reduction of mortality for patients affected by esophageal/gastric cancer during the last three decades in Western countries. Evidence indicates that this disheartening scenario derives from a high variability of execution of EGD which determines its quality and diagnostic yield, delaying the diagnosis of neoplastic diseases. Based on this evidence, in recent years many scientific societies have produced different position papers aimed at defining quality performance measures in EGD. Thus, the Italian Association of Gastroenterologists and Endoscopists, the Italian Society of Digestive Endoscopy and the Italian Society of Gastroenterology have produced this joint document based on the review of ASGE, ACG, BSG, ESGE and Asian Consensus EGD position papers with the aim of indicating the quality standards of EGD (pre-, intra- and post-procedure) focused on lesion detection to be adopted in the Italian context.
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Affiliation(s)
| | - Saverio Alicante
- Gastroenterology and Digestive Endoscopy Department, Maggiore Hospital, ASST Crema, Italy
| | - Arnaldo Amato
- GastroenterologyDivision, Valduce Hospital, Como, Italy
| | - Leonardo Frazzoni
- Gastroenterology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Giovanni Lombardi
- Gastroenterology and Digestive Endoscopy, AORN Cardarelli, Naples, Italy
| | - Guido Manfredi
- Gastroenterology and Digestive Endoscopy Department, Maggiore Hospital, ASST Crema, Italy
| | - Fabio Monica
- Gastroenterology and Digestive Endoscopy, Cattinara Academic Hospital, Trieste, Italy
| | - Sandro Sferrazza
- Gastroenterology and Endoscopy, APSS Santa Chiara Hospital, Trento, Italy
| | - Roberto Vassallo
- Gastroenterology and Endoscopy Unit, Buccheri la Ferla Hospital, Palermo, Italy
| | | | | | - Bruno Annibale
- Medical, Surgical and Translational Medicine Department, Sant'andrea Hospital, Sapienza University, Rome, Italy
| | - Sergio Cadoni
- Digestive Endoscopy Unit, CTO Hospital, Iglesias, Italy
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167
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Schutte S, Nimma SR, Smith CR, Le-Wendling L. Gastric Emptying of Orange Juice With and Without Pulp: A Point-of-Care Ultrasound Study. Cureus 2022; 14:e30959. [PMID: 36465215 PMCID: PMC9713721 DOI: 10.7759/cureus.30959] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/01/2022] [Indexed: 06/17/2023] Open
Abstract
Purpose The American Society of Anesthesiologists (ASA) preoperative fasting recommendations regarding fruit juice with pulp is unclear. In addition, it is debatable whether orange juice without pulp should be treated as a clear liquid. Our objective is to determine the gastric emptying time of orange juice with and without pulp. Methods This is an observational study of gastric emptying time using point-of-care ultrasound (POCUS). Thirty-five adult volunteers were enrolled in this study. Exclusion criteria included pregnancy, diabetes, body mass index > 40 kg/m2, previous lower esophageal or upper abdominal surgery, hiatal hernia, and upper gastrointestinal bleed. The study was carried out on three separate days for each volunteer. After fasting a minimum of 8 h, the volunteers were asked to drink 240 ml of water on day 1, orange juice without pulp on day 2, and orange juice with pulp on day 3. Gastric volumes were estimated using gastric antrum cross-sectional area at fasting state, and then 30, 60, 90 120, 180, and 240 min after drinking until the gastric volume returned to baseline. Results A gastric volume of 1.5 mL/kg was defined as a baseline. All subjects' gastric volume returned to baseline 90 min after drinking water. More than 97% of the subjects who drank orange juice without pulp and 93.9% of the subjects who drank orange juice with pulp reached a gastric volume of less than 1.5 mL/kg after 2 h. All subjects' gastric volume returned to baseline 3 h after drinking orange juice with pulp. Conclusions Orange juice without pulp can be treated as a clear liquid in a majority of patients who do not have conditions that would cause delayed gastric emptying. Orange juice with pulp required 3 h to empty.
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Affiliation(s)
- Soleil Schutte
- Department of Anesthesiology, University of Florida, Gainesville, USA
| | | | - Cameron R Smith
- Department of Anesthesiology, University of Florida, Gainesville, USA
| | - Linda Le-Wendling
- Department of Anesthesiology, University of Florida, Gainesville, USA
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AUGS-IUGA Joint Clinical Consensus Statement on Enhanced Recovery After Urogynecologic Surgery: Developed by the Joint Writing Group of the International Urogynecological Association and the American Urogynecologic Society. Individual writing group members are noted in the Acknowledgements section. UROGYNECOLOGY (HAGERSTOWN, MD.) 2022; 28:716-734. [PMID: 36288110 DOI: 10.1097/spv.0000000000001252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
INTRODUCTION AND HYPOTHESIS Enhanced recovery after surgery (ERAS) evidence-based protocols for perioperative care can lead to improvements in clinical outcomes and cost savings. This article aims to present consensus recommendations for the optimal perioperative management of patients undergoing urogynecological surgery. METHODS A review of meta-analyses, randomized clinical trials, large nonrandomized studies, and review articles was conducted via PubMed and other databases for ERAS and urogynecological surgery. ERAS protocol components were established, and then quality of the evidence was both graded and used to form consensus recommendations for each topic. These recommendations were developed and endorsed by the writing group, which is comprised of the American Urogynecologic Society and the International Urogynecological Association members. RESULTS All recommendations on ERAS protocol items are based on best available evidence. The level of evidence for each item is presented accordingly. The components of ERAS with a high level of evidence to support their use include fasting for 6 h and taking clear fluids up to 2 h preoperatively, euvolemia, normothermia, surgical site preparation, antibiotic and antithrombotic prophylaxis, strong antiemetics and dexamethasone to reduce postoperative nausea and vomiting, multimodal analgesia and restrictive use of opiates, use of chewing gum to reduce ileus, removal of catheter as soon as feasible after surgery and avoiding systematic use of drains/vaginal packs. CONCLUSIONS The evidence base and recommendations for a urogynecology-relevant ERAS perioperative care pathway are presented in this consensus review. There are several elements of ERAS with strong evidence of benefit in urogynecological surgery.
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Alcarraz P, Servente L, Kuster F, Duarte L, Garau M, Desirello M, Blanc L, Bracesco N, Perlas A. Preoperative fasting for the infusion of "yerba mate": a randomized clinical trial with ultrasound evaluation of gastric contents. BRAZILIAN JOURNAL OF ANESTHESIOLOGY (ELSEVIER) 2022; 72:757-761. [PMID: 35121062 PMCID: PMC9659983 DOI: 10.1016/j.bjane.2021.12.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Revised: 12/22/2021] [Accepted: 12/26/2021] [Indexed: 06/14/2023]
Abstract
BACKGROUND The traditional infusion of "yerba mate" is widely consumed in South America and exported to countries around the world. Although generally considered a "clear fluid", there is no data to date on the gastric emptying time of yerba mate and safe preoperative fasting intervals. The objective of this study was to evaluate the gastric emptying time of a standardized infusion of yerba mate using bedside ultrasound and compare it with the time confirm of hot and cold tea. METHODS This was a prospective, randomized crossover experimental study. Thirty healthy volunteers were evaluated after 8 hours of fasting for both fluids and solids. Gastric antral area and gastric volume were evaluated at baseline and every 20 minutes after drinking 300 mL of randomly assigned infusion of "yerba mate", hot tea, or cold tea. RESULTS The mean gastric emptying time was: 69.7 ± 22.1 min, 63.1 ± 14.5 min, and 64.3 ± 23.5 min for the mate, hot tea, and cold tea respectively. No significant differences were found in emptying time among the infusion groups (p-value = 0.043). When same time measures were compared, the only significant difference detected was between hot teas and mate infusion at 20 minutes (p-value = 0.012) CONCLUSION: Yerba mate infusion has a similar gastric emptying time to that of tea. All subject's gastric volume returned to baseline values by 100 minutes. It is reasonable to recommend a similar fasting period of 2 hours for mate infusion prior to elective surgery.
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Affiliation(s)
- Paola Alcarraz
- Facultad de Medicina UDELAR, Hospital de Clínicas "Dr. Manuel Quintela", Departmento de Anestesiología, Montevideo, Uruguay.
