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Tamborrino PP, Papi L, Michelotti L, Vitale C, Caravelli P, Petronio AS, Terlizzi E, Della Volpe L, Virlan M, Sardanelli A, Morganti R, De Caterina R. Do We Need Fasting Prior to Coronary Angiography? The CORO-NF Randomized Pragmatic Study. Am J Med 2024; 137:666-672. [PMID: 38336086 DOI: 10.1016/j.amjmed.2024.01.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2024] [Revised: 01/27/2024] [Accepted: 01/29/2024] [Indexed: 02/12/2024]
Abstract
BACKGROUND Similar to procedures requiring general anesthesia, current guidelines recommend fasting for 6 hours for solids and for 2 hours for liquids prior to coronary angiography, but without data supporting such recommendation. The CORO-NF study aimed at assessing whether a shorter fasting period prior to elective coronary angiography associates with improved patient satisfaction without more complications compared with the standard fasting approach. METHODS We conducted a single-center, randomized, prospective, pragmatic study in 2 sequential phases: a "conventional protocol phase," continuing the usual practice (F Group); and an "experimental phase" (NF Group), reducing minimum fasting duration to 2 hours. Patients received a questionnaire to express a satisfaction score ranging from 1 (maximum complain/no approval) to 5 (minimum or no complain/full approval). All patients admitted acutely were enrolled in a control A Group registry. Fasting time and every major complication and periprocedural complications were analyzed. RESULTS Fasting time was 821 ± 357 minutes in the F Group and 230 ± 146 minutes in the NF Group (P < .001). The satisfaction score was higher in the NF Group (4.2 ± 0.7 vs 2.9 ± 1.2, P < .001), even at multivariable analysis considering fasting time (P < .001). No intraprocedural food ingestion-related adverse events occurred in either of the 2 experimental groups, as well as in the parallel A Group, with no excess of peri- and postprocedural complications in the NF Group. CONCLUSIONS The significantly higher satisfaction scores among patients undergoing a shorter-than-recommended fasting period prior to coronary angiography, not counterbalanced by decreased safety, underscores the potential benefits of revising the traditional 6-hour fasting protocols.
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Affiliation(s)
- Pietro Paolo Tamborrino
- Chair and Postgraduate School of Cardiology, University of Pisa and Cardiovascular Division 1, Pisa University Hospital, Italy
| | - Laura Papi
- Chair and Postgraduate School of Cardiology, University of Pisa and Cardiovascular Division 1, Pisa University Hospital, Italy
| | - Laura Michelotti
- Chair and Postgraduate School of Cardiology, University of Pisa and Cardiovascular Division 1, Pisa University Hospital, Italy
| | - Carlo Vitale
- Chair and Postgraduate School of Cardiology, University of Pisa and Cardiovascular Division 1, Pisa University Hospital, Italy
| | - Paolo Caravelli
- Chair and Postgraduate School of Cardiology, University of Pisa and Cardiovascular Division 1, Pisa University Hospital, Italy
| | - Anna Sonia Petronio
- Cardiac Catheterization Laboratory, Cardiothoracic and Vascular Department, University of Pisa, Italy
| | - Emilia Terlizzi
- Chair and Postgraduate School of Cardiology, University of Pisa and Cardiovascular Division 1, Pisa University Hospital, Italy
| | - Ludovica Della Volpe
- Chair and Postgraduate School of Cardiology, University of Pisa and Cardiovascular Division 1, Pisa University Hospital, Italy
| | - Mihaela Virlan
- Chair and Postgraduate School of Cardiology, University of Pisa and Cardiovascular Division 1, Pisa University Hospital, Italy
| | - Annamaria Sardanelli
- Chair and Postgraduate School of Cardiology, University of Pisa and Cardiovascular Division 1, Pisa University Hospital, Italy
| | - Riccardo Morganti
- Section of Statistics, Department of Clinical and Experimental Medicine, University of Pisa, Italy
| | - Raffaele De Caterina
- Chair and Postgraduate School of Cardiology, University of Pisa and Cardiovascular Division 1, Pisa University Hospital, Italy; Fondazione VillaSerena per la Ricerca, Città Sant'Angelo-Pescara, Italy.
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Yap KS, Loh PS, Foong YX, Mok CZ, Ong T, Khor HM. A feasibility study on preoperative carbohydrate loading in older patients undergoing hip fracture surgery. BMC Geriatr 2024; 24:401. [PMID: 38711010 PMCID: PMC11075227 DOI: 10.1186/s12877-024-04958-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Accepted: 04/08/2024] [Indexed: 05/08/2024] Open
Abstract
BACKGROUND Preoperative carbohydrate loading in Enhanced Recovery After Surgery is an independent predictor of postoperative outcomes. By reducing the impact of surgical stress response, fasting-induced insulin resistance is modulated. As a clear fluid, consuming carbohydrate drink is safe up to 2 h preoperatively. Widely practiced in abdominal surgeries, its implementation in hip fracture surgeries is yet to be recognized. This study aimed to identify the feasibility of preoperative carbohydrate loading in hip fracture surgery and assess its clinical effects. METHODS This was a randomized controlled, open labelled trial. Patients ≥ 65 years old without diabetes mellitus, has hip fracture were recruited in a tertiary hospital between November 2020 and May 2021. The intervention was carbohydrate loading versus standard preoperative fasting. RESULTS Thirty-four ASA I-III patients (carbohydrate loading and control, n = 17 each), mean age 78 years (SEM ± 1.5), mean body mass index 23.7 (SEM ± 0.6 kg/m2) were recruited. Analysis for feasibility of carbohydrate loading (n = 17) demonstrated attrition rate of 29% (n = 5). Otherwise, all recruited patients were compliant (100% compliance) with no adverse events reported. There was no significant difference among groups in the postoperative nausea and vomiting, pain score, fatigue level, muscle strength, postoperative infection and length of hospital stay assessed at 24-48 h postoperatively. CONCLUSION The implementation of preoperative carbohydrate loading was found to be feasible preoperatively in hip fracture surgeries but requires careful coordination among multidisciplinary teams. An adequately powered randomized controlled study is needed to examine the full benefits of preoperative carbohydrate loading in this group of patients. TRIAL REGISTRATION This study was registered in ClinicalTrial.gov (ClinicalTrials.gov identifier: NCT04614181, date of registration: 03/11/2020).
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Affiliation(s)
- Kai Sing Yap
- Department of Anaesthesiology, Faculty of Medicine, Universiti Malaya, 50603, Kuala Lumpur, Malaysia
| | - P S Loh
- Department of Anaesthesiology, Faculty of Medicine, Universiti Malaya, 50603, Kuala Lumpur, Malaysia.
| | - Yi Xian Foong
- Department of Anaesthesiology, Faculty of Medicine, Universiti Malaya, 50603, Kuala Lumpur, Malaysia
| | - Chu Zhen Mok
- Department of Dietetics, University of Malaya Medical Centre, Kuala Lumpur, Malaysia
| | - Terence Ong
- Department of Medicine, Faculty of Medicine, Universiti Malaya, Kuala Lumpur, Malaysia
| | - Hui Min Khor
- Department of Medicine, Faculty of Medicine, Universiti Malaya, Kuala Lumpur, Malaysia
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Shi H, Zheng C, Zhu B. Effects of Preoperative Oral Carbohydrate on Perioperative Maternal Outcomes Undergoing Cesarean Section: A Systematic Review and Meta-Analysis. Anesthesiol Res Pract 2024; 2024:4660422. [PMID: 38586152 PMCID: PMC10999288 DOI: 10.1155/2024/4660422] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2024] [Revised: 03/18/2024] [Accepted: 03/23/2024] [Indexed: 04/09/2024] Open
Abstract
Purpose Preoperative oral carbohydrate (CHO) is a rapid postoperative rehabilitation protocol that improves perioperative outcomes and is widely used in adult surgical patients. However, pregnant women are excluded because of the possibility of aspiration due to delayed gastric emptying. This meta-analysis was conducted to evaluate the efficacy of preoperative oral CHO in elective cesarean section. Methods PubMed, Embase, Web of Science, and the Cochrane Library were searched from inception to July 2023. Randomized controlled trials were included. The risk of bias was assessed using the Cochrane tool. Risk ratios and 95% confidence intervals were calculated. Meta-analysis was performed using random-effects models to estimate risk ratios and mean differences (MDs) with 95% confidence intervals (CIs). The outcomes included thirst and hunger scores, incidence of vomiting and nausea, time to flatus, and homeostatic model assessment of insulin resistance (HOMA-IR). Results A total of nine studies with 1211 patients were included in the analysis. The levels of thirst and hunger were evaluated using a 10-point visual analog scale, with 0 representing the best and 10 representing the worst. The severity of hunger (weighted mean difference (WMD: -2.34, 95% CI: -3.13 to -1.54), time to flatus (WMD: -3.51 hours, 95% CI: -6.85 to -0.17), and HOMA-IR (WMD: -1.04, 95% CI: -1.31 to -0.77) were significantly lower in the CHO group compared to the control group. However, there were no significant differences in the severity of thirst or the incidence of vomiting and nausea between the CHO and control groups. Conclusion Preoperative oral CHO during cesarean section alleviates thirst and hunger, shortens the time of postoperative flatus, and reduces HOMA-IR. However, the available evidence is insufficient to reach a clear consensus on the benefits or harms of preoperative oral CHO during cesarean section. Therefore, it is premature to make a definitive recommendation for or against its routine use.
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Affiliation(s)
- Haibin Shi
- Department of Anesthesiology, Affiliated Hangzhou First People's Hospital, School of Medicine, Westlake University, Hangzhou, Zhejiang, China
| | - Caihong Zheng
- Department of Anesthesiology, Hangzhou Women's Hospital, Hangzhou, Zhejiang, China
| | - Bin Zhu
- Department of Anesthesiology, Hangzhou Women's Hospital, Hangzhou, Zhejiang, China
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Chen L, Wang N, Xie G, Wang M, Yu Y, Wang H, Fang X. The safety of preoperative carbohydrate drinks in extremely elderly patients assessed by gastric ultrasonography: a randomized controlled trial. BMC Anesthesiol 2024; 24:78. [PMID: 38408918 PMCID: PMC10895784 DOI: 10.1186/s12871-024-02457-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Accepted: 02/12/2024] [Indexed: 02/28/2024] Open
Abstract
BACKGROUND Modern perioperative guidelines encourage drinking oral carbohydrates 2 h before management. Nevertheless, research on the safety of preoperative carbohydrate drinks, particularly in extremely elderly patients is lacking. We aimed to evaluate the safety of carbohydrate drinks 2 h before surgery in extremely elderly patients (≥ 80 years) using gastric ultrasonography. METHODS We conducted a randomized prospective comparative study of 70 patients aged over 80 years who were scheduled for total knee arthroplasty, hip fracture or humerus fracture surgery. These patients were randomly assigned to the carbohydrate group (n = 35), which fasted from midnight, except for drinking 355 mL of a carbohydrate-containing fluid 2 h before surgery, or the fasting group (n = 35), which fasted from midnight and drank no fluid before surgery. The primary outcome of the study was the cross-sectional area (CSA) of the gastric antrum in the right lateral decubitus position (RLDP) before surgery. The secondary outcomes included CSA in the supine position, intraoperative blood glucose levels and their variability coefficients, Perlas grade, and the visual analog scale of subjective feelings. RESULTS The CSA in the RLDP and supine positions revealed no differences between the carbohydrate and fasting groups at 0 h preoperatively (P > 0.05). In the qualitative assessment, preoperative 0-h Perlas grading did not differ significantly between the groups (P > 0.05). From 2 h before surgery to transfer out of the post-anesthesia care unit, the average blood glucose level of patients in the carbohydrate group was significantly higher than that in the fasting group (P < 0.001) but remained within the normal range. Moreover, the blood glucose variability coefficient was significantly lower in the carbohydrate group than in the fasting group (P = 0.009). Oral intake of 355 mL carbohydrates before surgery significantly relieved patients' feelings (P < 0.001). CONCLUSION Preoperative consumption of carbohydrate drinks 2 h before surgery is safe in "healthy" extremely elderly patients. In addition, preoperative drinking has potential value in maintaining ideal blood glucose levels and stable blood glucose fluctuations perioperatively and improving subjective perceptions of preoperative preparation. This finding warrants further investigation in clinical practice. TRIAL REGISTRATION Chinese Clinical Trial Registry (Registration Number ChiCTR1900024812), first registered on 29/07/2019.
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Affiliation(s)
- Lingyang Chen
- Department of Anesthesiology, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
- Department of Anesthesiology, Taizhou Hospital of Zhejiang Province, Zhejiang University, Linhai, China
| | - Nana Wang
- Department of Anesthesiology, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
- Department of Anesthesiology, Taizhou Hospital of Zhejiang Province, Zhejiang University, Linhai, China
| | - Guohao Xie
- Department of Anesthesiology, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
| | - Mingcang Wang
- Department of Anesthesiology, Taizhou Hospital of Zhejiang Province, Zhejiang University, Linhai, China
| | - Yulong Yu
- Department of Anesthesiology, Taizhou Hospital of Zhejiang Province, Zhejiang University, Linhai, China
| | - Huiqin Wang
- Department of Anesthesiology, Taizhou Hospital of Zhejiang Province, Zhejiang University, Linhai, China
| | - Xiangming Fang
- Department of Anesthesiology, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China.
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Jolley A, Jin W, Mansour K, Moore D, Douglas N, Loveday BPT. Reducing Preoperative Fasting Through Technology and Education in an Acute General Surgical Adult Cohort. Jt Comm J Qual Patient Saf 2023; 49:584-591. [PMID: 37419782 DOI: 10.1016/j.jcjq.2023.06.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Revised: 05/31/2023] [Accepted: 06/01/2023] [Indexed: 07/09/2023]
Abstract
BACKGROUND Despite widespread support for reduced fasting protocols prior to anesthesia, the traditional "fast from midnight" (FFMN) remains widely employed. This study implemented a pilot preoperative fasting reduction program for patients booked for acute surgery in the Department of General Surgery at a busy metropolitan tertiary hospital, including use of an electronic health record (EHR)-based solution, aiming to measure effect on fasting times and use of intravenous fluid (IVF). METHODS A pilot program was implemented in August 2021 in the Emergency General Surgery (EGS) unit at the Royal Melbourne Hospital, Australia. This included a new smart phrase within the EHR (EU2WU6: Eat until 2, drink water until 6) and an education campaign. Adult patients who underwent preoperative fasting between September 1 and December 31, 2021, were screened. Uptake of the protocol was recorded. Further, total fasting times (TFT) and IVF use were recorded. Potential impact with varying levels of protocol uptake was modeled. RESULTS Uptake of EU2WU6 increased from 0% to 80%. TFT and total time on IVF (TT-IVF) were lower using EU2WU6 (TFT 7 hours vs. 13 hours, p < 0.001; TT-IVF 3 hours vs. 8 hours, p < 0.001). Proportion of patients requiring fluid overnight when using EU2WU6 was lower (18/45 vs. 34/50, p = 0.0062). Hospitalwide yearly savings, with 100% application of EU2WU6, were projected at 2,050 bags of IVF (at a cost savings of A$2,296), 10,251 minutes for physicians, and 20,502 minutes for nurses. CONCLUSION The pilot preoperative fasting reduction program successfully reduced disparity between evidence and clinical practice.
