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Lin X, Feng X, Sun L, Wang Y, Wu X, Lu S, Shao L, Wang W, Yang L, Geng W, Lin H. Effects of esketamine on postoperative fatigue syndrome in patients after laparoscopic resection of gastric carcinoma: a randomized controlled trial. BMC Anesthesiol 2024; 24:185. [PMID: 38789968 PMCID: PMC11127346 DOI: 10.1186/s12871-024-02513-w] [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: 10/31/2023] [Accepted: 03/27/2024] [Indexed: 05/26/2024] Open
Abstract
BACKGROUND Despite the implementation of various postoperative management strategies, the prevalence of postoperative fatigue syndrome (POFS) remains considerable among individuals undergoing laparoscopic radical gastrectomy. While the N-methyl-D-aspartic acid receptor antagonist esketamine has demonstrated efficacy in enhancing sleep quality and alleviating postoperative pain, its impact on POFS remains uncertain. Consequently, the objective of this study is to ascertain whether perioperative administration of esketamine can effectively mitigate the occurrence of POFS in patients undergoing laparoscopic radical gastrectomy. METHODS A total of 133 patients diagnosed with gastric cancer were randomly assigned to two groups, namely the control group (Group C) (n = 66) and the esketamine group (Group E) (n = 67), using a double-blind method. The Group C received standardized anesthesia, while the Group E received esketamine in addition to the standardized anesthesia. The primary outcome measure assessed was the Christensen fatigue score at 3 days after the surgical procedure, while the secondary outcomes included the disparities in postoperative fatigue, postoperative pain, sleep quality, and adverse reactions between the two groups. RESULTS In the group receiving esketamine, the fatigue scores of Christensen on the third day after surgery were significantly lower compared to the Group C (estimated difference, -0.70; 95% CI, -1.37 to -0.03; P = 0.040). Additionally, there was a significant decrease in the occurrence of fatigue in the Group E compared to the Group C on the first and third days following surgery (P < 0.05). Also, compared to individuals who had distal gastrectomy, those who had entire gastrectomy demonstrated a higher degree of postoperative tiredness reduction with esketamine. Furthermore, the Group E exhibited reduced postoperative pain and improved sleep in comparison to the Group C. Both groups experienced similar rates of adverse events. CONCLUSIONS The use of esketamine during the perioperative period can improve POFS after laparoscopic radical gastrectomy, without adverse reactions. TRIAL REGISTRATION Registered in the Chinese Clinical Trial Registry (ChiCTR2300072167) on 05/06 /2023.
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Affiliation(s)
- Xinru Lin
- Department of Pain, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, 325000, China
- Wenzhou Key Laboratory of Perioperative Medicine (2021HZSY0069), Wenzhou, 325000, China
| | - Xiaoxue Feng
- Department of Pain, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, 325000, China
- Wenzhou Key Laboratory of Perioperative Medicine (2021HZSY0069), Wenzhou, 325000, China
| | - Linxiao Sun
- Key Laboratory of Diagnosis and Treatment of Severe Hepato-Pancreatic Diseases of Zhejiang Province, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang Province, 325000, China
| | - Yijian Wang
- Department of Pain, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, 325000, China
- Wenzhou Key Laboratory of Perioperative Medicine (2021HZSY0069), Wenzhou, 325000, China
| | - Xudong Wu
- Department of Pain, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, 325000, China
- Wenzhou Key Laboratory of Perioperative Medicine (2021HZSY0069), Wenzhou, 325000, China
| | - Shufang Lu
- Department of Pain, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, 325000, China
- Wenzhou Key Laboratory of Perioperative Medicine (2021HZSY0069), Wenzhou, 325000, China
| | - Lulu Shao
- Department of Pain, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, 325000, China
- Wenzhou Key Laboratory of Perioperative Medicine (2021HZSY0069), Wenzhou, 325000, China
| | - Wenchao Wang
- Department of Pain, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, 325000, China
- Wenzhou Key Laboratory of Perioperative Medicine (2021HZSY0069), Wenzhou, 325000, China
| | - Liqun Yang
- Department of Anesthesiology Renji Hospital, Shanghai Jiaotong University School of Medicine, No.160 Pujian road, Shanghai, 200127, China.
| | - Wujun Geng
- Department of Pain, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, 325000, China.