| | - Liliana Servente
- Facultad de Medicina UDELAR, Hospital de Clínicas "Dr. Manuel Quintela", Departmento Clínico de Imagenología, Montevideo, Uruguay
| | - Federico Kuster
- Facultad de Medicina UDELAR, Hospital de Clínicas "Dr. Manuel Quintela", Departmento de Anestesiología, Montevideo, Uruguay
| | - Leticia Duarte
- Facultad de Medicina UDELAR, Hospital de Clínicas "Dr. Manuel Quintela", Departmento de Anestesiología, Montevideo, Uruguay
| | - Mariela Garau
- Facultad de Medicina UDELAR, Departmento de Métodos Cuantitativos, Montevideo, Uruguay
| | - María Desirello
- Facultad de Medicina UDELAR, Hospital de Clínicas "Dr. Manuel Quintela", Departmento Clínico de Imagenología, Montevideo, Uruguay
| | - Lourdes Blanc
- Facultad de Medicina UDELAR, Laboratorio de Radiobiología Departmento Biofísica, Montevideo, Uruguay
| | - Nelson Bracesco
- Facultad de Medicina UDELAR, Laboratorio de Radiobiología Departmento Biofísica, Montevideo, Uruguay
| | - Anahi Perlas
- University Health Network and University of Toronto, Toronto Western Hospital, Department of Anesthesia, Toronto, Canada
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Lee S, Sohn JY, Lee HJ, Yoon S, Bahk JH, Kim BR. Effect of pre-operative carbohydrate loading on aspiration risk evaluated with ultrasonography in type 2 diabetes patients: a prospective observational pilot study. Sci Rep 2022; 12:17521. [PMID: 36266449 PMCID: PMC9584891 DOI: 10.1038/s41598-022-21696-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Accepted: 09/30/2022] [Indexed: 01/12/2023] Open
Abstract
Owing to concerns about delayed gastric emptying or hyperglycemia, evidence is lacking regarding whether pre-operative carbohydrate loading can be routinely administered to patients with type 2 diabetes. The objective of this study was to determine the aspiration risk and gastric volume after pre-operative carbohydrate loading in patients with type 2 diabetes. A prospective, single-center, observational cohort study. The study was conducted at a tertiary teaching hospital in Seoul, Korea, from May 2020 to May 2021. Patients (n = 49) with type 2 diabetes underwent elective noncardiac surgery. All patients were administered carbohydrate loading two hours before surgery. Once in the operating room, they underwent gastric ultrasonography to determine gastric volume. The anesthesiologists monitored the patients' glucose concentrations during and after surgery. The primary outcome was the predicted risk of aspiration. The secondary outcomes were gastric volume, antral grade, satisfaction score, and perioperative glucose profile. Forty-nine patients were analyzed. All patients had a low risk of aspiration after carbohydrate loading, as follows: 33 (67.3%) patients classified as antral grade 0 and 16 (32.7%) patients classified as antral grade 1. The median time from carbohydrate drink ingestion to ultrasound examination was 120 min (IQR 115-139). After carbohydrate loading, the median gastric volume in the right-lateral position after carbohydrate loading was 2.64 ml (IQR 0.00-32.05). The mean glucose concentrations (SD) were 134 (24) mg/dl, 159 (37) mg/dl, 150 (32) mg/dl, and 165 (36) mg/dl at baseline, after induction, 30 min after surgery, and in the post anesthesia care unit, respectively. The median satisfaction score of the patients was 5 (IQR 4-5). Pre-operative carbohydrate loading may be feasible for patients with type 2 diabetes and without complications.Trial registration: ClinicalTrials.gov (NCT04456166). Registered on 2 July 2020.
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Affiliation(s)
- Seohee Lee
- grid.31501.360000 0004 0470 5905Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Jin Young Sohn
- grid.31501.360000 0004 0470 5905Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Ho-jin Lee
- grid.31501.360000 0004 0470 5905Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Susie Yoon
- grid.31501.360000 0004 0470 5905Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Jae-Hyon Bahk
- grid.31501.360000 0004 0470 5905Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Bo Rim Kim
- grid.222754.40000 0001 0840 2678Department of Anesthesiology and Pain Medicine, Korea University Guro Hospital, Korea University College of Medicine, 148 Gurodong-ro, Guro-gu, Seoul, 08308 Korea
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171
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Young VA, Thakor AS, Josephs SC. Update on Pediatric Interventional Radiology. Radiographics 2022; 42:1580-1597. [DOI: 10.1148/rg.220019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Affiliation(s)
- Victoria A. Young
- From the Division of Pediatric Radiology, Department of Radiology, Stanford University School of Medicine, 725 Welch Rd, Room 1927, Palo Alto, CA 94304
| | - Avnesh S. Thakor
- From the Division of Pediatric Radiology, Department of Radiology, Stanford University School of Medicine, 725 Welch Rd, Room 1927, Palo Alto, CA 94304
| | - Shellie C. Josephs
- From the Division of Pediatric Radiology, Department of Radiology, Stanford University School of Medicine, 725 Welch Rd, Room 1927, Palo Alto, CA 94304
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172
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Bourgonjon B, Vermeylen K, Tytgat N, Forget P. Anaesthesia for elite athletes. Eur J Anaesthesiol 2022; 39:825-834. [PMID: 35943185 DOI: 10.1097/eja.0000000000001719] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Sports participation has been growing rapidly since the 1960s. Anaesthesiologists are increasingly confronted with athletes in a peri-operative setting. The right choice of type of anaesthesia technique, pain management of injuries, specific physiologic adaptations of the athlete and knowledge of prohibited substances are eminent for a correct approach of this subpopulation. PURPOSE This review aims to give an overview of athletes' specific anaesthetic management in peri-operative and postoperative settings and to guide the nonspecialised anaesthetist. METHODS We comprehensively reviewed the literature, gathered all the information available on, and synthesised it in a narrative way, regarding preoperative evaluation, intraoperative implications and postoperative pain management of the elite athlete undergoing a surgical procedure. RESULTS An anaesthesiologist should recognise the most common benign ECG findings in athletes like bradycardia, isolated left ventricle hypertrophy on voltage criteria and early repolarisation as normal features in the athlete's heart. Isotonic physiology typically produces four-chamber dilation. In contrast, isometric stress creates high intravascular pressure leading to left ventricular hypertrophy. Pre-operative evaluation should also identify possible consumers of performance-enhancing drugs. Intraoperative points of interest for the anaesthesiologist is mainly avoiding drugs on the prohibited list of the World Anti-Doping Agency (WADA). Postoperative and chronic pain management are still developing fields in this population. The International Olympic Committee (IOC) proposed treating acute pain with a combination of paracetamol, non-steroidal anti-inflammatory drugs (NSAIDs), topical analgesics, injectable NSAIDs and local anaesthetics. It may be suggested that chronic pain management in elite athletes could benefit from treatment in specialised multidisciplinary pain clinics. CONCLUSION This literature review aims to serve as a guide for the anaesthesiologist taking care of the elite athlete.
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Affiliation(s)
- Bram Bourgonjon
- From the Department of Anaesthesiology, GZA Antwerpen (BB), Department of Anaesthesiology, AZ Turnhout, Turnhout (KV), Department of Anaesthesiology, ASZ Aalst, Aalst, Belgium (NT) and Institute of Applied Health Sciences, Epidemiology Group, School of Medicine, Medical Sciences and Nutrition, University of Aberdeen; Department of Anaesthesia, NHS Grampian, Aberdeen, UK (PF)
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173
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AUGS-IUGA Joint clinical consensus statement on enhanced recovery after urogynecologic surgery. Int Urogynecol J 2022; 33:2921-2940. [DOI: 10.1007/s00192-022-05223-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Accepted: 02/19/2022] [Indexed: 10/14/2022]
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174
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Park YE, Jeong SJ, Lee J, Park J, Yu SJ, Jee SR, Kim TO. Multi-center study of residual gastric volume and bowel preparation after the usage of 1L and 2L polyethylene glycol in Korea. Medicine (Baltimore) 2022; 101:e30795. [PMID: 36197218 PMCID: PMC9509098 DOI: 10.1097/md.0000000000030795] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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 In colonoscopy, good bowel preparation is an important factor in determining the quality of colonoscopy. However, an increase in residual gastric volume (RGV) can lead to a higher risk of aspiration pneumonia. Therefore, the purpose of this study was to investigate the factors related to an increase in RGV with the usage of 1L polyethylene glycol (PEG). METHODS We prospectively analyzed 268 patients who underwent both gastroscopy and colonoscopy at 2 hospitals from May to October 2021. Bowel preparation was performed using 1L in 127 patients (47.4%) and 2L PEG in 141 patients (52.6%). We investigated the time taken for bowel preparation solutions, the last water intake, total water intake, and RGV, and conducted a survey on taking compliance and satisfaction. RESULTS The level of RGV was significantly increased in the 1L PEG group when compared to the 2L PEG group (1L, 52.26 ± 65.33 vs 2L, 23.55 ± 22.99; P < .001). There was no difference between the 2 groups in the degree of bowel preparation, but there were more bubbles formed in the 1L group (1L, 1.91 ± 2.74 vs 2L, 1.10 ± 2.02; P = .007). In the case of RGV ≥ 50 mL, in multivariate analysis, the risk was higher in water intake within 5 hours and the patients who think the dose is too high (all P < .05). CONCLUSION Therefore, since RGV is higher in 1L PEG than in 2L PEG, it is necessary to be careful not to take water for at least 5 hours before the test.
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Affiliation(s)
- Yong Eun Park
- Division of Gastroenterology, Department of Internal Medicine, Inje University College of Medicine, Haeundae Paik Hospital, Busan, Republic of Korea
| | - Su Jin Jeong
- Division of Gastroenterology, Department of Internal Medicine, Inje University College of Medicine, Haeundae Paik Hospital, Busan, Republic of Korea
| | - Jin Lee
- Division of Gastroenterology, Department of Internal Medicine, Inje University College of Medicine, Haeundae Paik Hospital, Busan, Republic of Korea
| | - Jongha Park
- Division of Gastroenterology, Department of Internal Medicine, Inje University College of Medicine, Haeundae Paik Hospital, Busan, Republic of Korea
| | - Seung Jung Yu
- Division of Gastroenterology, Department of Internal Medicine, Inje University College of Medicine, Busan Paik Hospital, Busan, Republic of Korea
| | - Sam Ryong Jee
- Division of Gastroenterology, Department of Internal Medicine, Inje University College of Medicine, Busan Paik Hospital, Busan, Republic of Korea
| | - Tae Oh Kim
- Division of Gastroenterology, Department of Internal Medicine, Inje University College of Medicine, Haeundae Paik Hospital, Busan, Republic of Korea
- *Correspondence: Tae Oh Kim, Department of Internal Medicine, Inje University College of Medicine, 875 Haeundae-ro, Haeundae-gu, Busan 48108, Republic of Korea (e-mail: )
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175
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He H, Yang G, Wang S, Han X, Li J. Fast-track surgery nursing intervention in CRC patients with laparotomy and laparoscopic surgery. Medicine (Baltimore) 2022; 101:e30603. [PMID: 36123937 PMCID: PMC9478316 DOI: 10.1097/md.0000000000030603] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
In this study, the application effect of fast-track surgery (FTS) nursing intervention in laparotomy and laparoscopic surgery for colorectal cancer (CRC) is investigated, and the optimal perioperative management strategy for CRC surgery is explored. One hundred thirty CRC patients are included in this study, in which 67 patients undergo laparotomy (Group A) and 63 patients undergo laparoscopic surgery (Group B). These patients were also randomly divided into traditional nursing subgroup (Group A1 [n = 33] and Group B1 [n = 31]) and FTS nursing subgroup (Group A2 [n = 34] and Group B2 [n = 32]). The general data of patients, pre-operative preparation, intra-operative data, postoperative recovery data, and postoperative complications are recorded. Both FTS and laparoscopic surgery can advance the anal exhaust time, and shorten postoperative fasting and water deprivation time, and the hospitalization time without increasing the incidence of complications. FTS has advantages in reducing the indwelling time of gastric tube and throat pain. Simultaneous implementation of FTS and laparoscopic surgery has the best effect on the postoperative recovery of CRC patients.