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Nordkamp S, Creemers DMJ, Glazemakers S, Ketelaers SHJ, Scholten HJ, van de Calseijde S, Nieuwenhuijzen GAP, Tolenaar JL, Crezee HW, Rutten HJT, Burger JWA, Bloemen JG. Implementation of an Enhanced Recovery after Surgery Protocol in Advanced and Recurrent Rectal Cancer Patients after beyond Total Mesorectal Excision Surgery: A Feasibility Study. Cancers (Basel) 2023; 15:4523. [PMID: 37760492 PMCID: PMC10526990 DOI: 10.3390/cancers15184523] [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: 08/03/2023] [Revised: 09/06/2023] [Accepted: 09/07/2023] [Indexed: 09/29/2023] Open
Abstract
INTRODUCTION The implementation of an Enhanced Recovery After Surgery (ERAS) protocol in patients with locally advanced rectal cancer (LARC) and locally recurrent rectal cancer (LRRC) has been deemed unfeasible until now because of the heterogeneity of this disease and low caseloads. Since evidence and experience with ERAS principles in colorectal cancer care are increasing, a modified ERAS protocol for this specific group has been developed. The aim of this study is to evaluate the implementation of a tailored ERAS protocol for patients with LARC or LRRC, requiring beyond total mesorectal excision (bTME) surgery. METHODS Patients who underwent a bTME for LARC or LRRC between October 2021 and December 2022 were prospectively studied. All patients were treated in accordance with the ERAS LARRC protocol, which consisted of 39 ERAS care elements specifically developed for patients with LARC and LRRC. One of the most important adaptations of this protocol was the anaesthesia procedure, which involved the use of total intravenous anaesthesia with intravenous (iv) lidocaine, iv methadone, and iv ketamine instead of epidural anaesthesia. The outcomes showed compliance with ERAS care elements, complications, length of stay, and functional recovery. A follow-up was performed at 30 and 90 days post-surgery. RESULTS Seventy-two patients were selected, all of whom underwent bTME for either LARC (54.2%) or LRRC (45.8%). Total compliance with the adjusted ERAS protocol was 73.6%. Major complications were present in 12 patients (16.7%), and the median length of hospital stay was 9 days (IQR 6.0-14.0). Patients who received multimodal anaesthesia (75.0%) stayed in the hospital for a median of 7.0 days (IQR 6.8-15.5). These patients received fewer opioids on the first three postoperative days than patients who received epidural analgesia (p < 0.001). CONCLUSIONS The implementation of the ERAS LARRC protocol seemed successful according to its compliance rate of >70%. Its complication rate was substantially reduced in comparison with the literature. Multimodal anaesthesia is feasible in beyond TME surgery with promising effects on recovery after surgery.
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Affiliation(s)
- Stefi Nordkamp
- Department of Surgery, Catharina Hospital, 5623 EJ Eindhoven, The Netherlands (G.A.P.N.)
- Department of GROW, School for Oncology and Reproduction, Maastricht University, 6229 ER Maastricht, The Netherlands
| | - Davy M. J. Creemers
- Department of Surgery, Catharina Hospital, 5623 EJ Eindhoven, The Netherlands (G.A.P.N.)
| | - Sofie Glazemakers
- Department of Surgery, Catharina Hospital, 5623 EJ Eindhoven, The Netherlands (G.A.P.N.)
| | - Stijn H. J. Ketelaers
- Department of Surgery, Catharina Hospital, 5623 EJ Eindhoven, The Netherlands (G.A.P.N.)
| | - Harm J. Scholten
- Department of Anaesthesiology, Catharina Hospital, 5623 EJ Eindhoven, The Netherlands
| | | | | | - Jip L. Tolenaar
- Department of Surgery, Catharina Hospital, 5623 EJ Eindhoven, The Netherlands (G.A.P.N.)
| | - Hendi W. Crezee
- Department of Surgery, Catharina Hospital, 5623 EJ Eindhoven, The Netherlands (G.A.P.N.)
| | - Harm J. T. Rutten
- Department of Surgery, Catharina Hospital, 5623 EJ Eindhoven, The Netherlands (G.A.P.N.)
- Department of GROW, School for Oncology and Reproduction, Maastricht University, 6229 ER Maastricht, The Netherlands
| | - Jacobus W. A. Burger
- Department of Surgery, Catharina Hospital, 5623 EJ Eindhoven, The Netherlands (G.A.P.N.)
| | - Johanne G. Bloemen
- Department of Surgery, Catharina Hospital, 5623 EJ Eindhoven, The Netherlands (G.A.P.N.)
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Van Egmond JC, De Esch NHH, Verburg H, Van Dasselaar NT, Mathijssen NMC. Preoperative carbohydrate drink in fast-track primary total knee arthroplasty: a randomized controlled trial of 168 patients. Acta Orthop Belg 2023; 89:485-490. [PMID: 37935233 DOI: 10.52628/89.3.11930] [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: 11/09/2023]
Abstract
A key component in fast-track total knee arthroplasty (TKA) is early mobilization. Preoperative fasting might cause orthostatic hypotension and -intolerance which both can interfere with early mobilization. It was hypothesized that consuming a carbohydrate drink 2-3 hours prior to surgery is a viable option to reduce orthostatic hypotension, and as a result, improve rehabilitation. In this randomized controlled trial, all consecutive unilateral primary TKA patients were reviewed for eligibility. Exclusion criteria were American Society of Anesthesiologists (ASA) class above 3, older than 80 years of age, Diabetes Mellitus, and an insufficient comment of Dutch language. Patients were distributed in two groups. The control group was allowed to eat till 6 hours and drink clear fluids till 2 hours before surgery (standard treatment). The intervention group consumed, additionally to the standard treatment, a carbohydrate drink 2-3 hours before surgery. Blood pressure was measured both lying and standing as a measure for orthostatic hypotension during first time postoperative mobilization on day of surgery. A total of 168 patients were included. Prevalence of orthostatic hypotension in the control- and intervention group was 24 patients (34%) and 14 patients (19%) respectively, (p=0.05). Prevalence of orthostatic intolerance was 13 patients (19%) in the control group and 9 patients (13%) in the intervention group (p=0.32). No drink related adverse events occurred. In conclusion, taking a carbohydrate drink 2-3 hours before TKA significantly lowers the number of patients with orthostatic hypotension in early mobilization. However, the clinical relevance of the carbohydrate drink has to be studied further.
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Pettit MS, Crowder SL, Ackerman RS, Hafez O, Poch MA, Patel SY. Preoperative Nutritional Status and Enhanced Recovery after Surgery (ERAS) Prior to Radical Cystectomy: A Review of the Literature. Nutr Cancer 2023; 75:1743-1751. [PMID: 37553951 DOI: 10.1080/01635581.2023.2244172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Revised: 07/18/2023] [Accepted: 07/21/2023] [Indexed: 08/10/2023]
Abstract
Preoperative nutritional status is an important and modifiable risk factor of a patient's recovery and outcome after radical cystectomy. There are multiple malnutrition screening tools and treatment options. In this review, we discuss the best indicators of this condition and how to optimize nutrition status prior to radical cystectomy.
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Affiliation(s)
- Matthew S Pettit
- University of South Florida, Morsani College of Medicine, Tampa, Florida, USA
| | - Sylvia L Crowder
- Department of Health Outcomes and Behavior, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida, USA
| | - Robert S Ackerman
- Department of Anesthesiology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida, USA
| | - Osama Hafez
- Department of Anesthesiology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida, USA
| | - Michael A Poch
- Department of Genitourinary Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida, USA
| | - Sephalie Y Patel
- Department of Anesthesiology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida, USA
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Atkinson DJ, Romeiser JL, Almasry IO, Tannous HJ, Parikh PB, Bennett-Guerrero E. Randomized controlled trial of liberal vs. standard fasting instructions in percutaneous cardiac procedures. Perioper Med (Lond) 2023; 12:44. [PMID: 37553699 PMCID: PMC10408039 DOI: 10.1186/s13741-023-00333-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Accepted: 07/25/2023] [Indexed: 08/10/2023] Open
Abstract
BACKGROUND Pre-procedural fasting to reduce aspiration risk is usual care prior to surgery requiring anesthesia. Prolonged fasting, however, can result in dehydration and may adversely affect patient experience and outcomes. Previous studies suggest that providing a supplemental beverage to patients undergoing cardiac and a variety of other surgical procedures improves patients' subjective assessment of thirst and hunger and potentially decreases the need for inotrope and vasopressor therapy. Less is known, however, about the effects of ad libitum clear liquids up to 2 h prior to surgery. METHODS Adult patients undergoing transcatheter aortic valve replacement (TAVR) or arrhythmia ablation were randomized (1:1) to ad libitum clear liquids up to 2 h prior to their procedure vs. nil per os (NPO) after midnight (control group, usual care). The primary endpoint was a composite satisfaction score that included patient-reported thirst, hunger, headache, nausea, lightheadedness, and anxiousness prior to surgery. The incidence of case-delay was recorded. Intraoperative vasopressor administration, changes in creatinine, anti-emetic use, and hospital length of stay (LOS) were recorded. Safety endpoints including aspiration were assessed. RESULTS A total of 200 patients were randomized and 181 patients were included in the final analysis. Overall, 92% of patients were ASA class III or IV and 23% of patients had NYHA class III or IV symptoms. Groups were well balanced with no significant differences in age, sex or baseline cardiac or renal disease. The composite satisfaction score (primary endpoint) was not significantly different between groups (Ad libitum median = 12, IQR = [6, 17], vs Standard NPO median = 10, IQR = [5, 15], [95% CI = [-1, 4]). No significant differences between the two groups were observed in any of the individual survey questions (thirst, hunger, headache, nausea, lightheadedness, anxiousness). No significant differences between groups were observed for intra-operative vasopressor use, changes in creatinine, rescue anti-emetic use or hospital LOS. There were no case delays attributed to the intervention. There were no cases of suspected aspiration. CONCLUSION No adverse events or case delays were observed in the ad libitum clears group. No significant benefit, however, was observed in patient satisfaction or any of the pre-specified secondary endpoints in patients randomized to ad libitum clear liquids up to 2 h prior to their procedure. TRIAL REGISTRATION NCT04079543.
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Affiliation(s)
- Derek J Atkinson
- Departments of Anesthesiology (DA, JLR, EBG), Medicine/Cardiology (IA, PP), and Surgery/Cardiothoracic (HT), Stony Brook University Medical Center, 101 Nicolls Road, Stony Brook, NY, 11794, USA.
| | - Jamie L Romeiser
- Departments of Anesthesiology (DA, JLR, EBG), Medicine/Cardiology (IA, PP), and Surgery/Cardiothoracic (HT), Stony Brook University Medical Center, 101 Nicolls Road, Stony Brook, NY, 11794, USA
- Department of Public Health and Preventive Medicine, SUNY Upstate Medical University, Syracuse, NY, USA
| | - Ibrahim O Almasry
- Departments of Anesthesiology (DA, JLR, EBG), Medicine/Cardiology (IA, PP), and Surgery/Cardiothoracic (HT), Stony Brook University Medical Center, 101 Nicolls Road, Stony Brook, NY, 11794, USA
| | - Henry J Tannous
- Departments of Anesthesiology (DA, JLR, EBG), Medicine/Cardiology (IA, PP), and Surgery/Cardiothoracic (HT), Stony Brook University Medical Center, 101 Nicolls Road, Stony Brook, NY, 11794, USA
| | - Puja B Parikh
- Departments of Anesthesiology (DA, JLR, EBG), Medicine/Cardiology (IA, PP), and Surgery/Cardiothoracic (HT), Stony Brook University Medical Center, 101 Nicolls Road, Stony Brook, NY, 11794, USA
| | - Elliott Bennett-Guerrero
- Departments of Anesthesiology (DA, JLR, EBG), Medicine/Cardiology (IA, PP), and Surgery/Cardiothoracic (HT), Stony Brook University Medical Center, 101 Nicolls Road, Stony Brook, NY, 11794, USA
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Reuter S, Schmalfeldt B, Haas SA, Zapf A, Cevirme S, Prieske K, Wölber L, Müller V, Zöllner C, Jaeger A. Impact of Introducing a PACU24 Concept on the Perioperative Outcome of Patients with Advanced Ovarian Cancer Treated with Cytoreductive Surgery. Geburtshilfe Frauenheilkd 2023; 83:1022-1030. [PMID: 37588253 PMCID: PMC10427201 DOI: 10.1055/a-2055-9349] [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: 12/15/2022] [Accepted: 03/15/2023] [Indexed: 08/18/2023] Open
Abstract
Introduction Patients with ovarian cancer who undergo multivisceral surgery usually require intensive care monitoring postoperatively. In view of the ever-fewer numbers of high-care/intensive care beds and the introduction of fast-track treatment concepts, it is increasingly being suggested that these patients should be cared for postoperatively in 24-h Post Anesthesia Care Units (PACU24). No analyses have been carried out to date to investigate whether such a postoperative care concept might be associated with a potential increase in postoperative complications in this patient cohort. Methods A PACU24 unit was set up in our institution in 2015 and it has become the primary postoperative care pathway for patients with ovarian cancer who have undergone cytoreductive (debulking) surgery. A structured, retrospective analysis of data from patients treated before (control group) and after (PACU group) the introduction of this care concept was carried out, with a particular focus on postoperative complications and secondary admission to an intensive care unit where necessary. Results The data of 42 patients were analyzed for the PACU group and 45 patients for the control group. According to the analysis, the preoperative and surgical data of both groups were comparable (age, ASA, BMI, FIGO stage, duration of surgery, blood loss). The Physiological and Operative Severity Score for the enUmeration of Mortality and morbidity (POSSUM score) as a measure for the risk of postoperative complications was higher in the PACU group (11.1% vs. 9.7%, p = 0.001). Patients in the PACU group underwent bowel resection with anastomosis significantly more often (76.3% vs. 33.3%, p < 0.001), although the extent of surgery was otherwise comparable. The total number, type and severity of postoperative complications and the duration of the overall stay in hospital did not differ between the two groups. None of the patients required secondary transfer from the PACU or normal ward to an intensive care unit (ICU). Summary Our data support the assumption that the care concept of transferring patients to a PACU24 represents a safe and cost-saving care pathway for the postoperative care of patients even after complex gynecological-oncological procedures.
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Affiliation(s)
- Susanne Reuter
- Klinik und Poliklinik für Gynäkologie, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany
| | - Barbara Schmalfeldt
- Klinik und Poliklinik für Gynäkologie, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany
| | - Sebastian A. Haas
- Klinik und Poliklinik für Anästhesiologie, Intensivmedizin und Schmerztherapie, Universitätsmedizin Rostock, Rostock, Germany
| | - Antonia Zapf
- Institut für Medizinische Biometrie und Epidemiologie, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany
| | - Sinan Cevirme
- Institut für Medizinische Biometrie und Epidemiologie, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany
| | - Katharina Prieske
- Klinik und Poliklinik für Gynäkologie, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany
| | - Linn Wölber
- Klinik und Poliklinik für Gynäkologie, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany
| | - Volkmar Müller
- Klinik und Poliklinik für Gynäkologie, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany
| | - Christian Zöllner
- Klinik und Poliklinik für Anästhesiologie, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany
| | - Anna Jaeger
- Klinik und Poliklinik für Gynäkologie, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany
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Marsman M, Kappen TH, Vernooij LM, van der Hout EC, van Waes JA, van Klei WA. Association of a Liberal Fasting Policy of Clear Fluids Before Surgery With Fasting Duration and Patient Well-being and Safety. JAMA Surg 2023; 158:254-263. [PMID: 36598762 PMCID: PMC9857800 DOI: 10.1001/jamasurg.2022.5867] [Citation(s) in RCA: 14] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Accepted: 09/16/2022] [Indexed: 01/05/2023]
Abstract
Importance Current fasting guidelines for procedures under anesthesia are poorly implemented, leading to negative metabolic sequelae. Recent studies in children showed support of liberal clear fluid intake; adult physiology can support clear fluid intake, but implementation studies are lacking. Objective To evaluate the successfulness of implementation of a liberal clear fluid policy with regard to fasting duration, well-being, and safety in adults scheduled for anesthesia. Design, Setting, and Participants This was a quality improvement study conducted from January 2016 to July 2021 at a tertiary referral hospital in the Netherlands. Adults scheduled for nonemergency procedures under anesthesia were included in the study. Patients undergoing obstetrics procedures or those who were intubated preoperatively were excluded. Interventions Stepwise introduction of a liberal fluid fasting policy, allowing for ingestion of clear fluids until arrival at the operating room. Main Outcomes and Measures The primary outcome was change in fasting duration. Secondary outcomes were patient well-being, measured as preoperative thirst, amount of fluid ingested, postoperative nausea and vomiting (PONV), and administration of antiemetics. Safety was measured as incidence of regurgitation and aspiration (pneumonia). Results Of the 76 451 patients (mean [SD] age, 56 [17] years; 39 530 male individuals [52%] 36 921) included in the study, 59 036 (78%) followed the standard policy, and 16 815 (22%) followed the liberal policy. Time series analysis showed an estimated fasting duration decrease of 3:07 hours (IQR, 1:36-7:22; P < .001) after implementation of the liberal policy. Postimplementation median (IQR) fasting duration was 1:20 (0:48-2:24) hours. The incidence of regurgitation changed from 18 (95% CI, 14-21) to 24 (95% CI, 17-32) in 10 000 patients, and the incidence of aspiration changed from 1.7 (95% CI, 0.6-2.7) to 2.4 (95% CI, 0.5-4.7) in 10 000 patients. In the liberal policy, thirst feelings decreased (37% [4982 of 8615] vs 46% [3373 of 7362]; P < .001). PONV incidence decreased from 10.6% (6339 of 59 636) to 9.4% (1587 of 16 815; P < .001) and antiemetic administration decreased from 11.0% (6538 of 59 636) to 9.5% (1592 of 16 815; P < .001). Conclusions and Relevance Results of this quality improvement study suggest that a liberal fasting policy was associated with a clinically relevant reduction in fasting duration and improved patient well-being with regard to preoperative thirst and PONV. Although a slightly higher incidence of regurgitation could not be ruled out, wider implementation of such a policy may be advocated as results are still within the clinically accepted risks margins. Results suggest that surgical procedures in patients who drink clear fluids within 2 hours before anticipated anesthesia should not be postponed or canceled.