- Wenzhou Key Laboratory of Perioperative Medicine (2021HZSY0069), Wenzhou, 325000, China.
| | - Hai Lin
- Department of Pain, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, 325000, China.
- Wenzhou Key Laboratory of Perioperative Medicine (2021HZSY0069), Wenzhou, 325000, China.
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2
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Liu S, Cheng Y, Chen WZ, Lv JX, Zheng BS, Huang DD, Xia XF, Yu Z. Inflammation Disturbed the Tryptophan Catabolites in Hippocampus of Post-operative Fatigue Syndrome Rats via Indoleamine 2,3-Dioxygenas Enzyme and the Improvement Effect of Ginsenoside Rb1. Front Neurosci 2021; 15:652817. [PMID: 34512234 PMCID: PMC8427665 DOI: 10.3389/fnins.2021.652817] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Accepted: 08/02/2021] [Indexed: 11/17/2022] Open
Abstract
Aim Post-operative fatigue syndrome (POFS) is a common complication that prolongs the recovery to normal function and activity after surgery. The aim of the present study was to explore the mechanism of central fatigue in POFS and the anti-fatigue effect of ginsenoside Rb1. Method We investigated the association between inflammation, indoleamine 2,3-dioxygenase (IDO) enzyme, and tryptophan metabolism in the hippocampus of POFS rats. A POFS rat model was induced by major small intestinal resection. Rats with major small intestinal resection were administered ginsenoside Rb1 (15 mg/kg) once a day from 3 days before surgery to the day of sacrifice, or with saline as corresponding controls. Fatigue was assessed with the open field test (OFT) and sucrose preference test (SPT). ELISA, RT-PCR, Western blot, immunofluorescence, and high-performance liquid chromatography (HPLC) were used to test the inflammatory cytokines; p38MAPK, NF-κB/p65, and IDO enzyme expressions; and the concentrations of tryptophan, kynurenine, and serotonin, respectively. Result Our results showed that POFS was associated with increased expressions of inflammatory cytokines and p38MAPK and higher concentrations of kynurenine and tryptophan on post-operative days 1 and 3; a lower serotonin level on post-operative day 1; and an enhanced translocation of NF-κB/p65 and the IDO enzyme on post-operative days 1, 3, and 5. Ginsenoside Rb1 had an improvement effect on these. Conclusion Inflammatory cytokines induced by large abdominal surgery disturb tryptophan metabolism to cause POFS through the activation of the p38MAPK–NF-κB/p65–IDO pathway in the hippocampus. Ginsenoside Rb1 had an anti-fatigue effect on POFS by reducing inflammation and IDO enzyme.