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Affiliation(s)
- Hongyu He
- Department of Operating Theater and Anesthesiology, The Second Hospital of Jilin University, Changchun, China
| | - Guiyun Yang
- Department of Operating Theater and Anesthesiology, The Second Hospital of Jilin University, Changchun, China
| | - Shu Wang
- Department of Radiotherapy, The Second Hospital of Jilin University, Changchun, China
| | - Xu Han
- Department of General Surgery, The Second Hospital of Jilin University, Changchun, China
| | - Jiannan Li
- Department of General Surgery, The Second Hospital of Jilin University, Changchun, China
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176
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Hammond LRD, Barfett J, Baker A, McGlynn ND. Gastric Emptying of Maltodextrin versus Phytoglycogen Carbohydrate Solutions in Healthy Volunteers: A Quasi-Experimental Study. Nutrients 2022; 14:nu14183676. [PMID: 36145051 PMCID: PMC9502814 DOI: 10.3390/nu14183676] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Revised: 08/21/2022] [Accepted: 08/30/2022] [Indexed: 11/16/2022] Open
Abstract
Preoperative carbohydrate beverages have been shown to be beneficial in improving patient outcomes. There have been several investigations into the safety of maltodextrin as a preoperative carbohydrate. Although alternative preoperative carbohydrate sources have been proposed, there have been few investigations into the safety and gastric emptying of novel carbohydrate beverages. The present study aimed to compare the gastric emptying of phytoglycogen and maltodextrin to evaluate safety for use as presurgical carbohydrate beverages. In a quasi-experimental design, ten healthy participants orally consumed either a 12.5% maltodextrin or a 12.5% phytoglycogen solution. Gamma scintigraphy was used to evaluate gastric emptying at baseline at 45, 90, and 120 min. Serum insulin and serum glucose were measured at baseline at 15, 30, 45, 60, 90, and 120 min. Gastric volume was significantly lower in the phytoglycogen group at 45 min (p = 0.01) and 90 min (p = 0.01), but this difference lost significance at 120 min (p = 0.17). There were no significant differences between treatments for serum insulin or serum glucose at any time point. This study indicates that the gastric emptying of phytoglycogen is comparable to maltodextrin at 120 min after ingestion, opening the opportunity for the study of alternative carbohydrates for utilization as preoperative carbohydrates.
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Affiliation(s)
- Leila R. D. Hammond
- Enhanced Medical Nutrition, 50 Carroll Street, Toronto, ON M4M 3G3, Canada
- Correspondence: ; Tel.: +1-647-376-6431
| | - Joseph Barfett
- Department of Medical Imaging, St. Michael’s Hospital, Toronto, ON M5B 1W8, Canada
| | - Andrew Baker
- Departments of Critical Care and Anesthesia, St. Michael’s Hospital, Toronto, ON M5B 1W8, Canada
| | - Néma D. McGlynn
- Enhanced Medical Nutrition, 50 Carroll Street, Toronto, ON M4M 3G3, Canada
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O'Donoghue SD, Pincus JM, Pang GK, Roach RE, Anstey CM, Perlas A, Van Zundert A. Impact of fasting on the gastric volume of critically ill patients before extubation: a prospective observational study using gastric ultrasound. BJA OPEN 2022; 3:100023. [PMID: 37588578 PMCID: PMC10430804 DOI: 10.1016/j.bjao.2022.100023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Accepted: 06/10/2022] [Indexed: 08/18/2023]
Abstract
Background A period of fasting before tracheal extubation of ventilated patients in the ICU is common practice, aiming to reduce gastric volume and aspiration risk. As the volume of gastric content is unknown at the time of extubation, the efficacy of this practice is uncertain. Methods A prospective, observational study using gastric ultrasound was undertaken. Images were obtained at four time points: (i) at baseline, with gastric feeds running; (ii) after suctioning of gastric contents through a gastric tube; (iii) after a 4 h period with no gastric feed running; and (iv) after both a 4 h fasting period and gastric tube suctioning. The primary outcome was the proportion of patients classed as low risk of aspiration with each intervention, using qualitative and quantitative gastric ultrasound. Results Fifty-four patients in the ICU were enrolled. Forty-four (81%) subjects had images that were suitable for analysis. Suctioning of stomach content through a gastric tube and fasting were equivalent with 39/44 (88.6%) and 5/44 (11.4%) subjects classified as low risk and at risk of aspiration, respectively. A period of fasting followed by suction resulted in 41/44 (93.2%) patients being at low risk. Conclusions Suctioning of stomach contents through the gastric tube and a 4 h fasting period appear equivalent at reducing gastric volume below a safe threshold. A small percentage did not reach the threshold despite all interventions.
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Affiliation(s)
- Stephen D. O'Donoghue
- Department of Anaesthesia and Perioperative Medicine, Royal Brisbane and Women's Hospital, Herston, QLD, Australia
- Faculty of Medicine, The University of Queensland, Herston, QLD, Australia
| | - Jason M. Pincus
- Department of Anaesthesia and Perioperative Medicine, Royal Brisbane and Women's Hospital, Herston, QLD, Australia
- Faculty of Medicine, The University of Queensland, Herston, QLD, Australia
| | - George K.F. Pang
- Department of Anaesthesia and Perioperative Medicine, Royal Brisbane and Women's Hospital, Herston, QLD, Australia
- Faculty of Medicine, The University of Queensland, Herston, QLD, Australia
| | - Rebecca E. Roach
- Department of Intensive Care and Hyperbaric Medicine, The Alfred Hospital, Melbourne, VIC, Australia
| | | | - Anahi Perlas
- Department of Anaesthesia, Toronto Western Hospital, Toronto, ON, Canada
| | - André Van Zundert
- Department of Anaesthesia and Perioperative Medicine, Royal Brisbane and Women's Hospital, Herston, QLD, Australia
- Faculty of Medicine, The University of Queensland, Herston, QLD, Australia
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178
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Odendaal P, Burke A, Coetzee J. Effect of a carbohydrṇate lollipop on the gastric volume of fasted pediatric patients. Paediatr Anaesth 2022; 32:1031-1037. [PMID: 35524771 PMCID: PMC9545620 DOI: 10.1111/pan.14479] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Revised: 04/28/2022] [Accepted: 05/02/2022] [Indexed: 12/02/2022]
Abstract
BACKGROUND Preoperative fasting is part of routine practice. Children subjected to prolonged preoperative fasting often suffer adverse effects. Consuming a preoperative lollipop may lessen their anxiety and have clinical benefits. AIMS To assess the effect of consuming a lollipop on gastric volume and the feasibility of administering a lollipop to a child preoperatively. METHODS In this prospective, repeated measures interventional study, we measured gastric antrum volume using ultrasound in children aged 2-18 years. We measured antrum volumes after participants had fasted for a minimum of 6 h for solids and 2 h for clear fluids. They then consumed a standard carbohydrate lollipop, and we repeated the antrum volume measurements after 1 h. RESULTS Of the 38 patients enrolled, 32 completed the study; four had ingested additional food or liquid, and two were diagnosed with systemic disease the day after data collection. The gastric volume data were normally distributed. The mean volume change was 0.01 ml kg-1 (95% CI -0.02 to 0.05; p = .460). The mean postlollipop volume was 0.51 ml kg-1 (95% CI 0.43 to 0.58). CONCLUSIONS Consuming a standard lollipop did not affect the gastric volume of fasted pediatric patients.
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Affiliation(s)
- Pieter Odendaal
- Department of Anesthesiology and Critical Care, Tygerberg Academic HospitalUniversity of StellenboschParowSouth Africa
| | - Annemie Burke
- Department of Anesthesiology and Critical Care, Tygerberg Academic HospitalUniversity of StellenboschParowSouth Africa
| | - Johan Coetzee
- Department of Anesthesiology and Critical Care, Tygerberg Academic HospitalUniversity of StellenboschParowSouth Africa
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179
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Shin HJ, Koo BW, Lim D, Na HS. Ultrasound assessment of gastric volume in older adults after drinking carbohydrate-containing fluids: a prospective, nonrandomized, and noninferiority comparative study. Can J Anaesth 2022; 69:1160-1166. [PMID: 35449247 DOI: 10.1007/s12630-022-02262-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2021] [Revised: 01/20/2022] [Accepted: 02/23/2022] [Indexed: 11/27/2022] Open
Abstract
PURPOSE The aim of this study was to evaluate the safety of drinking carbohydrate-containing fluids two hours prior to surgery in older adults using ultrasonography. METHODS We conducted a nonrandomized and noninferiority comparative study in 60 patients aged over 65 yr who were scheduled for total knee arthroplasty. Patients who were fasted from midnight (fasting group) or who drank 400 mL of a carbohydrate-containing fluid (carbohydrate ingestion group) two hours prior to surgery were matched for age, sex, and body mass index. We measured the cross-sectional area (CSA) of gastric antrum using ultrasound and estimated the gastric fluid volume as the study's primary outcome measure. The noninferiority margin (δ) for the mean difference was predefined as 50 mL. The secondary outcome measures included CSA of the antrum and qualitative gastric volume. RESULTS The mean (standard deviation) gastric volume was not significantly different between the fasting group and the carbohydrate ingestion group (30.2 [25.4] mL vs 28.4 [35.8] mL; each group, n = 30; P = 0.81). The mean difference in gastric volume was -1.9 mL (95% confidence interval [CI], -17.9 to 14.2), and the upper limit of the 95% CI was lower than the prespecified noninferiority limit (δ = 50 mL). Secondary outcomes were not significantly different between the two groups. CONCLUSION Drinking of carbohydrate-containing fluid two hours prior to surgery was noninferior to overnight fasting with respect to residual gastric volume at induction of anesthesia in healthy older adults who undergoing total knee arthroplasty. STUDY REGISTRATION ClinicalTrials.gov (NCT04514380); registered 14 August 2020.