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Affiliation(s)
- Marije Marsman
- Department of Anesthesiology and Intensive Care Medicine, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Teus H. Kappen
- Department of Anesthesiology and Intensive Care Medicine, University Medical Center Utrecht, Utrecht, the Netherlands
- Department of Information Technology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Lisette M. Vernooij
- Department of Anesthesiology and Intensive Care Medicine, University Medical Center Utrecht, Utrecht, the Netherlands
| | | | - Judith A. van Waes
- Department of Anesthesiology and Intensive Care Medicine, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Wilton A. van Klei
- Department of Anesthesiology and Intensive Care Medicine, University Medical Center Utrecht, Utrecht, the Netherlands
- Department of Anesthesia and Pain Management, Toronto General Hospital, University Health Network Toronto, Ontario, Canada
- Department of Anesthesiology and Pain Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Toronto General Hospital Research Institute, Toronto, Ontario, Canada
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The Nuts and Bolts of Implementing a Modified ERAS Protocol for Minimally Invasive Colorectal Surgery: Group Practice vs. Solo Practice. J Clin Med 2022; 11:jcm11236992. [PMID: 36498566 PMCID: PMC9739177 DOI: 10.3390/jcm11236992] [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] [Received: 10/16/2022] [Revised: 11/13/2022] [Accepted: 11/24/2022] [Indexed: 11/29/2022] Open
Abstract
AIM: The ERAS protocol consists of multiple items that aim to improve the outcomes of patients receiving surgery. Adhering to the protocol is difficult. We wondered whether surgeons practicing the ERAS protocol in a group would improve patient outcomes. Methods: All patients who underwent colorectal resection for benign disease or malignancy from November 2017 to December 2018 were collected and reviewed retrospectively. According to the physician’s ward round strategy, the patients were categorized into two groups, either by solo practice or group practice. Results: This study enrolled 724 patients and divided them into two groups according to the practice method: group practice (n = 256) and solo practice (n = 468). The group practice cohort had less postoperative morbidity (14.0% vs. 21.4%, p = 0.048) and shorter postoperative hospital stays (mean: 6.6 ± 3.2 vs. 8.6 ± 5.5, p < 0.05) than the solo practice cohort. Group practice (p < 0.001), natural orifice specimen extraction (NOSE) procedure (p < 0.001), and blood loss >50 mL (p = 0.039) significantly affected discharge within 5 days postoperatively in multivariate analyses. Conclusions: Group practice based on a modified ERAS protocol shortens postoperative hospital stays with fewer morbidities compared with solo practice in which patients receive elective minimally invasive colorectal surgery.
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Efficacy and safety of pre-gastroscopy commercial carbohydrate-rich whey protein beverage vs. plain water: a randomised controlled trial. Sci Rep 2022; 12:17355. [PMID: 36253448 PMCID: PMC9576750 DOI: 10.1038/s41598-022-22363-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Accepted: 10/13/2022] [Indexed: 01/10/2023] Open
Abstract
Clinical benefits and safety of carbohydrate loading pre-gastroscopy remain unclear. We aimed to determine the effects of a commercial carbohydrate-rich whey protein beverage versus plain water given pre-gastroscopy on gastric residual volume and well-being, and to determine adverse events. This was a single centre, single-blinded, parallel-group, sex-stratified randomized controlled trial. Participants were randomized either to carbohydrate-rich whey protein beverage group (Resource®, Nestle Health Science) or control group (250 ml plain water) given pre-gastroscopy. Gastric contents were aspirated into a suction reservoir bottle to determine the gastric residual volume (GRV). Visual analogue scale (VAS) of well-being (anxiety, hunger, thirst, tiredness, and weakness) was compared before and after the intervention. Adverse events were also evaluated post-intervention. Of 369 screened, 78 participants (36 males, mean age 49 ± 14.3 years) were randomized. Compared with the control group, carbohydrate beverage was associated with significantly higher GRV (p < 0.001). Anxiety was less after intervention with carbohydrate beverage (p = 0.016), and after adjustment for confounders, fewer participants also experienced hunger (p = 0.043) and thirst (p = 0.021). No serious adverse events were reported with both interventions. Commercial carbohydrate-rich whey protein beverage is associated with higher gastric residual volume, better well-being and safe.Trial registration Clinicaltrial.gov. Identifier: NCT03948594, Date of registration: 14/05/2019.
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The Effect of Premedication on the Incidence of Gastroesophageal Reflux in 270 Dogs Undergoing General Anesthesia. Animals (Basel) 2022; 12:ani12192667. [PMID: 36230408 PMCID: PMC9559275 DOI: 10.3390/ani12192667] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Revised: 09/27/2022] [Accepted: 09/29/2022] [Indexed: 11/16/2022] Open
Abstract
The aim of this prospective, non-randomized study was to evaluate the effect of nine different premedication medications on the incidence of gastroesophageal reflux (GOR) in anesthetized dogs. Two hundred and seventy dogs undergoing non-intrathoracic, non-intrabdominal elective surgeries or invasive diagnostic procedures were included in the study, and were allocated into nine groups (30 dogs/group) defined by the type of premedication administered. Premedication consisted of dexmedetomidine with either morphine, pethidine or butorphanol, acepromazine with either one of the three opioids or midazolam with one of the above-mentioned opioids. Anesthesia was induced with propofol and maintained with isoflurane in oxygen. Esophageal pH was measured with the use of a pH-meter electrode and a pH-value less than 4 and over 7.5 was considered to be GOR. The study revealed that 119/270 (44.1%) dogs experienced a reflux episode during anesthesia. The incidence of reflux did not differ among groups (p = 0.117). In group AB the dogs refluxed within 10 min of the beginning of pH-measurements, in comparison with group DB in which dogs refluxed within 30 min (p = 0.029). Invasive diagnostic procedures had a lower incidence of GOR in comparison to castrations (p = 0.09). The outcome of the study suggests that none of the opioids used increased the incidence of GOR in anesthetized dogs.
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15
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Ying Y, Xu HZ, Han ML. Enhanced recovery after surgery strategy to shorten perioperative fasting in children undergoing non-gastrointestinal surgery: A prospective study. World J Clin Cases 2022; 10:5287-5296. [PMID: 35812657 PMCID: PMC9210880 DOI: 10.12998/wjcc.v10.i16.5287] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Revised: 04/02/2022] [Accepted: 04/28/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Enhanced recovery after surgery strategies are increasingly implemented to improve the management of surgical patients.
AIM To evaluate the effects of new perioperative fasting protocols in children ≥ 3 mo of age undergoing non-gastrointestinal surgery.
METHODS This prospective pilot study included children ≥ 3 mo of age undergoing non-gastrointestinal surgery at the Children’s Hospital (Zhejiang University School of Medicine) from January 2020 to June 2020. The children were divided into either a conventional group or an ERAS group according to whether they had been enrolled before or after the implementation of the new perioperative fasting strategy. The children in the conventional group were fasted using conventional strategies, while those in the ERAS group were given individualized fasting protocols preoperatively (6-h fasting for infant formula/non-human milk/solids, 4-h fasting for breast milk, and clear fluids allowed within 2 h of surgery) and postoperatively (food permitted from 1 h after surgery). Pre-operative and postoperative fasting times, pre-operative blood glucose, the incidence of postoperative thirst and hunger, the incidence of perioperative vomiting and aspiration, and the degree of satisfaction were evaluated.
RESULTS The study included 303 patients (151 in the conventional group and 152 in the ERAS group). Compared with the conventional group, the ERAS group had a shorter pre-operative food fasting time [11.92 (4.00, 19.33) vs 13.00 (6.00, 20.28) h, P < 0.001), shorter preoperative liquid fasting time [3.00 (2.00, 7.50) vs 12.00 (3.00, 20.28) h, P < 0.001], higher preoperative blood glucose level [5.6 (4.2, 8.2) vs 5.1 (4.0, 7.4) mmol/L, P < 0.001], lower incidence of thirst (74.5% vs 15.3%, P < 0.001), shorter time to postoperative feeding [1.17 (0.33, 6.83) vs 6.00 (5.40, 9.20), P < 0.001], and greater satisfaction [7 (0, 10) vs 8 (5, 10), P < 0.001]. No children experienced perioperative aspiration. The incidences of hunger, perioperative vomiting, and fever were not significantly different between the two groups.
CONCLUSION Optimizing fasting and clear fluid drinking before non-gastrointestinal surgery in children ≥ 3 mo of age is possible. It is safe and feasible to start early eating after evaluating the recovery from anesthesia and the swallowing function.
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Affiliation(s)
- Yan Ying
- Department of General Surgery, Children's Hospital of Zhejiang University School of Medicine, Hangzhou 310052, Zhejiang Province, China
| | - Hong-Zhen Xu
- Department of General Surgery, Children's Hospital of Zhejiang University School of Medicine, Hangzhou 310052, Zhejiang Province, China
| | - Meng-Lan Han
- Department of General Surgery, Children's Hospital of Zhejiang University School of Medicine, Hangzhou 310052, Zhejiang Province, China
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16
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Oodit R, Biccard BM, Panieri E, Alvarez AO, Sioson MRS, Maswime S, Thomas V, Kluyts HL, Peden CJ, de Boer HD, Brindle M, Francis NK, Nelson G, Gustafsson UO, Ljungqvist O. Guidelines for Perioperative Care in Elective Abdominal and Pelvic Surgery at Primary and Secondary Hospitals in Low-Middle-Income Countries (LMIC's): Enhanced Recovery After Surgery (ERAS) Society Recommendation. World J Surg 2022; 46:1826-1843. [PMID: 35641574 PMCID: PMC9154207 DOI: 10.1007/s00268-022-06587-w] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/16/2022] [Indexed: 12/24/2022]
Abstract
Background This is the first Enhanced Recovery After Surgery (ERAS®) Society guideline for primary and secondary hospitals in low–middle-income countries (LMIC’s) for elective abdominal and gynecologic care. Methods The ERAS LMIC Guidelines group was established by the ERAS® Society in collaboration with different representatives of perioperative care from LMIC’s. The group consisted of seven members from the ERAS® Society and eight members from LMIC’s. An updated systematic literature search and evaluation of evidence from previous ERAS® guidelines was performed by the leading authors of the Colorectal (2018) and Gynecologic (2019) surgery guidelines (Gustafsson et al in World J Surg 43:6592–695, Nelson et al in Int J Gynecol Cancer 29(4):651–668). Meta-analyses randomized controlled trials (RCTs), prospective and retrospective cohort studies from both HIC’s and LMIC’s were considered for each perioperative item. The members in the LMIC group then applied the current evidence and adapted the recommendations for each intervention as well as identifying possible new items relevant to LMIC’s. The Grading of Recommendations, Assessment, Development and Evaluation system (GRADE) methodology was used to determine the quality of the published evidence. The strength of the recommendations was based on importance of the problem, quality of evidence, balance between desirable and undesirable effects, acceptability to key stakeholders, cost of implementation and specifically the feasibility of implementing in LMIC’s and determined through discussions and consensus. Results In addition to previously described ERAS® Society interventions, the following items were included, revised or discussed: the Surgical Safety Checklist (SSC), preoperative routine human immunodeficiency virus (HIV) testing in countries with a high prevalence of HIV/AIDS (CD4 and viral load for those patients that are HIV positive), delirium screening and prevention, COVID 19 screening, VTE prophylaxis, immuno-nutrition, prehabilitation, minimally invasive surgery (MIS) and a standardized postoperative monitoring guideline. Conclusions These guidelines are seen as a starting point to address the urgent need to improve perioperative care and to effect data-driven, evidence-based care in LMIC’s.
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Affiliation(s)
- Ravi Oodit
- Division of Global Surgery, University of Cape Town, Anzio Road, Observatory, Cape Town, Western Cape, South Africa
| | - Bruce M Biccard
- Department of Anesthesia and Perioperative Medicine, Groote Schuur Hospital, University of Cape Town, Anzio Road, Observatory, Cape Town, Western Cape, South Africa
| | - Eugenio Panieri
- Division of General Surgery, Groote Schuur Hospital, University of Cape Town, Anzio Road, Observatory, Cape Town, Western Cape, South Africa
| | - Adrian O Alvarez
- Anesthesia Department, Hospital Italiano de Buenos Aires, Teniente General Juan Domingo Peron, 4190, C1199ABB, Beunos Aires, Argentina
| | - Marianna R S Sioson
- Head Section of Medical Nutrition, Department of Medicine and ERAS Team, The Medical City, Ortigas Avenue, Manila, Metro Manila, Philippines
| | - Salome Maswime
- Division of Global Surgery, University of Cape Town, Anzio Road, Observatory, Cape Town, Western Cape, South Africa
| | - Viju Thomas
- Department of Obstetrics and Gynaecology, Tygerberg Hospital and University of Stellenbosch, Francie Van Zyl Drive, Parow, Cape Town, Western Cape, South Africa
| | - Hyla-Louise Kluyts
- Department of Anaesthesiology, Sefako Makgatho Health Sciences University, Medunsa, Molotlegi Street, P.O. Box 60, Ga-Rankuwa, Pretoria, 0204, Gauteng, South Africa
| | - Carol J Peden
- Keck School of Medicine, University of Southern California, 1975 Zonal Ave, Los Angeles, CA, 90033, USA.,Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, 19104, USA
| | - Hans D de Boer
- Department of Anesthesiology, Pain Medicine and Procedural Sedation and Analgesia, Martini General Hospital Groningen, Van Swietenplein 1, 9728 NT, Groningen, The Netherlands
| | - Mary Brindle
- Cumming School of Medicine, University of Calgary, London, Canada.,Alberta Children's Hospital, Calgary, Canada.,Safe Systems, Ariadne Labs, Stockholm, USA.,EQuIS Research Platform, Orebro, Canada
| | - Nader K Francis
- Division of Surgery and Interventional Science- UCL, Gower Street, London, WC1E 6BT, UK
| | - Gregg Nelson
- Department of Obstetrics & Gynecology, University of Calgary, 1331 29 St NW, Calgary, AB, T2N 4N2, Canada
| | - Ulf O Gustafsson
- Department of Clinical Sciences, Division of Surgery, Danderyd Hospital, Karolinska Institutet, Entrevägen 2, 19257, Stockholm, Danderyd, Sweden
| | - Olle Ljungqvist
- School of Medical Sciences, Department of Surgery, Örebro University, 701 85, Örebro, Sweden.