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Affiliation(s)
- Shu Liu
- Department of Biomedical Sciences, College of Veterinary Medicine and Life Sciences, City University of Hong Kong, Kowloon Tong, Hong Kong, SAR China
| | - Yue Cheng
- Department of Clinical Laboratory, Tongde Hospital of Zhejiang Province, Hangzhou, China
| | - Wei-Zhe Chen
- Department of Gastrointestinal Surgery, First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Jin-Xiao Lv
- Department of Gastrointestinal Surgery, First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Bei-Shi Zheng
- Department of Gastrointestinal Surgery, First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Dong-Dong Huang
- Department of Gastrointestinal Surgery, First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Xu-Fen Xia
- Department of Clinical Laboratory, Tongde Hospital of Zhejiang Province, Hangzhou, China
| | - Zhen Yu
- Department of Surgery, Shanghai Tenth People's Hospital Affiliated to Tongji University, Shanghai, China
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3
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Cavaliere F, Allegri M, Apan A, Calderini E, Carassiti M, Cohen E, Coluzzi F, DI Marco P, Langeron O, Rossi M, Spieth P, Turnbull D. A year in review in Minerva Anestesiologica 2020. Anesthesia, analgesia, and perioperative medicine. Minerva Anestesiol 2021; 87:253-265. [PMID: 33599441 DOI: 10.23736/s0375-9393.21.15570-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Franco Cavaliere
- IRCCS A. Gemelli University Polyclinic Foundation, Sacred Heart Catholic University, Rome Italy -
| | - Massimo Allegri
- Unit of Pain Therapy of Column and Athlete, Policlinic of Monza, Monza, Italy
| | - Alparslan Apan
- Department of Anesthesiology and Intensive Care, Faculty of Medicine, University of Giresun, Giresun, Turkey
| | - Edoardo Calderini
- Unit of Women-Child Anesthesia and Intensive Care, Maggiore Polyclinic Hospital, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Massimiliano Carassiti
- Unit of Anesthesia, Intensive Care and Pain Management, Campus Bio-Medico University Hospital, Rome, Italy
| | - Edmond Cohen
- Department of Anesthesiology, Icahn School of Medicine at Mount Sinai, New York, NY, USA.,Department of Thoracic Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Flaminia Coluzzi
- Department of Medical and Surgical Sciences and Biotechnologies, Sapienza University, Polo Pontino, Latina, Italy.,Unit of Anesthesia, Intensive Care and Pain Medicine, Sant'Andrea University Hospital, Rome, Italy
| | - Pierangelo DI Marco
- Department of Internal Anesthesiologic and Cardiovascular Clinical Studies, Sapienza University, Rome, Italy
| | - Olivier Langeron
- Department of Anesthesia and Intensive Care, Henri Mondor University Hospital, Assistance Publique - Hôpitaux de Paris (AP-HP), University Paris-Est Créteil (UPEC), Paris, France
| | - Marco Rossi
- Institute of Anesthesia and Intensive Care, Sacred Heart Catholic University, Rome, Italy
| | - Peter Spieth
- Department of Anesthesiology and Critical Care Medicine, University Hospital Dresden, Dresden, Germany
| | - David Turnbull
- Department of Anaesthetics and Neuro Critical Care, Royal Hallamshire Hospital, Sheffield, UK
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4
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Mendy N, Moriceau J, Sacuto Y, Besnier E, Clavier T, Ndangang MM, Castel H, Dureuil B, Compère V. Postoperative fatigue after day surgery: prevalence and risk factors. A prospective observational study. Minerva Anestesiol 2020; 86:1269-1276. [DOI: 10.23736/s0375-9393.20.14358-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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5
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Wu JM, Yang HT, Ho TW, Shun SC, Lin MT. Association between Interleukin-6 Levels and Perioperative Fatigue in Gastric Adenocarcinoma Patients. J Clin Med 2019; 8:jcm8040543. [PMID: 31010015 PMCID: PMC6518263 DOI: 10.3390/jcm8040543] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2019] [Revised: 04/12/2019] [Accepted: 04/18/2019] [Indexed: 01/27/2023] Open
Abstract