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Affiliation(s)
- Hyun-Jung Shin
- Department of Anesthesiology and Pain Medicine, Seoul National University Bundang Hospital, 82, Gumi 173, Bundang, Seongnam, Gyeonggi, 13620, Republic of Korea
| | - Bon-Wook Koo
- Department of Anesthesiology and Pain Medicine, Seoul National University Bundang Hospital, 82, Gumi 173, Bundang, Seongnam, Gyeonggi, 13620, Republic of Korea
| | - Dongsik Lim
- Department of Anesthesiology and Pain Medicine, Seoul National University Bundang Hospital, 82, Gumi 173, Bundang, Seongnam, Gyeonggi, 13620, Republic of Korea
| | - Hyo-Seok Na
- Department of Anesthesiology and Pain Medicine, Seoul National University Bundang Hospital, 82, Gumi 173, Bundang, Seongnam, Gyeonggi, 13620, Republic of Korea.
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He Y, Tang X, Ning N, Chen J, Li P, Kang P. Effects of Preoperative Oral Electrolyte-Carbohydrate Nutrition Supplement on Postoperative Outcomes in Elderly Patients Receiving Total Knee Arthroplasty: A Prospective Randomized Controlled Trial. Orthop Surg 2022; 14:2535-2544. [PMID: 36040184 PMCID: PMC9531096 DOI: 10.1111/os.13424] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Revised: 06/12/2022] [Accepted: 07/02/2022] [Indexed: 12/28/2022] Open
Abstract
Objective Patients undergoing total knee arthroplasty (TKA) were primarily geriatric, with high risk of postoperative electrolyte disorders and malnutrition. Randomized controlled trials regarding oral nutrition supplement (ONS) strategies in TKA was sparse. This study aimed to evaluate the efficacy of preoperative oral electrolyte‐carbohydrate nutrition supplement (OECNS) on patients (aged >65 years) undergoing TKA. Methods From April 2019 to January 2020, 94 patients undergoing primary elective unilateral TKA in our hospital were considered in this prospective randomized controlled study. This study included patients aged over 65 years with ASA I‐III, and excluded patients with electrolyte disorders, malnutrition, and comorbidities. The control group (control group) received meal nutrition supplements (preoperative 6 h [Pre 6h]) and water (Pre 2h), while OECNS group (intervention group) received meal nutrition supplements (Pre 6h) and OECNS (Pre 2). The Student's t test and χ2 test was used. The primary outcomes were the patient‐reported comfort indicators (PRCIs) including hunger, thirst, nausea, vomiting, weakness, pain, anxiety, and general comfort. The secondary outcomes included indicators of electrolyte, nutrition, functional scores, clinical results, and complications. Results The scores of preoperative hunger (0.43 ± 0.10), pain (2.30 ± 0.34), and anxiety (9.04 ± 2.71) were significantly lower in OECNS group compared with control group (hunger, 1.19 ± 0.21; pain, 3.79 ± 0.26; anxiety, 11.21 ± 3.02) (Pre 1h) (all p < 0.05) as well as the weakness score on the first postoperative day (POD1) (OECNS group 3.57 ± 0.24; control group 5.15 ± 0.29; p < 0.001). A higher level of Na + (OECNS group 140.54 ± 3.39; control group 138.07 ± 5.21; p = 0.008) and a reduced rate of hyponatremia (OECNS group 6.4%; control group 21.3%; p = 0.036) on POD1 were found. Moreover, the higher level of blood glucose (Post 2h) and reduced rates of abnormal blood glucose (Pre 2h, Post 6h) were verified in control group (all p < 0.05). There was no significant difference regarding the other outcomes. Conclusion The administration of OECNS significantly improved subjective comfort, electrolytes, and blood glucose without increasing the rates of complications in patients (aged over 65 years) undergoing TKA.
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Affiliation(s)
- Yue He
- West China School of Nursing, Sichuan University/Department of Orthopedics, West China Hospital, Sichuan University, Chengdu, China
| | - Xiumei Tang
- West China School of Nursing, Sichuan University/Department of Orthopedics, West China Hospital, Sichuan University, Chengdu, China
| | - Ning Ning
- West China School of Nursing, Sichuan University/Department of Orthopedics, West China Hospital, Sichuan University, Chengdu, China
| | - Jiali Chen
- West China School of Nursing, Sichuan University/Department of Orthopedics, West China Hospital, Sichuan University, Chengdu, China
| | - Peifang Li
- West China School of Nursing, Sichuan University/Department of Orthopedics, West China Hospital, Sichuan University, Chengdu, China
| | - Pengde Kang
- Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, China
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181
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Liu B, Liu S, Zheng T, Lu D, Chen L, Ma T, Wang Y, Gao G, He S. Neurosurgical enhanced recovery after surgery ERAS for geriatric patients undergoing elective craniotomy: A review. Medicine (Baltimore) 2022; 101:e30043. [PMID: 35984154 PMCID: PMC9388027 DOI: 10.1097/md.0000000000030043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
Population aging is an unprecedented, multifactorial, and global process that poses significant challenges to healthcare systems. Enhanced recovery after surgery (ERAS) protocols aim to optimize perioperative care. The first neurosurgical ERAS protocol for elective craniotomy has contributed to a shortened postoperative hospital stay, accelerated functional recovery, improved patient satisfaction, and reduced medical care cost in adult patients aged 18 to 65 years compared with conventional perioperative care. However, ERAS protocols for geriatric patients over 65 years of age undergoing cranial surgery are lacking. In this paper, we propose a novel ERAS protocol for such patients by reviewing and summarizing the key elements of successful ERAS protocols/guidelines and optimal perioperative care for geriatric patients described in the literature, as well as our experience in applying the first neurosurgical ERAS protocol for a quality improvement initiative. This proposal aimed to establish an applicable protocol for geriatric patients undergoing elective craniotomy, with evidence addressing its feasibility, safety, and potential efficacy. This multimodal, multidisciplinary, and evidence-based ERAS protocol includes preoperative, intraoperative, and postoperative assessment and management as well as outcome measures. The implementation of the current protocol may hold promise in reducing perioperative morbidity, enhancing functional recovery, improving postoperative outcomes in geriatric patients scheduled for elective craniotomy, and serving as a stepping stone to promote further research into the advancement of geriatric patient care.
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Affiliation(s)
- Bolin Liu
- Department of Neurosurgery, Xi’an International Medical Center, Xi’an, China
| | - Shujuan Liu
- Department of Obstetrics and Gynecology, Xijing Hospital, Fourth Military Medical University, Xi’an, China
| | - Tao Zheng
- Department of Neurosurgery, Xi’an International Medical Center, Xi’an, China
| | - Dan Lu
- Department of Neurosurgery, Xi’an International Medical Center, Xi’an, China
| | - Lei Chen
- Department of Neurosurgery, Xi’an International Medical Center, Xi’an, China
| | - Tao Ma
- Department of Neurosurgery, Xi’an International Medical Center, Xi’an, China
| | - Yuan Wang
- Department of Neurosurgery, Tangdu Hospital, Fourth Military Medical University, Xi’an, China
| | - Guodong Gao
- Department of Neurosurgery, Tangdu Hospital, Fourth Military Medical University, Xi’an, China
| | - Shiming He
- Department of Neurosurgery, Xi’an International Medical Center, Xi’an, China
- Department of Obstetrics and Gynecology, Xijing Hospital, Fourth Military Medical University, Xi’an, China
- *Correspondence: Shiming He, Department of Neurosurgery, Xi’an International Medical Center, No. 777 Xitai Road, Xi’an 710100, China (e-mail: ; )
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Marinari G, Foletto M, Nagliati C, Navarra G, Borrelli V, Bruni V, Fantola G, Moroni R, Tritapepe L, Monzani R, Sanna D, Carron M, Cataldo R. Enhanced recovery after bariatric surgery: an Italian consensus statement. Surg Endosc 2022; 36:7171-7186. [PMID: 35953683 PMCID: PMC9485178 DOI: 10.1007/s00464-022-09498-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Accepted: 12/31/2021] [Indexed: 12/03/2022]
Abstract
Background Enhanced recovery after bariatric surgery (ERABS) is an approach developed to improve outcomes in obese surgical patients. Unfortunately, it is not evenly implemented in Italy. The Italian Society for the Surgery of Obesity and Metabolic Diseases and the Italian Society of Anesthesia, Analgesia, Resuscitation and Intensive Care joined in drafting an official statement on ERABS. Methods To assess the effectiveness and safety of ERABS and to develop evidence-based recommendations with regard to pre-, intra-, and post-operative care for obese patients undergoing ERABS, a 13-member expert task force of surgeons and anesthesiologists from Italian certified IFSO center of excellence in bariatric surgery was established and a review of English-language papers conducted. Oxford 2011 Levels of Evidence and U.S. Preventive Services Task Force Grade Definitions were used to grade the level of evidence and the strength of recommendations, respectively. The supporting evidence and recommendations were reviewed and discussed by the entire group at meetings to achieve a final consensus. Results Compared to the conventional approach, ERABS reduces the length of hospital stay and does not heighten the risk of major post-operative complications, re-operations, and hospital re-admissions, nor does it increase the overall surgical costs. A total of 25 recommendations were proposed, covering pre-operative evaluation and care (7 items), intra-operative management (1 item, 11 sub-items), and post-operative care and discharge (6 items). Conclusions ERABS is an effective and safe approach. The recommendations allow the proper management of obese patients undergoing ERABS for a better outcome.