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Alexander J, Castelow C, Cieker C, Wilbanks D, Asbeutah AA, Khouzam RN, Melton CD. Is NPO (Nil Per Os) order helping or hindering elective cardiac procedures? Curr Probl Cardiol 2022:101179. [PMID: 35341803 DOI: 10.1016/j.cpcardiol.2022.101179] [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: 02/27/2022] [Accepted: 03/22/2022] [Indexed: 11/26/2022]
Abstract
The practice of fasting before elective cardiac procedures including cardiac catheterization and transesophageal echocardiography is commonly implemented but evidence for these requirements is lacking. Fasting periods often exceed the intended length of time, increasing the risk of irritability, dehydration, acute kidney injury, hypoglycemia, and length of hospitalization. The practice of perioperative fasting relies on the premise that aspiration during general anesthesia can be mitigated by minimizing the volume of gastric contents, and stomach acidity. But the evidence has shown that fasting does not guarantee an empty stomach, and there is no observed association between aspiration and compliance with common fasting guidelines. Elective cardiac procedures are performed using procedural sedation, where the risk of serious aspiration is small. In most patients, we argue, that strict fasting requirements should be reduced, and a more nuanced fasting protocol based on individual patient characteristics and risk factors should be utilized given the overall low risk of aspiration with elective procedures utilizing procedural sedation. In this review, we examine the historical origins and current evidence relating to the practice of fasting as it relates to cardiac catheterization and transesophageal echocardiography.
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Affiliation(s)
- John Alexander
- Department of Internal Medicine, University of Tennessee Health Science Center, Memphis, TN.
| | | | | | - David Wilbanks
- Department of Internal Medicine, University of Tennessee Health Science Center, Memphis, TN
| | - Abdul Aziz Asbeutah
- Department of Internal Medicine, University of Tennessee Health Science Center, Memphis, TN
| | - Rami N Khouzam
- Department of Internal Medicine, Division of Cardiovascular Diseases, University of Tennessee Health Science Center, Memphis, TN
| | - Charles D Melton
- Baylor Scott and White Health, All Saints Medical Center, Fort Worth, TX
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Özdemir S, Aksungur N, Altundaş N, Kara S, Korkut E, Özkaraca M, Sefa Mendil A, Öztürk G. Genome-wide profiling of the expression of serum derived exosomal circRNAs in patients with hepatic alveolar echinococcosis. Gene 2022; 814:146161. [PMID: 34995736 DOI: 10.1016/j.gene.2021.146161] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Revised: 10/30/2021] [Accepted: 12/06/2021] [Indexed: 01/22/2023]
Abstract
The patients with hepatic alveolar echinococcosis is poorly detected due to invasive and slow growth. Thus, early diagnosis of hepatic alveolar echinococcosis is so important for patients. Circular RNAs are crucial types of the non-coding RNA. Recent studies have provided serum-derived exosomal circRNAs as potential biomarkers for detection of various diseases. The clinical importance of exosomal circRNAs in hepatic alveolar echinococcosis have never been explored before. Here, we investigated the serum-derived exosomal circRNAs in the diagnosis of hepatic alveolar echinococcosis. Firstly, High-throughput Sequencing was performed using 9 hepatic alveolar echinococcosis and 9 control samples to detect hepatic alveolar echinococcosis related circRNAs. Afterwards, bioinformatic analyzes were performed to identify differentially expressed circRNAs and pathway analyzes were performed. Finally, validation of the determined circRNAs was performed using RT-PCR. The sequencing data indicated that 59 differentially expressed circRNAs; 31 up-regulated and 28 down-regulated circRNA in hepatic alveolar echinococcosis patients. The top 5 up-regulated and down-regulated circRNAs were selected for validation by RT-qPCR assay. As a result of the verification, circRNAs that were significantly up- and down-regulated showed an expression profile consistent with the results obtained. Importantly, our findings suggested that identified exosomal circRNAs could be a potential biomarker for the detection of hepatic alveolar echinococcosis serum and may help to understand the pathogenesis of hepatic alveolar echinococcosis.
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Affiliation(s)
- Selçuk Özdemir
- Atatürk University, Faculty of Veterinary Medicine, Department of Genetics, Erzurum, Turkey; Heinrich Heine University, Faculty of Medicine, Department of Gastroenterology, Hepatology and Infection, Düsseldorf, Germany.
| | - Nurhak Aksungur
- Atatürk University, Faculty of Medicine, Department of General Surgery, Erzurum, Turkey
| | - Necip Altundaş
- Atatürk University, Faculty of Medicine, Department of General Surgery, Erzurum, Turkey
| | - Salih Kara
- Atatürk University, Faculty of Medicine, Department of General Surgery, Erzurum, Turkey
| | - Ercan Korkut
- Atatürk University, Faculty of Medicine, Department of General Surgery, Erzurum, Turkey
| | - Mustafa Özkaraca
- Sivas Cumhuriyet University, Faculty of Veterinary Medicine, Department of Pathology, Sivas, Turkey
| | - Ali Sefa Mendil
- Erciyes University, Faculty of Veterinary Medicine, Department of Pathology, Kayseri, Turkey
| | - Gürkan Öztürk
- Atatürk University, Faculty of Medicine, Department of General Surgery, Erzurum, Turkey
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Ocón Bretón MJ, Tapia Guerrero MJ, Ramírez Rodriguez JM, Peteiro Miranda C, Ballesteros Pomar MD, Botella Romero F, Martínez Olmos MÁ, Luengo Pérez LM, Cancer Minchot E, García Malpartida K, López Gómez JJ, Zugasti Murillo A, Álvarez Hernández J, Bretón Lesmes I. Multidisciplinary consensus on nutritional and metabolic therapy in enhanced recovery after abdominal surgery programs: NutRICA Project. ENDOCRINOL DIAB NUTR 2022; 69:98-111. [PMID: 35256065 DOI: 10.1016/j.endien.2021.02.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Accepted: 02/05/2021] [Indexed: 06/14/2023]
Abstract
BACKGROUND The Enhanced Recovery After Surgery (ERAS) care pathways include evidence-based items designed to accelerate recovery after surgery. Interdisciplinarity is one of the key points of ERAS programs. OBJECTIVE To prepare a consensus document among the members of the Nutrition Area of the Spanish Society of Endocrinology and Nutrition (SEEN) and the Spanish Group for Multimodal Rehabilitation (GERM), in which the goal is to homogenize the nutritional and metabolic management of patients included in an ERAS program. METHODS 69 specialists in Endocrinology and Nutrition and 85 members of the GERM participated in the project. After a literature review, 79 statements were proposed, divided into 5 sections: 17 of general characteristics, 28 referring to the preoperative period, 4 to the intraoperative, 13 to the perioperative and 17 to the postoperative period. The degree of consensus was determined through a Delphi process of 2 circulations that was ratified by a consistency analysis. RESULTS Overall, in 61 of the 79 statements there was a consistent agreement, with the degree of consensus being greater among members of the SEEN (64/79) than members of the GERM (59/79). Within the 18 statements where a consistent agreement was not reached, we should highlight some important nutritional strategies such as muscle mass assessment, the start of early oral feeding or pharmaconutrition. CONCLUSION Consensus was reached on the vast majority of the nutritional measures and care included in ERAS programs. Due to the lack of agreement on certain key points, it is necessary to continue working closely with both societies to improve the recovery of the surgical patients.
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Affiliation(s)
- M Julia Ocón Bretón
- Sección de Nutrición Clínica, Hospital Clínico Universitario Lozano Blesa, Zaragoza, Spain.
| | - M José Tapia Guerrero
- Servicio de Endocrinología y Nutrición, Hospital Regional Universitario de Málaga, Malaga, Spain
| | | | - Carlos Peteiro Miranda
- Servicio de Endocrinología y Nutrición, Hospital de Viladecans, Viladecans, Barcelona, Spain
| | | | - Francisco Botella Romero
- Servicio de Endocrinología y Nutrición, Complejo Hospitalario Universitario de Albacete, Albacete, Spain; Comité Gestor de Área de Nutrición de la Sociedad Española de Endocrinología y Nutrición (SEEN), Spain
| | - Miguel Ángel Martínez Olmos
- Servicio de Endocrinología y Nutrición, Complejo Hospitalario Universitario de Santiago de Compostela, Santiago de Compostela, Spain
| | | | - Emilia Cancer Minchot
- Sección de Endocrinología y Nutrición, Hospital Universitario de Fuenlabrada, Fuenlabrada, Madrid, Spain; Comité Gestor de Área de Nutrición de la Sociedad Española de Endocrinología y Nutrición (SEEN), Spain
| | - Katherine García Malpartida
- Sección de Endocrinología y Nutrición, Hospital Universitario y Politécnico la Fe, Valencia, Spain; Comité Gestor de Área de Nutrición de la Sociedad Española de Endocrinología y Nutrición (SEEN), Spain
| | - Juan José López Gómez
- Servicio de Endocrinología y Nutrición, Hospital Clínico Universitario de Valladolid, Valladolid, Spain; Comité Gestor de Área de Nutrición de la Sociedad Española de Endocrinología y Nutrición (SEEN), Spain
| | - Ana Zugasti Murillo
- Sección de Nutrición Clínica y Dietética, Complejo Hospitalario de Navarra, Pamplona, Navarra, Spain; Comité Gestor de Área de Nutrición de la Sociedad Española de Endocrinología y Nutrición (SEEN), Spain
| | - Julia Álvarez Hernández
- Servicio de Endocrinología y Nutrición, Hospital Universitario Príncipe de Asturias, Alcalá de Henares, Madrid, Spain
| | - Irene Bretón Lesmes
- Unidad de Nutrición Clínica y Dietética, Hospital General Universitario Gregorio Marañón, Madrid, Spain
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Factors Affecting Intraoperative Gastro-Oesophageal Reflux in Dogs and Cats. Animals (Basel) 2022; 12:ani12030247. [PMID: 35158572 PMCID: PMC8833530 DOI: 10.3390/ani12030247] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Revised: 12/16/2021] [Accepted: 01/19/2022] [Indexed: 02/02/2023] Open
Abstract
Simple Summary Gastro-oesophageal reflux (GOR) is an anaesthetic complication that causes oesophageal inflammation and stricture in animals. The aim of this systematic review is to systematically identify the effect of preoperative fasting duration and drugs (anaesthetic and nonanaesthetic agents) on GOR in dogs and cats during anaesthesia. Seven studies were included in the meta-analysis. Many factors seem to affect the development of GOR in dogs and cats. However, there is a limited number of studies investigating these factors, and as the level of evidence is low-to-medium, no reliable conclusions can be extracted. Abstract In animals, gastro-oesophageal reflux (GOR) may occur during anaesthesia, and it can lead to severe consequences such as oesophagitis and oesophageal stricture. This systematic review investigates the effect of fasting duration and anaesthetic and nonanaesthetic drugs on GOR in dogs and cats during general anaesthesia. Fifteen clinical studies met the inclusion criteria in this systematic review. In thirteen studies the population was dogs, while in two studies the population was cats. In the meta-analysis, seven studies were included. Four studies on the effect of fasting duration on GOR in dogs were included in the meta-analysis. In total, 191 dogs had a fasting duration less than 5 h, while 311 dogs had a fasting duration more than 5 h. The heterogeneity of the studies was high and statistically significant (p = 0.0002, I2 = 85%), but the overall effect was statistically nonsignificant (p = 0.82, odds ratio = 0.81, 95% CI 0.15, 4.26), in favour of the low fasting duration (<5 h). Concerning the effect of antacids on GOR, three studies were included in the meta-analysis. The heterogeneity of the studies was low and nonsignificant (p = 0.13, I2 = 52%) and the overall effect was statistically nonsignificant (p = 0.24). The low number of studies and the diverse factors affecting the incidence of reflux prevented us from reaching valuable conclusions on the risk factors for GOR.
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Lee B, Kim SY, Cho BW, Suh S, Park KK, Choi YS. Preoperative Carbohydrate Drink Intake Increases Glycemic Variability in Patients with Type 2 Diabetes Mellitus in Total Joint Arthroplasty: A Prospective Randomized Trial. World J Surg 2022; 46:791-799. [PMID: 35006328 DOI: 10.1007/s00268-021-06437-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/16/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND Preoperative carbohydrate treatment attenuates insulin resistance and improves metabolism to an anabolic state. Despite these benefits, impaired glycemic control and aspiration risk related to gastroparesis represent concerns for patients with diabetes undergoing surgery. This randomized controlled trial investigated the effects of oral carbohydrate therapy on perioperative glucose variability, metabolic responses, and gastric volume in diabetic patients undergoing elective total hip or knee arthroplasty. METHODS Fifty diabetic patients scheduled to undergo elective total knee or hip arthroplasty during August 2019-October 2020 were randomly assigned to a control or carbohydrate therapy (CHO) group. CHO group of patients received a 400-mL carbohydrate drink 2-3 h before anesthesia; control group of patients underwent overnight fasting from midnight, one night before surgery. Blood glucose levels were measured before intake of the carbohydrate drink, before spinal anesthesia, preoperatively, immediately postoperatively, and 1 h postoperatively. Insulin level and gastric volume were measured before spinal anesthesia. RESULTS The glucose variability of patients in the CHO group was significantly higher than that of those in the control group (16.5 vs. 10.1%, P = 0.008). Similarly, insulin resistance was higher in the CHO group than in the control group (8.5 vs. 2.7, P < 0.001). The gastric volume did not differ significantly between the groups (61.3 vs. 15.2 ml, P = 0.082). CONCLUSIONS Preoperative oral carbohydrate therapy increases glucose variability and insulin resistance in diabetic patients. Therefore, carbohydrate beverages should be cautiously administered to diabetic patients, considering metabolic and safety aspects. Trial registration number ClinicalTrials.gov (No. NCT04013594).
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Affiliation(s)
- Bora Lee
- Department of Anesthesiology and Pain Medicine, Anesthesia and Pain Research Institute, Severance Hospital, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-Gu, Seoul, 03722, Republic of Korea
| | - So Yeon Kim
- Department of Anesthesiology and Pain Medicine, Anesthesia and Pain Research Institute, Severance Hospital, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-Gu, Seoul, 03722, Republic of Korea
| | - Byung Woo Cho
- Department of Orthopedic Surgery, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-Gu, Seoul, 03722, Republic of Korea
| | - Sungmin Suh
- Department of Anesthesiology and Pain Medicine, Anesthesia and Pain Research Institute, Severance Hospital, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-Gu, Seoul, 03722, Republic of Korea
| | - Kwan Kyu Park
- Department of Orthopedic Surgery, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-Gu, Seoul, 03722, Republic of Korea.
| | - Yong Seon Choi
- Department of Anesthesiology and Pain Medicine, Anesthesia and Pain Research Institute, Severance Hospital, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-Gu, Seoul, 03722, Republic of Korea.
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Cho AR. Enhanced recovery after surgery: anesthesia-related components. JOURNAL OF THE KOREAN MEDICAL ASSOCIATION 2021. [DOI: 10.5124/jkma.2021.64.12.813] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Background: Enhanced recovery after surgery (ERAS) is a multidisciplinary and multimodal evidence-based approach aimed at improving the recovery of surgical patients. Successful implementation of ERAS protocols requires proper perioperative communication and collaboration among surgeons, anesthesiologists, nurses, and other medical personnel.Current Concepts: The anesthesiologist is the clinical leader responsible for the ERAS program. Preoperative patient evaluation, optimization, and patient education are essential components of the ERAS program. The program also involves preoperative fasting and carbohydrate loading to minimize catabolic effects. Selection of an appropriate anesthetic regimen, fluid and temperature management, avoidance of intra/postoperative nausea and vomiting, and multimodal pain management are the key components of ERAS for which the anesthesiologist is responsible.Discussion and Conclusion: Factors that enable the successful implementation of ERAS include the willingness to change to ERAS, formation of multidisciplinary teams to improve cooperation, and support from the hospital management, as well as standardization of order sets and care processes and the appropriate use of audits. As the leader of the ERAS team, the anesthesiologist should be actively involved in comprehensive management of the patient during the perioperative period.