Background: Gastric adenocarcinoma (GA), one of the most common gastrointestinal cancers worldwide, is often accompanied by cancer cachexia in the advanced stage owing to malnutrition and cancer-related symptoms. Although resection is the most effective curative procedure for GA patients, it may cause perioperative fatigue, worsening the extent of cancer cachexia. Although the relationship between cytokines and cancer fatigue has been evaluated, it is unclear which cytokines are associated with fatigue in GA patients. Therefore, this study aimed to investigate whether the changes in cytokine levels were associated with the perioperative changes in fatigue amongst GA patients. Methods: We included GA patients undergoing gastric surgery in a single academic medical center between June 2017 and December 2018. Fatigue-related questionnaires, serum cytokine levels (interferon-gamma, interleukin (IL)-1, IL-2, IL-5, IL-6, IL-12 p70, tumor necrosis factor-alpha, and granulocyte-macrophage colony-stimulating factor), and biochemistry profiles (albumin, prealbumin, C-reactive protein, and white blood cell counts) were assessed at three time points (preoperative day 0 (POD 0), post-operative day 1 (POD 1), and postoperative day 7 (POD 7)). We used the Brief Fatigue Inventory-Taiwan Form to assess the extent of fatigue. The change in fatigue scores among the three time points, as an independent variable, was adjusted for clinicopathologic characteristics, malnutrition risk, and cancer stages. Results: A total of 34 patients were included for analysis, including 12 female and 22 male patients. The mean age was 68.9 years. The mean score for fatigue on POD 0, POD 1, and POD 7 was 1.7, 6.2, and 3.6, respectively, with significant differences among the three time points (P < 0.001). Among the cytokines, only IL-6 was significantly elevated from POD 0 to POD 1. In the regression model, the change in IL-6 levels between POD 0 and POD 1 (coefficients = 0.01 for every 1 pg/mL increment; 95% confidence interval: 0.01–0.02; P = 0.037) and high malnutrition risk (coefficients = 2.80; 95% confidence interval: 1.45–3.52; P = 0.041) were significantly associated with changes in fatigue scores. Conclusions: The perioperative changes in plasma IL-6 levels are positively associated with changes in the fatigue scores of GA patients undergoing gastric surgery. Targeting the IL-6 signaling cascade or new fatigue-targeting medications may attenuate perioperative fatigue, and further clinical studies should be designed to validate this hypothesis.
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Affiliation(s)
- Jin-Ming Wu
- Department of Surgery, National Taiwan University Hospital and College of Medicine, National Taiwan University, 7 Chung-Shan South Rd. Taipei 10002, Taiwan.
| | - Hui-Ting Yang
- School of Nursing, College of Medicine, National Taiwan University, Taipei 10002, Taiwan.
| | - Te-Wei Ho
- Department of Surgery, National Taiwan University Hospital and College of Medicine, National Taiwan University, 7 Chung-Shan South Rd. Taipei 10002, Taiwan.
| | - Shiow-Ching Shun
- School of Nursing, College of Medicine, National Taiwan University, Taipei 10002, Taiwan.
| | - Ming-Tsan Lin
- Department of Surgery, National Taiwan University Hospital and College of Medicine, National Taiwan University, 7 Chung-Shan South Rd. Taipei 10002, Taiwan.
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Defining the cut-off point of clinically significant postoperative fatigue in three common fatigue scales. Qual Life Res 2018; 28:991-1003. [PMID: 30506178 DOI: 10.1007/s11136-018-2068-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/22/2018] [Indexed: 11/12/2022]
Abstract
PURPOSE Postoperative fatigue (POF) is an often underestimated problem after surgery. Studies on POF often report fatigue scores without relating this to the clinical relevance for the patients. The aim of this study was to define the cut-off point for clinically significant POF in three commonly applied fatigue scales; the Postoperative Fatigue Scale, Christensen's Fatigue Scale, and the Chalder Fatigue Questionnaire. The identification of cut-off points will make it possible to indicate whether statistically significant findings of increased fatigue are of clinical relevance. METHODS We combined data from day 0 (pre-operatively) and day 1, 3, 6, and 30 after surgery in two fatigue-related studies with 442 patients. In order to define clinically significant fatigue, a key question was added in each questionnaire; "Given your current description of fatigue, would you say it has been of considerable significance to you?"; "Yes/No". We analysed each scale's ability to identify clinically significant fatigue, by performing receiver-operating characteristics (ROC) analyses, and calculated the optimal cut-off point between Sensitivity and Specificity. RESULTS The average weighted cut-off point for clinically significant POF when measured with the Postoperative Fatigue Scale was ≥ 50 (scale range 0-100), with Christensen's Fatigue Scale ≥ 6 (scale range 1-10) and with the Chalder Fatigue Questionnaire ≥ 16 (scale range 0-33). CONCLUSION In three commonly used fatigue scales, we have identified cut-off points for clinically significant fatigue among patients recovering from surgery. This can be particularly valuable for diagnostic purposes and in treatment evaluation. Further, it may be possible to analyse and review data from earlier studies in light of clinical relevance.