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Affiliation(s)
- Giuseppe Marinari
- Bariatric Surgery Unit, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Mirto Foletto
- Bariatric Surgery Unit, Azienda Ospedale Università Padova, Padua, Italy
| | - Carlo Nagliati
- Department of Surgery, San Giovanni di Dio Hospital, Gorizia, Italy
| | - Giuseppe Navarra
- Department of Human Pathology, University of Messina, Messina, Italy
| | | | - Vincenzo Bruni
- Bariatric Surgery Unit, Campus Bio Medico University of Rome, Rome, Italy
| | - Giovanni Fantola
- Bariatric Surgery Unit, ARNAS, G. Brotzu Hospital, Cagliari, Italy
| | - Roberto Moroni
- Bariatric Surgery Unit, Policlinico Sassarese, Sassari, Italy
| | - Luigi Tritapepe
- Department of Anesthesia and Intensive Care, San Camillo-Forlanini Hospital, Sapienza University of Rome, Rome, Italy
| | - Roberta Monzani
- Department of Anesthesia and Intensive Care Units, Humanitas Research Hospital, Humanitas University Milan, Rozzano, Milan, Italy
| | - Daniela Sanna
- Emergency Department, Section of Anesthesiology and Intensive Care, ARNAS, G. Brotzu Hospital, Cagliari, Italy
| | - Michele Carron
- Department of Medicine-DIMED, Section of Anesthesiology and Intensive Care, University of Padua, Via V. Gallucci, 13, 35121, Padua, Italy.
| | - Rita Cataldo
- Unit of Anesthesia, Intensive Care and Pain Management, Campus Bio Medico University of Rome, Rome, Italy
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183
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Tewfik GL, Rodriguez-Aponte C, Zhang K, Ezzat B, Suri P, Chaudhry F. Outcomes and Disposition of Patients After Case Cancellation on Day of Surgery for Reasons Attributed to Medical or Anesthetic Care: A Retrospective Cohort Analysis. Anesth Analg 2022; 135:845-854. [PMID: 35913700 DOI: 10.1213/ane.0000000000006156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Many day-of-surgery cancellations are avoidable, and different strategies are used to prevent these costly adverse events. Despite these past analyses and evaluations of positive interventions, studies have not examined the final disposition of patients whose cases were canceled in this late manner. This study sought to determine whether surgical procedures canceled for medical or anesthetic reasons were ultimately rescheduled, and the time elapsed between cancellation and completion. In addition, the resolution of the underlying issue leading to cancellation was examined. METHODS Two years of surgical case data were reviewed in the electronic health record to isolate all procedures canceled on the intended operative date. These cases were then filtered by the documented reason for cancellation into 2 categories: 1 for cases related to medical or anesthetic care and 1 for unrelated cases. Medical- or anesthetic-related cases were further categorized to better elucidate the underlying reason for cancellation. Cases were then traced to determine if and when the procedure was ultimately completed. If a case was rescheduled, the record was reviewed to determine whether the underlying reason for cancellation was resolved. RESULTS A total of 4472 cases were canceled in the study period with only 20% associated with medical or anesthetic causes. Of these, 72% were rescheduled and 83% of all rescheduled cases resolved the underlying issue before the rescheduled procedure. Nearly half of all cases (47.8%) canceled on the day of surgery for reasons linked to medical and/or anesthetic care were due to acute conditions. CONCLUSIONS Nearly a fifth of cases that are canceled on the date of surgery are never rescheduled and, if they are rescheduled, the delay can be substantial. Although the majority of patients whose procedure are canceled for reasons related to medical or anesthetic care have resolved the underlying issue that led to initial postponement, a significant portion of patients have no change in their status before the ultimate completion of their surgical procedure.
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Affiliation(s)
- George L Tewfik
- From the Department of Anesthesiology, Rutgers New Jersey Medical School, Newark, New Jersey
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184
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Trivedi SB, Ray CE. Hypertensive and Hypotensive Emergencies in Interventional Radiology. Semin Intervent Radiol 2022; 39:373-380. [PMID: 36406023 PMCID: PMC9671685 DOI: 10.1055/s-0042-1757341] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Hyper- and hypotensive emergencies represent some of the most severe clinical issues that can occur during or around an interventional radiology procedure. While some patients are known to be more predisposed to cardiovascular collapse, nearly all patients are at risk for such an outcome. This is particularly true of patients undergoing moderate sedation, with the possibility of cardiovascular compromise occurring not just due to the underlying pathology for which the patient is being treated, but as a complication of sedation itself. Understanding the underlying cause of hyper- or hypotension is paramount to performing an appropriate and timely intervention. While the underlying cause is being corrected-if possible-the changes in blood pressure themselves may need to be intervened upon to maintain cardiovascular stability in these patients. Interventional radiologists must be familiar with measures taken to correct hyper- or hypotensive emergencies, including the most commonly used medications to treat these disorders. This article discusses the most common etiologies of such clinical scenarios, and the most common interventions performed for these settings.
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Affiliation(s)
- Surbhi B. Trivedi
- Department of Radiology, University of Illinois Hospital and Health Sciences System, Chicago, Illinois
| | - Charles E. Ray
- Division of Interventional Radiology, Department of Radiology, University of Illinois College of Medicine, Chicago, Illinois
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185
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Abstract
PURPOSE OF REVIEW The scope of procedures conducted by neurointerventionalists is expanding quickly, with lacking consensus over the best anesthesia modality. Although the procedures involve all age groups, the interventions may be complex and lengthy and may be provided in hospitals currently not yet familiar with the field. Here we review current literature addressing elective outpatient neurointerventional procedures and aim to provide an update on the management of intervention-specific crises, address special patient populations, and provide key learning points for everyday use in the neurointerventional radiology suite. RECENT FINDINGS Various studies have compared the use of different anesthesia modalities and preinterventional and postinterventional care. Monitored anesthesia care is generally recommended for elderly patients, whereas children are preferably treated with general anesthesia. Additional local anesthesia is beneficial for procedures, such as percutaneous kyphoplasty and vascular access. SUMMARY Combining different anesthetic modalities is a valuable approach in the neurointerventional radiology suite. More interventional and patient population-specific studies are needed to improve evidence-based perioperative management.
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186
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Fasting guidelines: a review of practice over the past 10 years. Ugeskr Laeger 2022; 39:720-721. [PMID: 35822224 DOI: 10.1097/eja.0000000000001678] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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187
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Cummings LC, Liang C, Mascha EJ, Saager L, Smith ZL, Bhavani S, Vargo JJ, Cummings KC. Incidence of sedation-related adverse events during ERCP with anesthesia assistance: a multicenter observational study. Gastrointest Endosc 2022; 96:269-281.e1. [PMID: 35381231 DOI: 10.1016/j.gie.2022.03.023] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2022] [Accepted: 03/25/2022] [Indexed: 12/11/2022]
Abstract
BACKGROUND AND AIMS Anesthesia assistance is commonly used for ERCP. General anesthesia (GA) may provide greater airway protection but may lead to hypotension. We aimed to compare GA versus sedation without planned intubation (SWPI) on the incidence of hypoxemia and hypotension. We also explored risk factors for conversion from SWPI to GA. METHODS This observational study used data from the Multicenter Perioperative Outcomes Group. Adults with American Society of Anesthesiologists physical status class I to IV undergoing ERCP between 2006 and 2019 were included. We compared GA and SWPI on incidence of hypoxemia (oxygen saturation <90% for ≥3 minutes) and hypotension (mean arterial pressure <65 mm Hg for ≥5 minutes) using joint hypothesis testing. The association between anesthetic approach and outcomes was assessed using logistic regression. The noninferiority delta for hypoxemia and hypotension was an odds ratio of 1.20. One approach was deemed better if it was noninferior on both outcomes and superior on at least 1 outcome. To explore risk factors associated with conversion from SWPI to GA, we constructed a logistic regression model. RESULTS Among 61,735 cases from 42 institutions, 38,830 (63%) received GA and 22,905 (37%) received SWPI. The GA group had 1.27 times (97.5% confidence interval, 1.19-1.35) higher odds of hypotension but .71 times (97.5% confidence interval, .63-.80) lower odds of hypoxemia. Neither group was noninferior to the other on both outcomes. Conversion from SWPI to GA occurred in 6.5% of cases and was associated with baseline comorbidities and higher institutional procedure volume. CONCLUSIONS GA for ERCP was associated with less hypoxemia, whereas SWPI was associated with less hypotension. Neither approach was better on the combined incidence of hypotension and hypoxemia.
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Affiliation(s)
- Linda C Cummings
- Division of Gastroenterology and Liver Disease, Department of Medicine, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA; Department of Medicine, Case Western Reserve University School of Medicine, Case Western Reserve University, Cleveland, Ohio, USA
| | - Chen Liang
- Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, Ohio, USA; Department of Outcomes Research, Cleveland Clinic, Cleveland, Ohio, USA
| | - Edward J Mascha
- Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, Ohio, USA; Department of Outcomes Research, Cleveland Clinic, Cleveland, Ohio, USA
| | - Leif Saager
- Department of Anesthesiology, University Medical Center Göttingen, Göttingen, Germany; Department of Anesthesiology, University of Michigan, Ann Arbor, Michigan, USA
| | - Zachary L Smith
- Division of Gastroenterology and Hepatology, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Sekar Bhavani
- Anesthesiology Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - John J Vargo
- Department of Medicine, Cleveland Clinic Lerner College of Medicine, Case Western Reserve University, Cleveland, Ohio, USA; Digestive Disease and Surgery Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Kenneth C Cummings
- Anesthesiology Institute, Cleveland Clinic, Cleveland, Ohio, USA; Department of Anesthesiology, Cleveland Clinic Lerner College of Medicine, Case Western Reserve University, Cleveland, Ohio, USA
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Enhanced Recovery after Surgery (ERAS) protocols in craniomaxillofacial surgery: an evidence-based review. Curr Opin Otolaryngol Head Neck Surg 2022; 30:265-269. [PMID: 35906980 DOI: 10.1097/moo.0000000000000813] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW Enhanced Recovery after Surgery (ERAS) refers to a patient centered, multidisciplinary team developed pathway aimed at reducing the surgical stress response and facilitating expedited patient postoperative recovery. These protocols have been largely developed in the general surgery literature and have led to vast improvements in the patient experience. With a growing shortage of hospital resources during the height of the COVID-19 pandemic there has been a growing push to apply these principles to a wide variety of specialties. RECENT FINDINGS ERAS protocols are generally substantiated on three phases along the continuum of surgical care: preadmission optimization, intraoperative treatment, and postoperative management. In this article, the evidence for ERAS development in craniomaxillofacial surgery will be reviewed, and recommendations from prior studies for enhanced recovery will be outlined. SUMMARY ERAS protocols have been proven effective in many surgical arenas, however, modification is needed for the craniomaxillofacial population. The implications for widespread implementation of ERAS protocols during these procedures are a potentially shortened length of stay, expedited early return to function, reduction in narcotic dependence, and reduction in postdischarge complications necessitating additional intervention.