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Food Residue During Esophagogastroduodenoscopy Is Commonly Encountered and Is Not Pathognomonic of Delayed Gastric Emptying. Dig Dis Sci 2021; 66:3951-3959. [PMID: 33237388 DOI: 10.1007/s10620-020-06718-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Accepted: 11/12/2020] [Indexed: 02/06/2023]
Abstract
BACKGROUND AND AIMS Retained gastric food (RGF) identified during esophagogastroduodenoscopy (EGD) is often attributed to gastroparesis. This retrospective study evaluated the prevalence of RGF, risk factors for RGF, and the association between RGF and delayed gastric emptying (GE). METHODS The prevalence and odds ratios for RGF in patients with structural foregut abnormalities or medical risk factors for delayed GE were determined from 85,116 EGDs performed between 2012 and 2018. The associations between RGF, delayed GE, and medical comorbidities were evaluated in 2991 patients without structural abnormalities who had undergone EGD and gastric emptying scintigraphy. The relationship between medication use and RGF was evaluated in 249 patients without structural or medical risk factors for RGF. RESULTS RGF was identified during 3% of EGDs. The odds of RGF were increased in patients with type 1 diabetes (12%, OR 1.7, P ≤ 0.001), type 2 diabetes (6%, OR 1.4, P ≤ 0.001), gastroparesis (14%, OR 4.8, P ≤ 0.001), amyloidosis (5%, OR 1.7, P ≤ 0.001), and structural foregut abnormalities (6%, OR 2.6, P ≤ 0.001). Overall, the PPV of RGF for delayed GE was 55%. However, the PPV varied from 32% in patients without risk factors to 79% in patients with type 1 diabetes. Opioids, cardiovascular medications, and acid suppressants were associated with RGF. CONCLUSIONS RGF is common during EGD. The PPV of RGF for delayed GE varies depending on underlying risk factors (type 1 diabetes, type 2 diabetes, gastroparesis, and amyloidosis). Acid suppressants or antacids, cardiovascular medications, and opioids are associated with RGF independent of delayed GE.
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Pokhrel S, Gregory A, Mellor A. Perioperative care in cardiac surgery. BJA Educ 2021; 21:396-402. [PMID: 34567795 PMCID: PMC8446225 DOI: 10.1016/j.bjae.2021.05.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/17/2021] [Indexed: 10/20/2022] Open
Affiliation(s)
- S. Pokhrel
- James Cook University Hospital, Middlesbrough, UK
| | | | - A. Mellor
- James Cook University Hospital, Middlesbrough, UK
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Assen HE, Hassen AM, Abate A, Liyew B. Preoperative Fasting Time and Its Association with Hypoglycemia during Anesthesia in Pediatric Patients Undergoing Elective Procedures at Tikur Anbessa Specialized Hospital, Addis Ababa, Ethiopia. BIOMED RESEARCH INTERNATIONAL 2021; 2021:9166603. [PMID: 34337059 PMCID: PMC8298163 DOI: 10.1155/2021/9166603] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Accepted: 07/10/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND Preoperative fasting is important to reduce the risk of pulmonary aspiration during anesthesia. The influence of prolonged fasting time on glucose levels during anesthesia in children remains uncertain. Therefore, this study is aimed at assessing preoperative fasting time and its association with hypoglycemia during anesthesia in pediatric patients undergoing elective procedures at Tikur Anbessa Specialized Hospital, Addis Ababa, Ethiopia. The research hypothesis of the study is as follows: there is a prolonged preoperative fasting time, and it influences the glucose levels during anesthesia among pediatric patients undergoing elective procedures at Tikur Anbessa Specialized Hospital, Addis Ababa, Ethiopia. METHODS Institutional based cross-sectional study was conducted among 258 pediatric patients who had undergone elective procedures in a tertiary care center. A systematic sampling method was used to select study participants. The data were collected through face-to-face interviews and medical record reviews. Binary logistic regression was used to identify associated factors of hypoglycemia during anesthesia among pediatric patients undergoing elective procedures. All explanatory variables with a p value of ≤0.25 from the bivariable logistic regression model were fitted into the multivariable logistic regression model to control the possible effect of confounders, and finally, the variables which had an independent association with hypoglycemia were identified based on adjusted odds ratio with 95% confidence interval, and a p value less than 0.05 was significant. RESULTS The mean (standard deviation) fasting hours from breast milk, solid foods, and clear fluids were 7.75 (2.89), 13.25 (3.14), and 12.31 (3.22), respectively. The majority (89.9%, 57.9%, and 100%) of participants had fasted from solid, breast milk, and clear fluids for more than 8, 6, and 4 hours, respectively. More than one-fourth (26.2%) of participants were hypoglycemic immediately after induction. Residence, order of nothing per mouth, source of patient, and duration of fasting from solid foods had a significant association with hypoglycemia during anesthesia in children. CONCLUSION Children undergoing elective procedures were exposed to unnecessarily long fasting times which were associated with hypoglycemia during anesthesia.
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Affiliation(s)
- Hussien Endris Assen
- Department of Anesthesia, College of Medicine and Health Science, University of Gondar, Gondar, Ethiopia
| | - Anissa Mohammed Hassen
- School of Public Health, College of Medicine and Health Science, Wollo University, Dessie, Ethiopia
| | - Ananya Abate
- Department of Anesthesiology, College of Medicine and Health Science, Addis Ababa University, Addis Ababa, Ethiopia
| | - Bikis Liyew
- Department of Emergency and Critical Care Nursing, School of Nursing, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
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Small and Large Intestine (II): Inflammatory Bowel Disease, Short Bowel Syndrome, and Malignant Tumors of the Digestive Tract. Nutrients 2021; 13:nu13072325. [PMID: 34371835 PMCID: PMC8308711 DOI: 10.3390/nu13072325] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Revised: 06/29/2021] [Accepted: 07/02/2021] [Indexed: 12/15/2022] Open
Abstract
The small intestine is key in the digestion and absorption of macro and micronutrients. The large intestine is essential for the absorption of water, to allow adequate defecation, and to harbor intestinal microbiota, for which their nutritional role is as important as it is unknown. This article will describe the causes and consequences of malnutrition in patients with inflammatory bowel diseases, the importance of screening and replacement of micronutrient deficits, and the main indications for enteral and parenteral nutrition in these patients. We will also discuss the causes of short bowel syndrome, a complex entity due to anatomical or functional loss of part of the small bowel, which can cause insufficient absorption of liquid, electrolytes, and nutrients and lead to complex management. Finally, we will review the causes, consequences, and management of malnutrition in patients with malignant and benign digestive tumors, including neuroendocrine tumors (present not only in the intestine but also in the pancreas).
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27
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Ocón Bretón MJ, Tapia Guerrero MJ, Ramírez Rodriguez JM, Peteiro Miranda C, Ballesteros Pomar MD, Botella Romero F, Martínez Olmos MÁ, Luengo Pérez LM, Cancer Minchot E, García Malpartida K, López Gómez JJ, Zugasti Murillo A, Álvarez Hernández J, Bretón Lesmes I. Multidisciplinary consensus on nutritional and metabolic therapy in enhanced recovery after abdominal surgery programs: NutRICA Project. ENDOCRINOL DIAB NUTR 2021; 69:S2530-0164(21)00121-X. [PMID: 34088633 DOI: 10.1016/j.endinu.2021.02.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Accepted: 02/05/2021] [Indexed: 02/04/2023]
Abstract
BACKGROUND The Enhanced Recovery After Surgery (ERAS) care pathways include evidence-based items designed to accelerate recovery after surgery. Interdisciplinarity is one of the key points of ERAS programs. OBJECTIVE To prepare a consensus document among the members of the Nutrition Area of the Spanish Society of Endocrinology and Nutrition (SEEN) and the Spanish Group for Multimodal Rehabilitation (GERM), in which the goal is to homogenize the nutritional and metabolic management of patients included in an ERAS program. METHODS 69 specialists in Endocrinology and Nutrition and 85 members of the GERM participated in the project. After a literature review, 79 statements were proposed, divided into 5 sections: 17 of general characteristics, 28 referring to the preoperative period, 4 to the intraoperative, 13 to the perioperative and 17 to the postoperative period. The degree of consensus was determined through a Delphi process of 2 circulations that was ratified by a consistency analysis. RESULTS Overall, in 61 of the 79 statements there was a consistent agreement, with the degree of consensus being greater among members of the SEEN (64/79) than members of the GERM (59/79). Within the 18 statements where a consistent agreement was not reached, we should highlight some important nutritional strategies such as muscle mass assessment, the start of early oral feeding or pharmaconutrition. CONCLUSION Consensus was reached on the vast majority of the nutritional measures and care included in ERAS programs. Due to the lack of agreement on certain key points, it is necessary to continue working closely with both societies to improve the recovery of the surgical patients.
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Affiliation(s)
- M Julia Ocón Bretón
- Sección de Nutrición Clínica, Hospital Clínico Universitario Lozano Blesa, Zaragoza, España.
| | - M José Tapia Guerrero
- Servicio de Endocrinología y Nutrición, Hospital Regional Universitario de Málaga, malaga, España
| | | | - Carlos Peteiro Miranda
- Servicio de Endocrinología y Nutrición, Hospital de Viladecans, Viladecans, Barcelona, España
| | | | - Francisco Botella Romero
- Servicio de Endocrinología y Nutrición, Complejo Hospitalario Universitario de Albacete, Albacete, España; Comité Gestor de Área de Nutrición de la Sociedad Española de Endocrinología y Nutrición (SEEN), España
| | - Miguel Ángel Martínez Olmos
- Servicio de Endocrinología y Nutrición, Complejo Hospitalario Universitario de Santiago de Compostela, Santiago de Compostela, España
| | | | - Emilia Cancer Minchot
- Sección de Endocrinología y Nutrición, Hospital Universitario de Fuenlabrada, Fuenlabrada, Madrid, España; Comité Gestor de Área de Nutrición de la Sociedad Española de Endocrinología y Nutrición (SEEN), España
| | - Katherine García Malpartida
- Sección de Endocrinología y Nutrición, Hospital Universitario y Politécnico La Fe, Valencia, España; Comité Gestor de Área de Nutrición de la Sociedad Española de Endocrinología y Nutrición (SEEN), España
| | - Juan José López Gómez
- Servicio de Endocrinología y Nutrición, Hospital Clínico Universitario de Valladolid, Valladolid, España; Comité Gestor de Área de Nutrición de la Sociedad Española de Endocrinología y Nutrición (SEEN), España
| | - Ana Zugasti Murillo
- Sección de Nutrición Clínica y Dietética, Complejo Hospitalario de Navarra, Pamplona, Navarra, España; Comité Gestor de Área de Nutrición de la Sociedad Española de Endocrinología y Nutrición (SEEN), España
| | - Julia Álvarez Hernández
- Servicio de Endocrinología y Nutrición, Hospital Universitario Príncipe de Asturias, Alcalá de Henares, Madrid, España
| | - Irene Bretón Lesmes
- Unidad de Nutrición Clínica y Dietética, Hospital General Universitario Gregorio Marañón, Madrid, España
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Black MKM, Lupa MC, Lemley LW, Dreesen EB, Deaton AM, Wardrop RM. Things We Do for No Reason™: NPO After Midnight. J Hosp Med 2021; 16:368-370. [PMID: 35179460 PMCID: PMC8191764 DOI: 10.12788/jhm.3537] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2020] [Accepted: 09/18/2020] [Indexed: 11/20/2022]
Affiliation(s)
- Meghan KM Black
- Division of General Internal Medicine, Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama
- Section of General Internal Medicine, Birmingham VA Medical Center, Birmingham, Alabama
| | - M Concetta Lupa
- Departments of Anesthesiology and Pediatrics, University of North Carolina, Chapel Hill, North Carolina
| | - Laura W Lemley
- Department of Pediatrics, North Carolina Children’s Hospital, UNC Health Care, Chapel Hill, North Carolina
| | - Elizabeth B Dreesen
- Division of General and Acute Care Surgery, Department of Surgery, University of North Carolina, Chapel Hill, North Carolina
| | - Alyssa M Deaton
- Department of Internal Medicine, UNC Health Care, Chapel Hill, North Carolina
| | - Richard M Wardrop
- Department of Medicine, University of Mississippi Medical Center, Jackson, Mississippi
- Division of Hospital Medicine, St. Dominic’s Hospital, Jackson, Mississippi
- Corresponding Author: Richard M Wardrop III, MD, PhD, FAAP, FACP; ; Telephone: 601-200-4644
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Debono B, Wainwright TW, Wang MY, Sigmundsson FG, Yang MMH, Smid-Nanninga H, Bonnal A, Le Huec JC, Fawcett WJ, Ljungqvist O, Lonjon G, de Boer HD. Consensus statement for perioperative care in lumbar spinal fusion: Enhanced Recovery After Surgery (ERAS®) Society recommendations. Spine J 2021; 21:729-752. [PMID: 33444664 DOI: 10.1016/j.spinee.2021.01.001] [Citation(s) in RCA: 145] [Impact Index Per Article: 48.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2020] [Revised: 12/02/2020] [Accepted: 01/04/2021] [Indexed: 02/03/2023]
Abstract
BACKGROUND Enhanced Recovery After Surgery (ERAS) evidence-based protocols for perioperative care have led to improvements in outcomes in numerous surgical areas, through multimodal optimization of patient pathway, reduction of complications, improved patient experience and reduction in the length of stay. ERAS represent a relatively new paradigm in spine surgery. PURPOSE This multidisciplinary consensus review summarizes the literature and proposes recommendations for the perioperative care of patients undergoing lumbar fusion surgery with an ERAS program. STUDY DESIGN This is a review article. METHODS Under the impetus of the ERAS® society, a multidisciplinary guideline development group was constituted by bringing together international experts involved in the practice of ERAS and spine surgery. This group identified 22 ERAS items for lumbar fusion. A systematic search in the English language was performed in MEDLINE, Embase, and Cochrane Central Register of Controlled Trials. Systematic reviews, randomized controlled trials, and cohort studies were included, and the evidence was graded according to the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) system. Consensus recommendation was reached by the group after a critical appraisal of the literature. RESULTS Two hundred fifty-six articles were included to develop the consensus statements for 22 ERAS items; one ERAS item (prehabilitation) was excluded from the final summary due to very poor quality and conflicting evidence in lumbar spinal fusion. From these remaining 21 ERAS items, 28 recommendations were included. All recommendations on ERAS protocol items are based on the best available evidence. These included nine preoperative, eleven intraoperative, and six postoperative recommendations. They span topics from preoperative patient education and nutritional evaluation, intraoperative anesthetic and surgical techniques, and postoperative multimodal analgesic strategies. The level of evidence for the use of each recommendation is presented. CONCLUSION Based on the best evidence available for each ERAS item within the multidisciplinary perioperative care pathways, the ERAS® Society presents this comprehensive consensus review for perioperative care in lumbar fusion.
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Affiliation(s)
- Bertrand Debono
- Paris-Versailles Spine Center (Centre Francilien du Dos), Paris, France; Ramsay Santé-Hôpital Privé de Versailles, Versailles, France.
| | - Thomas W Wainwright
- Research Institute, Bournemouth University, Bournemouth, UK; The Royal Bournemouth and Christchurch Hospitals NHS Foundation Trust, Bournemouth, Bournemouth, UK
| | - Michael Y Wang
- Department of Neurological Surgery, University of Miami, Miller School of Medicine, Miami, FL, USA
| | - Freyr G Sigmundsson
- Department of Orthopedic Surgery, Örebro University Hospital, Södra Grev Rosengatan, Örebro, Sweden
| | - Michael M H Yang
- Department of Clinical Neurosciences, Section of Neurosurgery, University of Calgary, Calgary, Alberta, Canada
| | | | - Aurélien Bonnal
- Department of Anesthesiology, Clinique St-Jean- Sud de France, Santécité Group. St Jean de Vedas, Montpellier Metropole, France
| | - Jean-Charles Le Huec
- Department of Orthopedic Surgery - Polyclinique Bordeaux Nord Aquitaine, Bordeaux, France
| | - William J Fawcett
- Department of Anaesthesia, Royal Surrey County Hospital NHS Foundation Trust, Guildford, UK
| | - Olle Ljungqvist
- School of Medical Sciences, Department of Surgery, Örebro University, Örebro, Sweden
| | - Guillaume Lonjon
- Department of Orthopedic Surgery, Orthosud, Clinique St-Jean- Sud de France, SantéCité Group. St Jean de Vedas, Montpellier Metropole, France
| | - Hans D de Boer
- Department of Anesthesiology, Pain Medicine and Procedural Sedation and Analgesia, Martini General Hospital Groningen, the Netherlands
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Licina A, Silvers A, Laughlin H, Russell J, Wan C. Pathway for enhanced recovery after spinal surgery-a systematic review of evidence for use of individual components. BMC Anesthesiol 2021; 21:74. [PMID: 33691620 PMCID: PMC7944908 DOI: 10.1186/s12871-021-01281-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Accepted: 02/16/2021] [Indexed: 02/07/2023] Open
Abstract
Background Enhanced recovery in spinal surgery (ERSS) has shown promising improvements in clinical and economical outcomes. We have proposed an ERSS pathway based on available evidence. We aimed to delineate the clinical efficacy of individual pathway components in ERSS through a systematic narrative review. Methods We included systematic reviews and meta-analysis, randomized controlled trials, non-randomized controlled studies, and observational studies in adults and pediatric patients evaluating any one of the 22 pre-defined components. Our primary outcomes included all-cause mortality, morbidity outcomes (e.g., pulmonary, cardiac, renal, surgical complications), patient-reported outcomes and experiences (e.g., pain, quality of care experience), and health services outcomes (e.g., length of stay and costs). Following databases (1990 onwards) were searched: MEDLINE, EMBASE, and Cochrane Library (Cochrane Database of Systematic Reviews and CENTRAL). Two authors screened the citations, full-text articles, and extracted data. A narrative synthesis was provided. We constructed Evidence Profile (EP) tables for each component of the pathway, where appropriate information was available. Due to clinical and methodological heterogeneity, we did not conduct a meta-analyses. GRADE system was used to classify confidence in cumulative evidence for each component of the pathway. Results We identified 5423 relevant studies excluding duplicates as relating to the 22 pre-defined components of enhanced recovery in spinal surgery. We included 664 studies in the systematic review. We identified specific evidence within the context of spinal surgery for 14/22 proposed components. Evidence was summarized in EP tables where suitable. We performed thematic synthesis without EP for 6/22 elements. We identified appropriate societal guidelines for the remainder of the components. Conclusions We identified the following components with high quality of evidence as per GRADE system: pre-emptive analgesia, peri-operative blood conservation (antifibrinolytic use), surgical site preparation and antibiotic prophylaxis. There was moderate level of evidence for implementation of prehabilitation, minimally invasive surgery, multimodal perioperative analgesia, intravenous lignocaine and ketamine use as well as early mobilization. This review allows for the first formalized evidence-based unified protocol in the field of ERSS. Further studies validating the multimodal ERSS framework are essential to guide the future evolution of care in patients undergoing spinal surgery. Supplementary Information The online version contains supplementary material available at 10.1186/s12871-021-01281-1.
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Affiliation(s)
- Ana Licina
- Austin Health, 145 Studley Road, Heidelberg, Victoria, 3084, Australia.
| | - Andrew Silvers
- Monash Health, Clayton, Australia, Faculty of Medicine, Nursing and Health Science, Monash University, Melbourne, Victoria, Australia
| | | | - Jeremy Russell
- Department of Neurosurgery, Austin Health, Melbourne, Victoria, Australia
| | - Crispin Wan
- Royal Hobart Hospital, Hobart, Tasmania, Australia.,St Vincent's Hospital, Melbourne, Australia
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Dominique I, Palamara C, Seizilles De Mazancourt E, Ecochard R, Hacquard H, Tremblais B, Morel Journel N, Champetier D, Ruffion A, Paparel P. Enhanced Recovery after Robot-Assisted Partial Nephrectomy for Cancer: Is it Better for Patients to Have a Quick Discharge? Urol Int 2021; 105:499-506. [PMID: 33647899 DOI: 10.1159/000505757] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2019] [Accepted: 01/04/2020] [Indexed: 11/19/2022]
Abstract
OBJECTIVES The aim of the study was to assess the efficacy and safety of an enhanced recovery program (ERP) after robot-assisted partial nephrectomy (RAPN) for cancer. METHODS It was a monocentric, retrospective, comparative study. An ERP after RAPN was introduced at our institution in 2015 and proposed to all consecutive patients admitted for RAPN. The control group for this study was composed of patients managed immediately before the introduction of the ERP. We collected information on patient characteristics, tumor sizes, ischemia times, biology, hospital length of stays, postoperative (≤30 days) complications, and readmission rates. Group comparisons were made using the Pearson χ2 test for qualitative data and the Student t test for quantitative data. RESULTS Between 2015 and 2017, 112 patients were included in the ERP group. Fifty patients were included in the control group. Ninety patients in the ERP group (80.4%) were discharged at or before postoperative day (POD) 2 versus 10 patients (20%) in the control group (p < 0.001). There was no significant difference between the ERP and control groups for the urinary retention rate (respectively 3.6 vs. 2%; p = 0.593). Resumption of normal bowel function was significantly shorter in the ERP group (94.6% at POD1 vs. 69.6% in the control group, p < 0.001). There were no significant differences for postoperative complications (15.2% in the ERP group vs. 20% in the control group, p = 0.447) or readmissions within 30 days (8.04 vs. 0.2%, p = 0.140). CONCLUSIONS ERP after RAPN seems to reduce postoperative length of stay without increasing postoperative complications or readmissions.
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Affiliation(s)
- Inès Dominique
- Department of Urology, GH Diaconnesses-Croix Saint Simon, Paris, France,
| | | | | | - Rene Ecochard
- Department of Statistics, CHU Lyon Sud, Pierre-Bénite, France
| | | | | | | | | | - Alain Ruffion
- Department of Urology, CHU Lyon Sud, Pierre-Bénite, France
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32
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El-Sharkawy AM, Daliya P, Lewis-Lloyd C, Adiamah A, Malcolm FL, Boyd-Carson H, Couch D, Herrod PJJ, Hossain T, Couch J, Sarmah PB, Sian TS, Lobo DN. Fasting and surgery timing (FaST) audit. Clin Nutr 2021; 40:1405-1412. [PMID: 32933783 PMCID: PMC7957363 DOI: 10.1016/j.clnu.2020.08.033] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Revised: 08/12/2020] [Accepted: 08/26/2020] [Indexed: 12/14/2022]
Abstract
BACKGROUND & AIMS International guidance advocates the avoidance of prolonged preoperative fasting due to its negative impact on perioperative hydration. This study aimed to assess the adherence to these guidelines for fasting in patients undergoing elective and emergency surgery in the East Midlands region of the UK. METHODS This prospective audit was performed over a two-month period at five National Health Service (NHS) Trusts across the East Midlands region of the UK. Demographic data, admission and operative details, and length of preoperative fasting were collected on adult patients listed for emergency and elective surgery. RESULTS Of the 343 surgical patients included within the study, 50% (n = 172) were male, 78% (n = 266) had elective surgery and 22% (n = 77) underwent emergency surgery. Overall median fasting times (Q1, Q3) were 16.1 (13.0, 19.4) hours for food and 5.8 (3.5, 10.7) hours for clear fluids. Prolonged fasting >12 h was documented in 73% (n = 250) for food, and 21% (n = 71) for clear fluids. Median fasting times from clear fluids and food were longer in the those undergoing emergency surgery when compared with those undergoing elective surgery: 13.0 (6.4, 22.6) vs. 4.9 (3.3, 7.8) hours, and 22.0 (14.0, 37.4) vs. 15.6 (12.9, 17.8) hours respectively, p < 0.0001. CONCLUSIONS Despite international consensus on the duration of preoperative fasting, patients continue to fast from clear fluids and food for prolonged lengths of time. Patients admitted for emergency surgery were more likely to fast for longer than those having elective surgery.
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Affiliation(s)
- Ahmed M El-Sharkawy
- East Midlands Surgical Academic Network, Queen's Medical Centre, Nottingham, NG7 2UH, UK; Gastrointestinal Surgery, Nottingham Digestive Diseases Centre and National Institute for Health Research (NIHR) Nottingham Biomedical Research Centre, Nottingham University Hospitals and University of Nottingham, Queen's Medical Centre, Nottingham, NG7 2UH, UK
| | - Prita Daliya
- East Midlands Surgical Academic Network, Queen's Medical Centre, Nottingham, NG7 2UH, UK; Gastrointestinal Surgery, Nottingham Digestive Diseases Centre and National Institute for Health Research (NIHR) Nottingham Biomedical Research Centre, Nottingham University Hospitals and University of Nottingham, Queen's Medical Centre, Nottingham, NG7 2UH, UK
| | - Christopher Lewis-Lloyd
- East Midlands Surgical Academic Network, Queen's Medical Centre, Nottingham, NG7 2UH, UK; Gastrointestinal Surgery, Nottingham Digestive Diseases Centre and National Institute for Health Research (NIHR) Nottingham Biomedical Research Centre, Nottingham University Hospitals and University of Nottingham, Queen's Medical Centre, Nottingham, NG7 2UH, UK
| | - Alfred Adiamah
- East Midlands Surgical Academic Network, Queen's Medical Centre, Nottingham, NG7 2UH, UK; Gastrointestinal Surgery, Nottingham Digestive Diseases Centre and National Institute for Health Research (NIHR) Nottingham Biomedical Research Centre, Nottingham University Hospitals and University of Nottingham, Queen's Medical Centre, Nottingham, NG7 2UH, UK
| | - Francesca L Malcolm
- East Midlands Surgical Academic Network, Queen's Medical Centre, Nottingham, NG7 2UH, UK; Department of Surgery, University Hospitals of Derby and Burton NHS Foundation Trust, Uttoxeter Road, Derby, DE22 2QG, UK
| | - Hannah Boyd-Carson
- East Midlands Surgical Academic Network, Queen's Medical Centre, Nottingham, NG7 2UH, UK; Department of Surgery, University Hospitals of Derby and Burton NHS Foundation Trust, Uttoxeter Road, Derby, DE22 2QG, UK
| | - Daniel Couch
- East Midlands Surgical Academic Network, Queen's Medical Centre, Nottingham, NG7 2UH, UK; Department of Surgery, University Hospitals of Derby and Burton NHS Foundation Trust, Uttoxeter Road, Derby, DE22 2QG, UK
| | - Philip J J Herrod
- East Midlands Surgical Academic Network, Queen's Medical Centre, Nottingham, NG7 2UH, UK; Department of Surgery, University Hospitals of Derby and Burton NHS Foundation Trust, Uttoxeter Road, Derby, DE22 2QG, UK
| | - Tanvir Hossain
- East Midlands Surgical Academic Network, Queen's Medical Centre, Nottingham, NG7 2UH, UK; Gastrointestinal Surgery, Nottingham Digestive Diseases Centre and National Institute for Health Research (NIHR) Nottingham Biomedical Research Centre, Nottingham University Hospitals and University of Nottingham, Queen's Medical Centre, Nottingham, NG7 2UH, UK
| | - Jennifer Couch
- East Midlands Surgical Academic Network, Queen's Medical Centre, Nottingham, NG7 2UH, UK; Gastrointestinal Surgery, Nottingham Digestive Diseases Centre and National Institute for Health Research (NIHR) Nottingham Biomedical Research Centre, Nottingham University Hospitals and University of Nottingham, Queen's Medical Centre, Nottingham, NG7 2UH, UK
| | - Panchali B Sarmah
- East Midlands Surgical Academic Network, Queen's Medical Centre, Nottingham, NG7 2UH, UK; Leicester Cancer Research Centre, University of Leicester, Leicester, LE2 7LX, UK
| | - Tanvir S Sian
- East Midlands Surgical Academic Network, Queen's Medical Centre, Nottingham, NG7 2UH, UK; Department of Surgery, University Hospitals of Derby and Burton NHS Foundation Trust, Uttoxeter Road, Derby, DE22 2QG, UK
| | - Dileep N Lobo
- East Midlands Surgical Academic Network, Queen's Medical Centre, Nottingham, NG7 2UH, UK; Gastrointestinal Surgery, Nottingham Digestive Diseases Centre and National Institute for Health Research (NIHR) Nottingham Biomedical Research Centre, Nottingham University Hospitals and University of Nottingham, Queen's Medical Centre, Nottingham, NG7 2UH, UK; MRC Versus Arthritis Centre for Musculoskeletal Ageing Research, School of Life Sciences, University of Nottingham, Queen's Medical Centre, Nottingham, NG7 2UH, UK.
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Cui Y, Cui Y. [Intraoperative Aspiration]. ZHONGGUO FEI AI ZA ZHI = CHINESE JOURNAL OF LUNG CANCER 2021; 23:393-401. [PMID: 32429641 PMCID: PMC7260386 DOI: 10.3779/j.issn.1009-3419.2020.101.22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
术中误吸是外科手术中常见的肺部并发症,麻醉和体位是导致术中误吸的主要因素。近年来,围手术期肺保护已受到外科和麻醉医师的广泛关注,如何加速术后康复进程,减少相关并发症发生,显著改善患者预后已成为当前外科治疗的主要目标。本文将以术中误吸为重点,从解剖、病理生理、表现、诊断、处理和预防等方面展开综述。
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Affiliation(s)
- Yiyao Cui
- Department of Thoracic Surgery, Beijing Friendship Hospital Affiliated to Capital Medical University, Beijing 100050, China
| | - Yong Cui
- Department of Thoracic Surgery, Beijing Friendship Hospital Affiliated to Capital Medical University, Beijing 100050, China
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34
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Oparin Y, Zeraatkar D, Shanthanna H, Motaghi S, Couban R, Kattail D, Paul J, Mbuagbaw L, Sadeghirad B. Preoperative fasting for prevention of perioperative complications in children. Hippokratia 2021. [DOI: 10.1002/14651858.cd013809.pub2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Yvgeniy Oparin
- Department of Anesthesia; McMaster University; Hamilton Canada
| | - Dena Zeraatkar
- Department of Health Research Methods, Evidence and Impact; McMaster University; Hamilton Canada
| | | | - Shahrzad Motaghi
- Department of Health Research Methods, Evidence and Impact; McMaster University; Hamilton Canada
| | - Rachel Couban
- Department of Anesthesia; McMaster University; Hamilton Canada
| | - Deepa Kattail
- Department of Anesthesia; McMaster University; Hamilton Canada
| | - James Paul
- Department of Anesthesia; McMaster University; Hamilton Canada
| | - Lawrence Mbuagbaw
- Department of Health Research Methods, Evidence and Impact; McMaster University; Hamilton Canada
- Centre for the Development of Best Practices in Health (CDBPH); Yaoundé Central Hospital; Yaoundé Cameroon
| | - Behnam Sadeghirad
- Department of Anesthesia; McMaster University; Hamilton Canada
- Department of Health Research Methods, Evidence and Impact; McMaster University; Hamilton Canada
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35
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Effects of a short message service (SMS) by cellular phone to improve compliance with fasting guidelines in patients undergoing elective surgery: a retrospective observational study. BMC Health Serv Res 2021; 21:27. [PMID: 33407397 PMCID: PMC7788820 DOI: 10.1186/s12913-020-06039-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2019] [Accepted: 12/21/2020] [Indexed: 11/10/2022] Open
Abstract
Background Contemporary perioperative fasting guidelines aim to alleviate patient discomfort before surgery and enhance postoperative recovery whilst seeking to reduce the risk of pulmonary aspiration during anesthesia. The impact of a short message service (SMS) reminder on fasting guideline compliance is unknown. Therefore, we performed a retrospective observational study and quality improvement project aiming to quantify the extent of excessive and prolonged fasting, and then assessed the impact of a SMS reminder in reducing fasting times. Methods After ethics committee approval we performed a retrospective observational study investigating preoperative fasting times of adult patients undergoing elective surgery. First, we assessed whether the fasting guideline times were adhered to (Standard Care group). All patients received internationally recommended fasting guidelines in the form of a written hospital policy document. We then implemented an additional prompt via a mobile phone SMS 1 day prior to surgery containing a reminder of fasting guideline times (SMS group). The primary aims were to compare fasting times between the Standard Care group and the SMS group. Results The fasting times of 160 patients in the Standard Care group and 110 patients in the SMS group were evaluated. Adherence to the fasting guidelines for solids occurred in 14 patients (8.8%) in the Standard Care group vs. Twenty-two patients (13.6%) in the SMS group (p=0.01). Adherence to the fasting guidelines for fluids occurred in 4 patients (2.5%) in the Standard Care group vs. Ten patients (6.3%) in the SMS group (p=0.023). Patients in the Standard Care group had a longer median (inter-quartile range (IQR)) fasting time for fluids compared the SMS group [6.5 h (IQR 4.5:11) vs 3.5 h (IQR 3:8.5), p< 0.0001]. Median fasting times for solids were 11 h (IQR 7:14) in the Standard Care group and 11.5 h (IQR 7:13.5) in the SMS group (p=0.756). Conclusion Adherence to internationally recommended fasting guidelines for patients undergoing elective surgery is poor. The introduction of a fasting guideline reminder via a mobile phone SMS in addition to a written hospital policy improved adherence to fasting advice and reduced the fasting times for fluids but not for solids. The use of an SMS reminder of fasting guidelines is a simple, feasible, low-cost, and effective tool in minimising excessive fasting for fluids among elective surgical patients. Trial registration ACTRN12619001232123 (Australia New Zealand Clinical Trials Registry). Registered 6th September 2019 (retrospectively registered).