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189
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Urdaneta F, Wardhan R, Wells G, White JD. Prevention of pulmonary complications in sedated patients undergoing interventional procedures in the nonoperating room anesthesia setting. Curr Opin Anaesthesiol 2022; 35:493-501. [PMID: 35787534 DOI: 10.1097/aco.0000000000001158] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
PURPOSE OF REVIEW Nonoperating room anesthesia (NORA) procedures have expanded in number, variety, and complexity. NORA involves all age groups, including frail older adults and patients often considered too sick to tolerate traditional surgical interventions. Postoperative pulmonary complications are a significant source of adverse events in the perioperative setting. We present a review focused on preventing pulmonary complications in the interventional NORA setting. RECENT FINDINGS NORA locations should function as independent, autonomous ambulatory units. We discuss a strategic plan involving a thorough preoperative evaluation of patients, including recognizing high-risk patients and their anesthetic management. Finally, we offer guidance on the challenges of conducting sedation and anesthesia in patients with coronavirus disease 2019 (COVID-19) or a history of COVID-19. SUMMARY The demands on the interventional NORA anesthesia team are increasing. Strategic planning, checklists, consistent staffing assignments, and scheduled safety drills are valuable tools to improve patient safety. In addition, through quality improvement initiatives and reporting, NORA anesthetists can achieve reductions in periprocedural pulmonary complications.
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Affiliation(s)
- Felipe Urdaneta
- Department of Anesthesiology, University of Florida College of Medicine, Gainesville, Florida, USA
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190
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Oliveira CBD, Garcia AKA, Nascimento LAD, Conchon MF, Furuya RK, Rodrigues R, Fonseca LF. Effects of carbohydrate use on preoperative thirst: a randomized clinical trial. Rev Bras Enferm 2022; 75:e20210355. [PMID: 35894410 DOI: 10.1590/0034-7167-2021-0355] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Accepted: 03/31/2022] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVES to evaluate the effectiveness of carbohydrate popsicles, carbohydrate solution, and usual care (fasting) on the intensity and discomfort of preoperative thirst. METHODS a randomized clinical trial with 60 preoperative patients aged between 18 and 60 years, randomized into three groups: control (fasting), carbohydrate solution (100 ml), and carbohydrate popsicle (100 ml). The outcomes were thirst intensity and discomfort. RESULTS there was a difference between groups for final thirst intensity (p = 0.01) and final thirst discomfort (p = 0.001). The effect size for both the Solution Group and the Popsicle Group was robust: 0.99 and 1.14, respectively. CONCLUSIONS the groups that received the carbohydrate fasting abbreviation showed a reduction in thirst discomfort compared to the control group. The carbohydrate popsicle proved more effective in reducing the intensity of thirst. NCT: 3.209.283.
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191
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Evaluation of adequacy of ventilation and gastric insufflation at three levels of inspiratory pressure for facemask ventilation during induction of anaesthesia: A randomised controlled trial. Anaesth Crit Care Pain Med 2022; 41:101132. [PMID: 35901954 DOI: 10.1016/j.accpm.2022.101132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Revised: 05/20/2022] [Accepted: 05/21/2022] [Indexed: 11/21/2022]
Abstract
BACKGROUND In this study, we aimed to compare three inspiratory pressures during face-mask ventilation in paralysed patients regarding the subsequent incidence of gastric insufflation and the adequacy of lung ventilation. METHODS In this randomised controlled trial, we included adult patients undergoing elective surgery under general anaesthesia. The patients were randomly allocated to receive positive inspiratory pressure (PIP) of 10, 15, or 20 cmH2O during pressure-controlled mask ventilation. Antral cross-sectional area (CSA) was assessed by ultrasound at baseline before mask ventilation and after endotracheal intubation and gastric insufflation was defined as increased CSA after endotracheal intubation > 30% of the baseline measurement. The primary outcome was the incidence of gastric insufflation. Other outcomes included the tidal volume, and the incidence of adequate ventilation (tidal volume of 6-10 mL/kg predicted body weight). RESULTS We analysed data from 36 patients in each group. The number of patients with gastric insufflation was lowest in the PIP 10 group (0/36 [0%]) in comparison with PIP 15 (2/36 [19%] and PIP 20 36/36 [100%] groups (P-values of 0.019 and < 0.001, respectively). The probability of adequate ventilation at any time point was the highest in PIP 10, followed by PIP 15, and was the lowest in the PIP 20 group. CONCLUSION An inspiratory pressure of 10 cmH2O in paralysed patients provided the least risk of gastric insufflation with adequate ventilation during induction of general anaesthesia compared to inspiratory pressure of 15- and 20 cmH2O.
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192
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Lu J, Xue M, Fu P, Qian D, Chen X, Yao D, Zhang Y. Evaluation of open reduction of distal humerus fractures in children after implementation of an enhanced recovery after surgery program. BMC Musculoskelet Disord 2022; 23:705. [PMID: 35879748 PMCID: PMC9310416 DOI: 10.1186/s12891-022-05675-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Accepted: 07/20/2022] [Indexed: 12/04/2022] Open
Abstract
Objective This study assessed whether an enhanced recovery after surgery (ERAS) protocol could be beneficial for children with distal humerus fractures. Methods Children with distal humerus fractures (n = 85) were randomly assigned to the ERAS and control groups and subjected to different perioperative managements. This was followed by the evaluation of their intraoperative characteristics (operation time and bleeding), postoperative characteristics (food intake conditions, pain scores, and discharge time), and postoperative functions. Results The operation time, intraoperative bleeding, and postoperative hematological indices did not differ significantly between the two groups. Preoperative thirst and hunger were considerably less and the initial food intake duration following surgery was markedly shorter in the ERAS group than in the control group, whereas no difference between the groups was observed in the incidences of postoperative nausea and vomiting. A markedly reduced highest postoperative pain score and reduced mean pain score and demand for additional analgesic interventions were observed in the ERAS group compared with those in the control group, although the differences were not statistically significant. No noticeable between-group differences were observed in the incidences of postoperative incision problems, aspirational pneumonia, and gastroesophageal reflux. The total length of hospital stay was not significantly different between the two groups. However, the length of postoperative hospital stay was remarkably shorter and the elbow joint function at 2 months after surgery was significantly improved in the ERAS group compared with those in the control group. Conclusion The ERAS protocol can ameliorate preoperative discomfort and postoperative pain, shorten the postoperative hospital stay, and accelerate postoperative functional recovery without increasing the risks of postoperative nausea, vomiting, and poor incision healing and is, therefore, worthy of clinical application.
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Affiliation(s)
- Jialing Lu
- Department of Pediatric Orthopedics, The Second Affiliated Hospital of Jiaxing University (The Second Hospital of Jiaxing), Zhejiang, Jiaxing, 314000, People's Republic of China
| | - Mingfeng Xue
- Department of Pediatric Orthopedics, The Second Affiliated Hospital of Jiaxing University (The Second Hospital of Jiaxing), Zhejiang, Jiaxing, 314000, People's Republic of China
| | - Peng Fu
- Department of Pediatric Orthopedics, The Second Affiliated Hospital of Jiaxing University (The Second Hospital of Jiaxing), Zhejiang, Jiaxing, 314000, People's Republic of China
| | - Damei Qian
- Department of Pediatric Orthopedics, The Second Affiliated Hospital of Jiaxing University (The Second Hospital of Jiaxing), Zhejiang, Jiaxing, 314000, People's Republic of China
| | - Xingguang Chen
- Department of Pediatric Orthopedics, The Second Affiliated Hospital of Jiaxing University (The Second Hospital of Jiaxing), Zhejiang, Jiaxing, 314000, People's Republic of China
| | - Danhua Yao
- Department of Pediatric Orthopedics, The Second Affiliated Hospital of Jiaxing University (The Second Hospital of Jiaxing), Zhejiang, Jiaxing, 314000, People's Republic of China
| | - Yanli Zhang
- Department of Anesthesiology, The Second Affiliated Hospital of Jiaxing University (The Second Hospital of Jiaxing), Zhejiang, Jiaxing, 314000, People's Republic of China.
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193
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Sun ZJ, Sun X, Huo Y, Mi M, Peng GL, Zhang CL, Jiang Y, Zhou Y, Zhao X, Li T, Wu XB. Abbreviated perioperative fasting management for elective fresh fracture surgery: guideline adherence analysis. BMC Musculoskelet Disord 2022; 23:688. [PMID: 35858882 PMCID: PMC9297612 DOI: 10.1186/s12891-022-05574-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2021] [Accepted: 06/10/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Long-term fasting for elective surgery has been proven unnecessary based on established guidelines. Instead, preoperative carbohydrate loading 2 h before surgery and recommencing oral nutrition intake as soon as possible after surgery is recommended. This study was performed to analyze the compliance with and effect of abbreviated perioperative fasting management in patients undergoing surgical repair of fresh fractures based on current guidelines. METHODS Patients with fresh fractures were retrospectively analyzed from the prospectively collected database about perioperative managements based on enhanced recovery of surgery (ERAS) from May 2019 to July 2019 at our hospital. A carbohydrate-enriched beverage was recommended up to 2 h before surgery for all surgical patients except those with contraindications. Postoperatively, oral clear liquids were allowed once the patients had regained full consciousness, and solid food was allowed 1 to 2 h later according to the patients' willingness. The perioperative fasting time was recorded and the patients' subjective comfort with respect to thirst and hunger was assessed using an interview-assisted questionnaire. RESULTS In total, 306 patients were enrolled in this study. The compliance rate of preoperative carbohydrate loading was 71.6%, and 93.5% of patients began ingestion of oral liquids within 2 h after surgery. The median (interquartile range) preoperative fasting time for liquids and solids was 8 (5.2-12.9) and 19 (15.7-22) hours, respectively. The median postoperative fasting time for liquids and solids was 1 (0.5-1.9) and 2.8 (2.2-3.5) hours, respectively. A total of 70.3% and 74.2% of patients reported no thirst and hunger during the perioperative period, respectively. Logistic regression analysis showed that the preoperative fasting time for liquids was an independent risk factor for perioperative hunger. No risk factor was identified for perioperative thirst. No adverse events such as aspiration pneumonia or gastroesophageal reflux were observed. CONCLUSIONS In this study of a real clinical practice setting, abbreviated perioperative fasting management was carried out with high compliance in patients with fresh fractures. The preoperative fasting time should be further shortened to further improve patients' subjective comfort.
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Affiliation(s)
- Zhi-Jian Sun
- Department of Orthopedic Trauma, Beijing Jishuitan Hospital, Beijing, 100035, China
| | - Xu Sun
- Department of Orthopedic Trauma, Beijing Jishuitan Hospital, Beijing, 100035, China
| | - Yan Huo
- Department of Orthopedic Trauma, Beijing Jishuitan Hospital, Beijing, 100035, China
| | - Meng Mi
- Department of Orthopedic Trauma, Beijing Jishuitan Hospital, Beijing, 100035, China
| | - Gui-Ling Peng
- Department of Orthopedic Trauma, Beijing Jishuitan Hospital, Beijing, 100035, China
| | - Chun-Ling Zhang
- Department of Orthopedic Trauma, Beijing Jishuitan Hospital, Beijing, 100035, China
| | - Yao Jiang
- Department of Orthopedic Trauma, Beijing Jishuitan Hospital, Beijing, 100035, China
| | - Yan Zhou
- Department of Anesthesiology, Beijing Jishuitan Hospital, Beijing, 100035, China
| | - Xia Zhao
- Department of Nutriology, Beijing Jishuitan Hospital, Beijing, 100035, China
| | - Ting Li
- Department of Orthopedic Trauma, Beijing Jishuitan Hospital, Beijing, 100035, China.
| | - Xin-Bao Wu
- Department of Orthopedic Trauma, Beijing Jishuitan Hospital, Beijing, 100035, China
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194
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Lee HJ, Desai MA, Sadlak N, Fiorello MG, Githere WG, Subramanian ML. Oral Sedation is Non-Inferior to Intravenous Sedation for Cornea and Glaucoma Surgery: A Randomized Controlled Trial. Clin Ophthalmol 2022; 16:2105-2117. [PMID: 35837489 PMCID: PMC9274777 DOI: 10.2147/opth.s354570] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Accepted: 04/28/2022] [Indexed: 11/23/2022] Open
Affiliation(s)
- Hyunjoo J Lee
- Correspondence: Hyunjoo J Lee, Department of Ophthalmology, Boston Medical Center, 85 East Concord Street, 8th Floor, Boston, MA, 02118, USA, Tel +1 617 414 2020, Fax +1 617 414 2929, Email
| | - Manishi A Desai
- Department of Ophthalmology, Boston Medical Center, Boston, MA, USA
| | - Natalie Sadlak
- Department of Ophthalmology, Boston Medical Center, Boston, MA, USA
| | | | | | | | - On behalf of The Oral versus Intravenous Sedation Study Group
CroughNoelleEliassi-RadBabakEsparazElizabeth S.KimJiwooVelazquez-LamelaMariaMDLeidlMatthewLevittCatherine V.LutherDaniel J.MarfatiaHeenalNegahbanKambizNessStevenPeelerCrandall E.PiraTonyRaoRohiniRoweSusannahSiegelNicole H.VigVihaDepartment of Ophthalmology, Boston Medical Center,, Boston, Massachusetts, USAMustafaWissam H.NorrisMark C.SekharPavanDepartment of Anesthesiology, Boston Medical Center,, Boston, Massachusetts, USAPeelerCrandall E.Department of Neurology, Boston Medical Center,, Boston, Massachusetts, USAZalewskiStephenDepartment of Investigational Pharmacy Services, Boston Medical Center,, Boston, Massachusetts, USA
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195
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Adams AJ, Songster JC, Harig JP, Markin NW. Perioperative gastric ultrasound: utility and limitations. Int Anesthesiol Clin 2022; 60:45-54. [PMID: 35499911 DOI: 10.1097/aia.0000000000000365] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Austin J Adams
- Department of Anesthesiology, University of Nebraska Medical Center, Omaha, Nebraska
| | - Jeffrey C Songster
- Department of Anesthesiology, University of Nebraska Medical Center, Omaha, Nebraska
| | - Jason P Harig
- Department of Anesthesiology, University of Utah Health, Salt Lake City, Utah
| | - Nicholas W Markin
- Department of Anesthesiology, University of Nebraska Medical Center, Omaha, Nebraska
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196
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Kalaiselvan J, Kashav RC, Kohli JK, Magoon R, Shri I, Grover V, Jhajharia NS. ICU Readmission in Cardiac Surgical Subset: A Problem Worth Pondering. JOURNAL OF CARDIAC CRITICAL CARE TSS 2022. [DOI: 10.1055/s-0042-1759816] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/07/2022] Open
Abstract
AbstractOver the past decades, there have been noteworthy advancements in the cardiac surgical practice that have assisted fast-tracking and enhanced recovery after cardiac surgery (ERACS). With that said, intensive care unit (ICU) readmission in this high-risk patient cohort entails a significant morbidity–mortality burden. As an extension of the same, there has been a heightened emphasis on a comprehensive evaluation of the predisposition to readmission following a primary ICU discharge. However, the variability of the institutional perioperative practices and the research complexities compound our understanding of this heterogeneous outcome of readmission, which is intricately linked to both patient and organizational factors. Moreover, a discussion on ICU readmission in the recent times can only be rendered comprehensive when staged in close conjunction to the fast-tracking practices in cardiac surgery. From a more positive probing of the matter, a preventative outlook can likely mitigate a part of the larger problem of ICU readmission. Herein, focused cardiac prehabilitation programs can play a potential role given the emerging literature on the positive impact of the former on the most relevant readmission causes. Therefore, the index review article aims to address the subject of cardiac surgical ICU readmission, highlighting the magnitude and burden, the causes and risk-factors, and the research complexities alongside deliberating the topic in the present-day context of ERACS and cardiac prehabilitation.
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Affiliation(s)
- Jaffrey Kalaiselvan
- Department of Cardiac Anaesthesia, Atal Bihari Vajpayee Institute of Medical Sciences (ABVIMS) and Dr. Ram Manohar Lohia Hospital, Baba Kharak Singh Marg, New Delhi, India
| | - Ramesh Chand Kashav
- Department of Cardiac Anaesthesia, Atal Bihari Vajpayee Institute of Medical Sciences (ABVIMS) and Dr. Ram Manohar Lohia Hospital, Baba Kharak Singh Marg, New Delhi, India
| | - Jasvinder Kaur Kohli
- Department of Cardiac Anaesthesia, Atal Bihari Vajpayee Institute of Medical Sciences (ABVIMS) and Dr. Ram Manohar Lohia Hospital, Baba Kharak Singh Marg, New Delhi, India
| | - Rohan Magoon
- Department of Cardiac Anaesthesia, Atal Bihari Vajpayee Institute of Medical Sciences (ABVIMS) and Dr. Ram Manohar Lohia Hospital, Baba Kharak Singh Marg, New Delhi, India
| | - Iti Shri
- Department of Cardiac Anaesthesia, Atal Bihari Vajpayee Institute of Medical Sciences (ABVIMS) and Dr. Ram Manohar Lohia Hospital, Baba Kharak Singh Marg, New Delhi, India
| | - Vijay Grover
- Department of Cardiothoracic and Vascular Surgery, Atal Bihari Vajpayee Institute of Medical Sciences (ABVIMS) and Dr. Ram Manohar Lohia Hospital, Baba Kharak Singh Marg, New Delhi, India
| | - Narender Singh Jhajharia
- Department of Cardiothoracic and Vascular Surgery, Atal Bihari Vajpayee Institute of Medical Sciences (ABVIMS) and Dr. Ram Manohar Lohia Hospital, Baba Kharak Singh Marg, New Delhi, India
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197
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Enhanced Recovery After Surgery Pathway in Kidney Transplantation: The Road Less Traveled. Transplant Direct 2022; 8:e1333. [PMID: 35747520 PMCID: PMC9208883 DOI: 10.1097/txd.0000000000001333] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Revised: 03/03/2022] [Accepted: 03/23/2022] [Indexed: 11/25/2022] Open
Abstract
Enhanced recovery after surgery (ERAS) pathway is a multimodal perioperative care pathway designed to achieve early recovery after surgery. ERAS protocols have not yet been well recognized in kidney transplantation. The aim of this study was to investigate the impact of ERAS pathway on early recovery and short-term clinical outcomes of kidney transplant.