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36
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The Safety of Preoperative Amino Acid (Elental) Loading in Colon Cancer Surgery: Prospective Cohort Study. Int Surg 2021. [DOI: 10.9738/intsurg-d-16-00088.1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
The aim of this prospective study was to evaluate the safety of preoperative amino acid plus carbohydrate drink (Elental) loading in colon cancer surgery. Prolonged preoperative fasting increases insulin resistance, and current evidence recommends carbohydrate drinks 2 hours before surgery. We prospectively enrolled consecutive patients with a preoperative diagnosis of colon cancer who underwent surgery. The patients received 600 mL of Elental the night before surgery and 300 mL of Elental 3 hours prior to induction of anesthesia. Primary end point was the safety of preoperative amino acid (Elental) loading in colon cancer surgery. Safety measurement was anastomotic leakage and aspiration pneumonia. Secondary end points were incidence rate of incisional surgical site infection, recovery of bowel movement, length of hospital stay, postoperative nutritional status, and insulin resistance. A total of 80 consecutive patients were enrolled in this study from February 2013 to January 2014. The incidence of anastomotic leakage was 3 patients (3.8%), and there was no aspiration pneumonia. The incidence of incisional surgical site infection was 2 patients (2.5%). The median times of first flatus, defecation after surgery, and postoperative hospital stay were 1 day, 2 days, and 6 days, respectively. The insulin resistance recovered to a preoperative level after 3 days after surgery. The preoperative amino acid plus carbohydrate drink (Elental) loading 3 hours prior to induction of anesthesia in colon cancer surgery is safe, and incisional surgical site infection rate and recovery of bowel movement and insulin resistance are feasible.
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37
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Oparin Y, Zeraatkar D, Shanthanna H, Motaghi S, Couban R, Kattail D, Paul J, Sadeghirad B, Mbuagbaw L. Preoperative fasting for prevention of perioperative complications in children. Hippokratia 2020. [DOI: 10.1002/14651858.cd013809] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Yvgeniy Oparin
- Department of Anesthesia; McMaster University; Hamilton Canada
| | - Dena Zeraatkar
- Department of Health Research Methods, Evidence and Impact; McMaster University; Hamilton Canada
| | | | - Shahrzad Motaghi
- Department of Health Research Methods, Evidence and Impact; McMaster University; Hamilton Canada
| | - Rachel Couban
- Department of Anesthesia; McMaster University; Hamilton Canada
| | - Deepa Kattail
- Department of Anesthesia; McMaster University; Hamilton Canada
| | - James Paul
- Department of Anesthesia; McMaster University; Hamilton Canada
| | - Behnam Sadeghirad
- Department of Health Research Methods, Evidence and Impact; McMaster University; Hamilton Canada
| | - Lawrence Mbuagbaw
- Centre for the Development of Best Practices in Health (CDBPH); Yaoundé Central Hospital; Yaoundé Cameroon
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38
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Zeraatkar D, Shanthanna H, Mbuagbaw L, Morgan RL, Reddy D, Couban R, Paul J, Sadeghirad B. Preoperative fasting for prevention of perioperative complications in adults. Hippokratia 2020. [DOI: 10.1002/14651858.cd013772] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Affiliation(s)
- Dena Zeraatkar
- Department of Health Research Methods, Evidence and Impact; McMaster University; Hamilton Canada
| | | | - Lawrence Mbuagbaw
- Department of Health Research Methods, Evidence and Impact; McMaster University; Hamilton Canada
- Centre for the Development of Best Practices in Health (CDBPH); Yaoundé Central Hospital; Yaoundé Cameroon
| | - Rebecca L Morgan
- Department of Health Research Methods, Evidence and Impact; McMaster University; Hamilton Canada
| | - Desigen Reddy
- Department of Anesthesia; McMaster University; Hamilton Canada
| | - Rachel Couban
- Department of Anesthesia; McMaster University; Hamilton Canada
| | - James Paul
- Department of Anesthesia; McMaster University; Hamilton Canada
| | - Behnam Sadeghirad
- Department of Health Research Methods, Evidence and Impact; McMaster University; Hamilton Canada
- Department of Anesthesia; McMaster University; Hamilton Canada
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39
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Pasechnik IN, Rybintsev VY, Markelov KM. [Perioperative nutritional support for surgical patients]. Khirurgiia (Mosk) 2020:95-103. [PMID: 33047592 DOI: 10.17116/hirurgia202010195] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
The article presents an algorithm for perioperative nutritional support of surgical patients operated on as planned. Today, planned surgical care is provided in accordance with the canons of the accelerated rehabilitation Program (ARP). The relevance of the problem of nutritional insufficiency, which is an important component of ARP, is due to the dependence of the results of surgical treatment on the initial nutritional status of the patient. Methods of screening for nutritional deficiency and options for correcting protein-energy disorders are described. The predominant method is the enteral delivery of nutrients and energy. Oral supplemental nutrition by sipping is a convenient way to correct nutritional disorders at all stages of the perioperative period.
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Affiliation(s)
- I N Pasechnik
- Central State Medical Academy of the President of the Russian Federation, Moscow, Russia
| | - V Yu Rybintsev
- Central State Medical Academy of the President of the Russian Federation, Moscow, Russia
| | - K M Markelov
- Central State Medical Academy of the President of the Russian Federation, Moscow, Russia
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40
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Kotfis K, Jamioł-Milc D, Skonieczna-Żydecka K, Folwarski M, Stachowska E. The Effect of Preoperative Carbohydrate Loading on Clinical and Biochemical Outcomes after Cardiac Surgery: A Systematic Review and Meta-Analysis of Randomized Trials. Nutrients 2020; 12:nu12103105. [PMID: 33053694 PMCID: PMC7600335 DOI: 10.3390/nu12103105] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Revised: 10/04/2020] [Accepted: 10/06/2020] [Indexed: 12/11/2022] Open
Abstract
Background and aim: Preoperative fasting leads to metabolic stress and causes insulin resistance in patients undergoing cardiac surgery. The aim of this study was to assess the effect of preoperative oral carbohydrate loading (OCH) on outcome in patients undergoing planned cardiac surgery by systematically reviewing the literature and synthesizing evidence from randomized controlled trials (RCTs). Methods: Systematic search of PubMed/MEDLINE/Embase/Cinahl/Web of Science/ClinicalTrials databases was performed to identify relevant RCTs from databased inception until 05/03/2020. We included studies that compared outcome measures between OCH with control (placebo or standard starvation). We conducted a random-effect meta-analysis of clinical and biochemical parameters. Results: Nine studies (N = 9) were included with a total of 507 patients. OCH significantly decreased aortic clamping duration (n = 151, standardized mean difference (SMD) = −0.28, 95% confidence interval (CI) = −0.521 to −0.038, p = 0.023 and differences in means (DM) = −6.388, 95%CI = −11.246 to −1.529, p = 0.010). Patients from treatment groups had shorter intensive care unit (ICU) stay (n = 202, SMD = −0.542, 95%CI = −0.789 to −0.295, p < 0.001 and DM = −25.925, 95%CI = −44.568 to −7.283, p = 0.006) and required fewer units of insulin postoperatively (n = 85, SMD = −0.349, 95%CI = −0.653 to −0.044, p = 0.025 and DM = −4.523, 95%CI = −8.417 to −0.630, p = 0.023). The necessity to use inotropic drugs was significantly lower in the OCH group (risk ratio (RR) = 0.795, 95%CI = 0.689 to 0.919, p = 0.002). All other primary outcomes did not reveal a significant effect. Conclusions: Preoperative OCH in patients undergoing cardiac surgery demonstrated a 20% reduction in the use of inotropic drugs, a 50% reduction of the length of ICU stay, a 28% decrease in aortic clamping duration and a 35% decrease of postoperative insulin requirement.
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Affiliation(s)
- Katarzyna Kotfis
- Department of Anesthesiology, Intensive Therapy and Acute Intoxications, Pomeranian Medical University, 70-111 Szczecin, Poland;
| | - Dominika Jamioł-Milc
- Department of Human Nutrition and Metabolomics, Pomeranian Medical University in Szczecin, 71-460 Szczecin, Poland; (K.S.-Ż.); (E.S.)
- Correspondence: ; Tel.: +48-91-441-48-06; Fax: +48-91-441-48-07
| | - Karolina Skonieczna-Żydecka
- Department of Human Nutrition and Metabolomics, Pomeranian Medical University in Szczecin, 71-460 Szczecin, Poland; (K.S.-Ż.); (E.S.)
| | - Marcin Folwarski
- Department of Clinical Nutrition and Dietetics, Medical University of Gdansk, 80-210 Gdansk, Poland;
- Home Enteral and Parenteral Nutrition Unit, General Surgery, Nicolaus Copernicus Hospital, 80-210 Gdansk, Poland
| | - Ewa Stachowska
- Department of Human Nutrition and Metabolomics, Pomeranian Medical University in Szczecin, 71-460 Szczecin, Poland; (K.S.-Ż.); (E.S.)
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Huang X, Zhang H, Lin Y, Chen L, Peng Y, Jiang F, Lin F, Li S, Lin L. Effect of Oral Glucose Water Administration 1 Hour Preoperatively in Children with Cyanotic Congenital Heart Disease: A Randomized Controlled Trial. Med Sci Monit 2020; 26:e922642. [PMID: 32621736 PMCID: PMC7357253 DOI: 10.12659/msm.922642] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Abstract
Background Guidelines recommend a clear liquid fasting time of 2 h before surgery, which is often exceeded, leading to adverse reactions (ARs) such as discomfort, thirst, and dehydration. We assessed the gastric contents and ARs after oral glucose water administration 1 h prior to surgery in children with cyanotic congenital heart disease (CCHD). Material/Methods This was a non-inferiority randomized controlled trial of children with CCHD enrolled at the Fujian Medical University Union Hospital from 09/2014 to 05/2017 and randomized to receive oral glucose water (10 g of glucose in 100 ml of warm water, 5 ml/kg) 2 h (2-h group, n=174) or 1 h (1-h group, n=170) before surgery. The primary endpoint was gastric volume. Secondary endpoints included pH of gastric content, preoperative blood glucose, and risk factors for aspiration pneumonia. Pre- and intraoperative ARs were recorded. Results The 1-h group showed smaller gastric content volumes (0.34±0.35 (95% CI: 0.29–0.39) vs. 0.43±0.33 (95% CI: 0.38–0.48) ml/kg, t=2.55, P<0.05) and higher blood glucose (6.21±0.78 (95% CI: 6.09–6.33) vs. 5.59±1.11 (95% CI: 5.43–5.76) mmol/L, t=−5.91, P<0.001). The 95% confidence interval of the volume difference between the 2 groups was 0.017–0.163, the upper limit value was 0.163 <δ=0.2 (P<0.01). The non-inferiority hypothesis was correct. The 1-h group showed lower incidence of crying, thirst and hypoxia (all P<0.05 vs. 2-h group). There were no differences in ARs between the 2 groups. Conclusions A 1-h fast prior to surgery was not inferior to a 2-h fast in terms of gastric residuals and ARs in pediatric patients with CCHD. Clinical trial registration: http://www.chictr.org.cn/showprojen.aspx?proj=9563 Registration number: ChiCTR-IPR-14005270
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Affiliation(s)
- Xizhen Huang
- Heart Medicine Research Center, Fujian Medical University Union Hospital, Fuzhou, Fujian, China (mainland)
| | - Haoruo Zhang
- Fujian Medical University Union Clinical Medicine College, Fuzhou, Fujian, China (mainland)
| | - Yanjuan Lin
- Heart Medicine Research Center, Fujian Medical University Union Hospital, Fuzhou, Fujian, China (mainland)
| | - Liangwan Chen
- Heart Medicine Research Center, Fujian Medical University Union Hospital, Fuzhou, Fujian, China (mainland)
| | - Yanchun Peng
- Heart Medicine Research Center, Fujian Medical University Union Hospital, Fuzhou, Fujian, China (mainland)
| | - Fei Jiang
- Heart Medicine Research Center, Fujian Medical University Union Hospital, Fuzhou, Fujian, China (mainland)
| | - Fen Lin
- Heart Medicine Research Center, Fujian Medical University Union Hospital, Fuzhou, Fujian, China (mainland)
| | - Sailan Li
- Heart Medicine Research Center, Fujian Medical University Union Hospital, Fuzhou, Fujian, China (mainland)
| | - Lingyu Lin
- Department of Nursing, Fujian Medical University, Fuzhou, Fujian, China (mainland)
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Grebić D, Rudec M, Kustić D, Naglič N, Nikić M, Mršić A, Mršić E. Preoperative evaluation of patients and preparation for surgery. Chirurgia (Bucur) 2020. [DOI: 10.23736/s0394-9508.19.04995-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Dongare PA, Bhaskar SB, Harsoor SS, Garg R, Kannan S, Goneppanavar U, Ali Z, Gopinath R, Sood J, Mani K, Bhatia P, Rohatgi P, Das R, Ghosh S, Mahankali SS, Singh Bajwa SJ, Gupta S, Pandya ST, Keshavan VH, Joshi M, Malhotra N. Perioperative fasting and feeding in adults, obstetric, paediatric and bariatric population: Practice Guidelines from the Indian Society of Anaesthesiologists. Indian J Anaesth 2020; 64:556-584. [PMID: 32792733 PMCID: PMC7413358 DOI: 10.4103/ija.ija_735_20] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Revised: 06/20/2020] [Accepted: 06/22/2020] [Indexed: 02/07/2023] Open
Affiliation(s)
- Pradeep A Dongare
- Assistant Professor, Department of Anaesthesiology, ESIPGIMSR, Bengaluru, India
| | - S Bala Bhaskar
- Department of Anaesthesiology, Vijayanagar Institute of Medical Sciences, Ballari, India
| | - S S Harsoor
- Professor, Department of Anaesthesiology, Dr BR Ambedkar Medical College and Hospital, Bengaluru, India
| | - Rakesh Garg
- Additional Professor, Department of Onco-Anaesthesia, Pain and Palliative Medicine, DR BRAIRCH, AIIMS, New Delhi, India
| | - Sudheesh Kannan
- Professor, Department of Anaesthesiology, BMCRI, Bengaluru, India
| | - Umesh Goneppanavar
- Professor, Department of Anaesthesiology, Dharwad Institute of Mental Health and Neurosciences, Dharwad, India
| | - Zulfiqar Ali
- Associate Professor, Department of Anesthesiology and Critical Care, Sher-I-Kashmir Institute of Medical Sciences, Srinagar, India
| | - Ramachandran Gopinath
- Professor and Head,Department of Anaesthesiology and Intensive Care, ESIC Medical College and Hospital, Hyderabad, India
| | - Jayashree Sood
- Honorary. Joint Secretary, Board of Management, Chairperson, Institute of Anaesthesiology, Pain and Perioperative Medicine, Sir Ganga Ram Hospital, New Delhi, India
| | - Kalaivani Mani
- Scientist IV, Department of Biostatistics, AIIMS, New Delhi, India
| | - Pradeep Bhatia
- Professor and Head, Department of Anaesthesiology and Critical Care, All India Institute of Medical Sciences, Jodhpur, India
| | | | - Rekha Das
- Professor and Head, Department Anaesthesiology, Critical care and Pain, Acharya Harihar Post Graduate Institute of Cancer, Cuttack, India
| | - Santu Ghosh
- Assistant Professor, Department of Biostatistics, St John's Medical College, Bengaluru, India
| | | | - Sukhminder Jit Singh Bajwa
- Professor and Head, Department of Anaesthesiology and Intensive Care, Gian Sagar Medical College and Hospital, Punjab, India
| | - Sunanda Gupta
- Professor and Head, Department of Anaesthesiology, Geetanjali Medical College and Hospital, Udaipur, India
| | - Sunil T Pandya
- Chief of Anaesthesia and Surgical ICU, AIG Hospitals, Hyderabad, India
| | - Venkatesh H Keshavan
- Senior Consultant and Chief, Department of Neuroanaesthesia and Critical Care, Apollo Hospitals, Bengaluru, India
| | - Muralidhar Joshi
- Head, Department of Anaesthesia and Pain Medicine, Virinchi Hospitals, Hyderabad, India
| | - Naveen Malhotra
- Professor, Department of Anaesthesiology and In Charge Pain Management Centre, Pt BDS PGIMS, Haryana, India
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A Review of Enhanced Recovery Protocols in Pelvic Surgery. CURRENT BLADDER DYSFUNCTION REPORTS 2020. [DOI: 10.1007/s11884-020-00582-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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BİRİCİK E, GÜNEŞ Y. Nörocerrahi ve Eras (Enhanced Recovery After Surgery). ARŞIV KAYNAK TARAMA DERGISI 2020. [DOI: 10.17827/aktd.604717] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Liang X, Shu W, Linyong Z, Jianshui L, Junqing G, Enzhu D, Mingqing X. Preoperative nutritional evaluation of patients with hepatic alveolar echinococcosis. PLoS One 2020; 15:e0229396. [PMID: 32092109 PMCID: PMC7039506 DOI: 10.1371/journal.pone.0229396] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2019] [Accepted: 02/05/2020] [Indexed: 02/05/2023] Open
Abstract
OBJECTIVE This study is aimed at determining the preoperative nutritional status of patients with hepatic alveolar echinococcosis (HAE), and subsequently establish a concise and reasonable nutritional evaluation indicator. The established evaluation method could be used for clinical preoperative risk assessment and prediction of post-operation recovery. METHODS The basic patient information on height, body weight, BMI and hepatic encephalopathy of 93 HAE patients were examined. Subsequently, abdominal ultrasonography, blood coagulation and liver function tests were done on the patients. Liver function was assessed using the Child-Pugh improved grading method while nutritional status was evaluated using the European Nutrition Risk Screening 2002 (NRS 2002) method. Additional parameters including hospitalization time, the hemoglobin (HGB) level on the 3rd day after the operation, and the number of postoperative complications of HAE patients were also recorded. RESULTS The NRS 2002 score was negatively correlated with body weight, body mass index (BMI)and albumin (ALB) (P<0.01), and positively correlated with the transverse and longitudinal diameters of the lesions (P<0.01). A worse grading of liver function was associated with a low ALB and a high NRS 2002 score (P<0.01). Results of the NRS 2002 score indicate that the hospitalization time of the normal nutrition group was significantly shorter than that of the malnourished group (P < 0.05). The HGB level of the control group on the 3rd day after the operation was significantly higher than that of the malnourished group (P < 0.05), and the number of postoperative complications was lower than that of malnutrition group (P < 0.05). CONCLUSION Malnutrition is common in HAE patients. The nutritional status of HAE patients is related to many clinical factors, such as Child-Pugh classification of liver function, size of the lesion, and ALB among others. Although both BMI and ALB can be used as primary screening indicators for malnutrition in HAE patients, NRS 2002 is more reliable and prudent in judging malnutrition in HAE patients. Therefore, BMI and ALB are more suitable for preoperative risk assessment and prediction of postoperative recovery.