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198
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Fung BM, Leon DJ, Beck LN, Tabibian JH. Pre-procedural Preparation and Sedation for Gastrointestinal Endoscopy in Patients with Advanced Liver Disease. Dig Dis Sci 2022; 67:2739-2753. [PMID: 34169430 DOI: 10.1007/s10620-021-07111-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Accepted: 06/10/2021] [Indexed: 12/09/2022]
Abstract
Gastrointestinal endoscopy in patients with advanced liver disease poses various challenges, a major one being procedural sedation and its associated considerations. While sedation during endoscopy can improve patient comfort, decrease anxiety, and facilitate procedural completion, in patients with advanced liver disease, it is also associated with substantial and unique risks due to alterations in drug metabolism and other factors. As such, the choice of sedative agent(s) and related logistics may require careful inter-disciplinary planning and individualized considerations. Furthermore, a large proportion of agents require dose reductions and particular monitoring of the vital signs, level of consciousness, and other indices. In the present review, we provide a contemporary overview of procedural sedation considerations, commonly used intravenous sedatives, and second-line as well as novel sedatives for gastrointestinal endoscopy in patients with advanced liver disease.
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Affiliation(s)
- Brian M Fung
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, University of Arizona College of Medicine - Phoenix, Phoenix, AZ, USA. .,Banner - University Medical Center Phoenix, Internal Medicine, LL2, 1111 E McDowell Road, Phoenix, AZ, 85006, USA.
| | - Deanna J Leon
- Department of Anesthesiology and Perioperative Medicine, University of California Los Angeles, Los Angeles, CA, USA
| | - Lauren N Beck
- Department of Anesthesiology and Perioperative Medicine, University of California Los Angeles, Los Angeles, CA, USA
| | - James H Tabibian
- Division of Gastroenterology, Department of Medicine, Olive View-UCLA Medical Center, Sylmar, CA, USA.,David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
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199
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Lin XQ, Chen YR, Chen X, Cai YP, Lin JX, Xu DM, Zheng XC. Impact of preoperative carbohydrate loading on gastric volume in patients with type 2 diabetes. World J Clin Cases 2022; 10:6082-6090. [PMID: 35949825 PMCID: PMC9254193 DOI: 10.12998/wjcc.v10.i18.6082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Revised: 03/21/2022] [Accepted: 04/21/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Enhanced recovery after surgery advocates that consuming carbohydrates two hours before anesthesia is beneficial to the patient's recovery. Patients with diabetes are prone to delayed gastric emptying. Different guidelines for preoperative carbohydrate consumption in patients with diabetes remain controversial due to concerns about the risk of regurgitation, aspiration and hyperglycemia. Ultrasonic gastric volume (GV) assessment and blood glucose monitoring can comprehensively evaluate the safety and feasibility of preoperative carbohydrate intake in type 2 diabetes (T2D) patients.
AIM To evaluate the impact of preoperative carbohydrate loading on GV before anesthesia induction in T2D patients.
METHODS Patients with T2D receiving surgery under general anesthesia from December 2019 to December 2020 were included. A total of 78 patients were randomly allocated to 4 groups receiving 0, 100, 200, or 300 mL of carbohydrate loading 2 h before anesthesia induction. Gastric volume per unit weight (GV/W), Perlas grade, changes in blood glucose level, and risk of reflux and aspiration were evaluated before anesthesia induction.
RESULTS No significant difference was found in GV/W among the groups before anesthesia induction (P > 0.05). The number of patients with Perlas grade II and GV/W > 1.5 mL/kg did not differ among the groups (P > 0.05). Blood glucose level increased by > 2 mmol/L in patients receiving 300 mL carbohydrate drink, which was significantly higher than that in groups 1 and 2 (P < 0.05).
CONCLUSION Preoperative carbohydrate loading < 300 mL 2 h before induction of anesthesia in patients with T2D did not affect GV or increase the risk of reflux and aspiration. Blood glucose levels did not change significantly with preoperative carbohydrate loading of < 200 mL. However, 300 mL carbohydrate loading may increase blood glucose levels in patients with T2D before induction of anesthesia.
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Affiliation(s)
- Xin-Qiang Lin
- Department of Anesthesiology, Affiliated Hospital of Putian College, Putian Maternity and Child Care Hospital, Putian 351100, Fujian Province, China
| | - Yu-Ren Chen
- Department of Anesthesiology, Affiliated Hospital of Putian College, Putian 351100, Fujian Province, China
| | - Xiao Chen
- Department of Anesthesiology, Affiliated Hospital of Putian College, Putian 351100, Fujian Province, China
| | - Yu-Ping Cai
- Department of Anesthesiology, Affiliated Hospital of Putian College, Putian 351100, Fujian Province, China
| | - Jian-Xin Lin
- Department of Anesthesiology, Affiliated Hospital of Putian College, Putian 351100, Fujian Province, China
| | - De-Ming Xu
- Department of Anesthesiology, Affiliated Hospital of Putian College, Putian 351100, Fujian Province, China
| | - Xiao-Chun Zheng
- Department of Anesthesiology, Shenli Clinical Medical College of Fujian Medical University, Fujian Provincial Hospital, Fuzhou 350001, Fujian Province, China
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200
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Bode K, Gerhards M, Doering M, Lucas J, Tijssen J, Dagres N, Hilbert S, Richter S, Nedios S, Lurz J, Moscoso-Luduena C, Arya A, Shamloo AS, Hindricks G. A randomized trial of non-fasting vs. fasting for cardiac implantable electronic device procedures (Fast-CIED Study). Europace 2022; 24:1617-1626. [PMID: 35726877 DOI: 10.1093/europace/euac081] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Accepted: 05/02/2022] [Indexed: 11/13/2022] Open
Abstract
AIMS Data on safety and efficacy of a non-fasting strategy in minimal invasive cardiac procedures are lacking. We assessed a non-fasting strategy compared with a fasting strategy regarding patient's well-being and safety in elective cardiac implantable electronic device (CIED) procedures. METHODS AND RESULTS In this randomized, single-blinded clinical trial, 201 patients (non-fasting = 100, fasting = 101) with a mean age of 72.0 ± 11.6 years (66.7% male) were assigned to a non-fasting strategy (solids/fluids allowed up to 1 h) or a fasting strategy (at least 6 h no solids and 2 h no fluids) before the procedure and analysed on an intention-to-treat basis. The co-primary outcomes were patients' well-being scores (based on numeric rating scale, 0-10) and incidence of intra-procedural food-related adverse events, including vomiting, perioperative pulmonary aspiration, and emergency intubation. Renal, haematological, and metabolic blood parameters and 30-day follow-up data were gathered. The summed pre-procedural patients' well-being score was significantly lower in the non-fasting group [non-fasting: 13.1 ± 9.6 vs. fasting: 16.5 ± 11.4, 95% confidence interval (CI) of mean difference (MD) -6.35 to -0.46, P = 0.029], which was mainly driven by significantly lower scores for hunger and tiredness in the non-fasting group (non-fasting vs. fasting; hunger: 0.9 ± 1.9 vs. 3.1 ± 3.2, 95% CI of MD -2.86 to -1.42, P < 0.001; tiredness: 1.6 ± 2.3 vs. 2.6 ± 2.7, 95% CI of MD -1.68 to -0.29, P = 0.023). No intra-procedural food-related adverse events were observed. Relevant blood parameters and 30-day follow-up did not show significant differences. CONCLUSION These results showed that a non-fasting strategy is beneficial to a fasting one regarding patient's well-being and comparable in terms of safety for CIED procedures (NCT04389697).
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Affiliation(s)
- Kerstin Bode
- Department of Electrophysiology, Heart Center Leipzig at University of Leipzig, Naumburger Str. 76, 04443 Weißenfels, Germany.,Department of Cardiology, Asklepios Clinic Weißenfels, Weißenfels, Germany
| | - Matthias Gerhards
- Department of Electrophysiology, Heart Center Leipzig at University of Leipzig, Naumburger Str. 76, 04443 Weißenfels, Germany
| | - Michael Doering
- Department of Electrophysiology, Heart Center Leipzig at University of Leipzig, Naumburger Str. 76, 04443 Weißenfels, Germany
| | - Johannes Lucas
- Department of Electrophysiology, Heart Center Leipzig at University of Leipzig, Naumburger Str. 76, 04443 Weißenfels, Germany
| | | | - Nikolaos Dagres
- Department of Electrophysiology, Heart Center Leipzig at University of Leipzig, Naumburger Str. 76, 04443 Weißenfels, Germany
| | - Sebastian Hilbert
- Department of Electrophysiology, Heart Center Leipzig at University of Leipzig, Naumburger Str. 76, 04443 Weißenfels, Germany
| | - Sergio Richter
- Department of Electrophysiology, Heart Center Leipzig at University of Leipzig, Naumburger Str. 76, 04443 Weißenfels, Germany
| | - Sotirios Nedios
- Department of Electrophysiology, Heart Center Leipzig at University of Leipzig, Naumburger Str. 76, 04443 Weißenfels, Germany
| | - Julia Lurz
- Department of Electrophysiology, Heart Center Leipzig at University of Leipzig, Naumburger Str. 76, 04443 Weißenfels, Germany
| | - Cathleen Moscoso-Luduena
- Department of Electrophysiology, Heart Center Leipzig at University of Leipzig, Naumburger Str. 76, 04443 Weißenfels, Germany
| | - Arash Arya
- Department of Electrophysiology, Heart Center Leipzig at University of Leipzig, Naumburger Str. 76, 04443 Weißenfels, Germany
| | - Alireza Sepehri Shamloo
- Department of Electrophysiology, Heart Center Leipzig at University of Leipzig, Naumburger Str. 76, 04443 Weißenfels, Germany.,Leipzig Heart Institute, Leipzig, Germany
| | - Gerhard Hindricks
- Department of Electrophysiology, Heart Center Leipzig at University of Leipzig, Naumburger Str. 76, 04443 Weißenfels, Germany
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