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Affiliation(s)
- Xie Liang
- Department of Hepatobiliary Surgery (2), the Affiliated Hospital of North Sichuan Medical College, Nanchong, China
- Northeast Sichuan Acute Pancreatic Research Center, North Sichuan Medical College, Nanchong, China
| | - Wang Shu
- Department of Urology Surgery, the Affiliated Hospital of North Sichuan Medical College, Nanchong, China
| | - Zhou Linyong
- Surgery Department of the People's Hospital of Ganzi County, Ganzi Tibetan Autonomous Prefecture, China
| | - Li Jianshui
- Department of Hepatobiliary Surgery (2), the Affiliated Hospital of North Sichuan Medical College, Nanchong, China
- Northeast Sichuan Acute Pancreatic Research Center, North Sichuan Medical College, Nanchong, China
| | - Gu Junqing
- Department of Urology Surgery, the Affiliated Hospital of North Sichuan Medical College, Nanchong, China
| | - Dawa Enzhu
- Surgery Department of the People's Hospital of Ganzi County, Ganzi Tibetan Autonomous Prefecture, China
| | - Xu Mingqing
- Department of hepatic surgery, West China Hospital of Sichuan University, Chengdu,China
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Al Hillan A, Curras-Martin D, Carson M, Gor S, Ezeume A, Gupta V, Copcaalvarez A, Beri G, Bermann M, Asif A. Capsule Endoscopy Transit Time to Duodenum: Relation to Patient Demographics. Cureus 2020; 12:e6894. [PMID: 32064217 PMCID: PMC7003722 DOI: 10.7759/cureus.6894] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Background Anesthesia guidelines recommend fasting for at least two hours to minimize aspiration risk related to endoscopic procedures, and the American Society for Gastrointestinal Endoscopy (ASGE) states that the final oral preparation liquid can be administered three to eight hours before the procedure. We have observed the cancellation of endoscopy procedures if liquids were consumed within four, six, or eight hours of the start time. Objectively, documenting gastric transit time via a review of pill endoscopy data could address clinician concerns, prevent delays in patient care, and improve the rate at which our clinicians practice within national guidelines. The objective was to utilize capsule endoscopy data from our center to report the relationship between patient factors that could affect gastric transit time (GTT) and small bowel transit time (SBTT) such as chronic kidney disease (CKD), diabetes mellitus (DM), nutritional status, and obesity. Methods This retrospective review obtained data on adult pill endoscopy (PillCam™ SB 3) (Medtronic, Minneapolis MN) studies on in- and outpatients. Past medical history and laboratory data were abstracted from electronic medical records. Mean GTT and SBTT are reported in minutes + standard deviation (SD) and times were compared accounting for conditions that could prolong transit, such as diabetes mellitus or chronic kidney disease (CKD). Results One hundred and sixty-three records reviewed. Four patients were excluded as the pill did not pass out of the stomach. The mean age was 66 years, 57% were female, and 26% were evaluated for gastrointestinal (GI) bleeding. The mean GTT for all patients (n = 159) was 35 + 49 with a median of 19 minutes. There were no statistically significant differences in GTT between the following subgroups: CKD0 (n = 100) 40 + 58 versus CKD5 (n = 11) 35 + 39, albumin > 3.0 (n = 123) 37 + 53 versus albumin < 3.0 (n = 36) 27 + 30, diabetes mellitus (DM) (n = 40) 51 + 71 vs. non-DM (n = 119) 42 + 79, body mass index (BMI) > 30, or aspirin use. The SBTT results in all patients (n = 124) was 238 + 88 minutes. Similarly, there was no relation between SBTT and albumin, any CKD, CKD0 versus CKD5, DM status, or BMI. The patients with the capsule stuck in the stomach did not have any other clinical history to explain this occurrence. Conclusions This analysis of objective data regarding pill endoscopy found that the mean GTT was 44 minutes, and it was < 60 minutes for 85% of the cohort. Patient factors were not associated with longer transit times, and this is the first report to document PillCam times in relation to CKD. These data support recommendations that endoscopic procedures, in accordance with anesthesia and ASGE guidelines, can be safely conducted in the majority of patients within 60 minutes of ingesting liquids.
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Affiliation(s)
- Alsadiq Al Hillan
- Internal Medicine, Jersey Shore University Medical Center, Neptune, USA
| | | | - Michael Carson
- Internal Medicine, Jersey Shore University Medical Center, Neptune, USA
| | - Shreya Gor
- Internal Medicine, Jersey Shore University Medical Center, Neptune, USA
| | - Adaeze Ezeume
- Internal Medicine, Jersey Shore University Medical Center, Neptune, USA
| | - Varsha Gupta
- Internal Medicine, Jersey Shore University Medical Center, Neptune, USA
| | | | - Gagan Beri
- Gastroenterology, Jersey Shore University Medical Center, Neptune, USA
| | - Mordechai Bermann
- Internal Medicine, Jersey Shore University Medical Center, Neptune, USA
| | - Arif Asif
- Internal Medicine, Jersey Shore University Medical Center, Neptune, USA
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Merchant RN, Chima N, Ljungqvist O, Kok JNJ. Preoperative Fasting Practices Across Three Anesthesia Societies: Survey of Practitioners. JMIR Perioper Med 2020; 3:e15905. [PMID: 33393934 PMCID: PMC7709845 DOI: 10.2196/15905] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2019] [Revised: 11/03/2019] [Accepted: 12/14/2019] [Indexed: 12/24/2022] Open
Abstract
Background Pulmonary aspiration of gastric contents is recognized as a complication of anesthesia. To minimize that risk, anesthesiologists advised fasting for solid foods and liquids for an often prolonged period of time. However, 30 years ago, evidence was promulgated that fasting for clear liquids was unnecessary to ensure an empty stomach. Despite a strong evidence base and the knowledge that fasting may be physiologically harmful and unpleasant for patients, the adoption of society guidelines recommending short fasting periods for clear fluids into clinical practice is uncertain. Objective This study aimed to determine the current practices of anesthetists with respect to fasting guidelines. Methods An electronic internet survey was distributed to anesthetists in Canada (CAN), Australia and New Zealand (ANZ), and Europe (EUR) during April 2014 to February 2015. The anesthetists were asked about fasting guidelines, their recommendations to patients for the consumption of clear fluids and solid foods, and the reasons and consequences if these guidelines were not followed. Results A total of 971 anesthetists completed the survey (CAN, n=679; ANZ, n=185; and EUR, n=107). Although 85.0% (818/962) of these participants claimed that their advice to patients followed current society guidelines, approximately 50.4% (476/945) enforced strict fasting and did not allow clear fluids after midnight. The primary reasons given were with regard to problems with a variable operating room schedule (255/476, 53.6%) and safety issues surrounding the implementation of clear fluid drinking guidelines (182/476, 38.2%). Conclusions Many anesthetists continue to follow outdated practices. The current interest in further liberalizing preoperative fluid intake will require more change in anesthesia culture.
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Affiliation(s)
- Richard Neville Merchant
- Department of Anesthesiology and Perioperative Medicine, Royal Columbian Hospital, Fraser Health Authority, University of British Columbia, New Westminster, BC, Canada
| | - Navraj Chima
- Vancouver Coastal Health Authority, University of British Columbia, Vancouver, BC, Canada
| | - Olle Ljungqvist
- Department of Surgery, Faculty of Medicine and Health, Orebro University, Orebro, Sweden
| | - Juliana Nai Jia Kok
- Department of Anaesthesia and Pain Management, Royal Melbourne Hospital, Melbourne, Australia
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Evaluation of Gastric Emptying Time of a Rice-Based Meal Using Serial Sonography. BIOMED RESEARCH INTERNATIONAL 2019; 2019:5917085. [PMID: 31781625 PMCID: PMC6855072 DOI: 10.1155/2019/5917085] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/30/2019] [Revised: 09/10/2019] [Accepted: 10/03/2019] [Indexed: 01/11/2023]
Abstract
The aim of this prospective study was to evaluate the gastric emptying time of a rice-based meal by serial ultrasonography of the stomach. After baseline ultrasonographic assessment of ten fasted healthy volunteers, volunteers ingested standardized 420 g, 536 kcal rice-based meal (bibimbap), and serial evaluations were performed every hour until the stomach became empty. At baseline, all the participants had an empty stomach. The average time of complete gastric emptying of the rice-based meal was 5.8 ± 0.8 h (95% confidence interval (CI), 5.0 h to 6.5 h). Since the first postintake cross-sectional area (CSA) measurement, a decrease was observed, and CSA was maintained until postprandial 3–4 h (P > 0.05). It declined rapidly 4 h after meal intake (P=0.031), reaching the nadir at approximately 6 h after meal intake. The gastric CSA and hunger score showed a positive correlation (correlation r = 0.616, P < 0). The rice-based meal is emptied after 5.8 ± 0.8 h on average in healthy volunteers. Based on our results, 6.5 h (upper limit of CI) of fasting after the ingestion of a rice-based meal would be a safe preoperative fasting time, and this is in accordance with the current guidelines for preoperative fasting.
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Yurashevich M, Chow A, Kowalczyk JJ, Traynor AJ, Carvalho B. Preoperative Fasting Times for Patients Undergoing Caesarean Delivery: Before and After a Patient Educational Initiative. Turk J Anaesthesiol Reanim 2019; 47:282-286. [PMID: 31380508 DOI: 10.5152/tjar.2019.95770] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2018] [Accepted: 11/14/2018] [Indexed: 12/20/2022] Open
Abstract
Objective Prolonged preoperative fasting may lead to dehydration, hypoglycaemia, ketoacidosis and delayed recovery. We hypothesised that a patient educational initiative would decrease our preoperative fasting periods for elective caesarean delivery. Methods This was an observational quality improvement impact study. Elective caesarean patients who delivered during our study period were included in the study, 40 patients in the pre-intervention and 40 patients in the post-intervention groups. Only English-speaking patients were included. We developed a patient educational pamphlet outlining preoperative fasting and analgesic expectations for caesarean delivery that was given to every patient at her preoperative anaesthesia consultation. The pamphlet included the American Society of Anesthesiologists' preoperative fasting and enhanced recovery carbohydrate drink recommendations. The primary outcome measure was intended fasting duration for liquids (defined as time from last reported liquid consumption to scheduled caesarean delivery) before and after the patient educational initiative. Secondary outcomes included solid fasting time, types of liquids and solids consumed. Results The intended median (interquartile range) fasting time for liquids decreased from 10 (8.9-12) h to 3.5 (2.5-10) h (p<0.001). The fasting period for solids was not significantly different: 12.5 (10.5-14) h pre- versus 12.4 (10.6-14) h post-pamphlet introduction (p=0.384). Despite the recommendation, only 22.5% consumed a carbohydrate-containing drink with a modest decrease in water consumption (87.5% before and 67.5% after; p=0.009). Conclusion A patient educational pamphlet significantly reduced fasting time for clear liquids. Future studies are needed to determine what barriers limited adherence to the recommended carbohydrate-containing drink consumption.
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Affiliation(s)
- Mary Yurashevich
- Department of Anaesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | - Adrian Chow
- Eastern Virginia Medical School, Norfolk, VA, USA
| | - John J Kowalczyk
- Department of Anaesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | - Andrea J Traynor
- Department of Anaesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | - Brendan Carvalho
- Department of Anaesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, CA, USA
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