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7
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Sposato NS, Bjerså K. Osteopathic Manipulative Treatment in Surgical Care: Short Review of Research Publications in Osteopathic Journals During the Period 1990 to 2017. J Evid Based Integr Med 2018; 23:2515690X18767671. [PMID: 29637792 PMCID: PMC5900809 DOI: 10.1177/2515690x18767671] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background. A growing trend in surgical care is the investigation and incorporation of multimodal interventions into standardized programs. Additionally, manual therapies such as osteopathic manipulative treatment (OMT) are being used with patients in surgical care. Yet the scientific dialogue and the use of OMT in surgical care are currently insubstantial. Objective. The aim of this study was to present an overview of published research articles within the subject field of OMT in surgical care. Method. Summative review of peer-reviewed research articles published in osteopathic journals during the period 1990 to 2017. In total, 10 articles were identified. Result. Previous research has been conducted within the areas of abdominal, thoracic, gynecological, and/or orthopedic surgery with measured outcomes such as pain, analgesia consumption, length of hospital stay, and range of motion. Heterogeneity was identified in usage of osteopathic techniques, treatment duration, and occurrence, as well as in the treating osteopath’s experience. Conclusion. Despite the small number of research articles within this field, both positive measured effects as well as the absence of such effects were identified. Overall, there was a heterogeneity concerning surgical contexts, diagnoses, signs and symptoms, as well as surgical phases in current interprofessional osteopathic publications. In this era of multimodal surgical care, we argue that there is an urgent need to evaluate OMT in this context of care and with a proper research approach.
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Affiliation(s)
- Niklas S Sposato
- 1 Scandinavian School of Osteopathy, Gothenburg, Sweden.,2 The Institute of Orthopaedic Medicine, Gothenburg, Sweden
| | - Kristofer Bjerså
- 3 Linköping University, Linköping, Sweden.,4 Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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8
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The efficacy and safety of two low-dose peri-operative dexamethasone on pain and recovery following total hip arthroplasty: a randomized controlled trial. INTERNATIONAL ORTHOPAEDICS 2017. [DOI: 10.1007/s00264-017-3537-8] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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9
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Nostdahl T, Fredheim OM, Bernklev T, Doksrod TS, Mohus RM, Raeder J. A randomised controlled trial of propofol vs. thiopentone and desflurane for fatigue after laparoscopic cholecystectomy. Anaesthesia 2017; 72:864-869. [DOI: 10.1111/anae.13909] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/29/2017] [Indexed: 12/22/2022]
Affiliation(s)
- T. Nostdahl
- Department of Anaesthesiology; Telemark Hospital; Skien Norway
| | - O. M. Fredheim
- Department of Circulation and Medical Imaging; Faculty of Medicine; Norwegian University of Science and Technology; Trondheim Norway
- Centre of Palliative Medicine, Surgical Division; Akershus University Hospital; Lørenskog Norway
- National Competence Centre for Complex Symptom Disorders; Department of Pain and Complex Disorders; Trondheim Norway
| | - T. Bernklev
- Research and Development; Vestfold Hospital Trust; Tønsberg Norway
- Institute of Clinical Medicine; Medical Faculty; University of Oslo; Oslo Norway
| | - T. S. Doksrod
- Department of Anaesthesiology; Telemark Hospital; Skien Norway
| | - R. M. Mohus
- Department of Anaesthesiology; St. Olav University Hospital; Trondheim Norway
| | - J. Raeder
- Institute of Clinical Medicine; Medical Faculty; University of Oslo; Oslo Norway
- Department of Anaesthesiology; Oslo University Hospital; Oslo Norway
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10
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Lu Y, Yang R, Jiang X, Yang Y, Peng F, Yuan H. Serum metabolite profiles of postoperative fatigue syndrome in rat following partial hepatectomy. J Clin Biochem Nutr 2016; 58:210-5. [PMID: 27257346 PMCID: PMC4865597 DOI: 10.3164/jcbn.15-72] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2015] [Accepted: 08/03/2015] [Indexed: 01/29/2023] Open
Abstract
Postoperative fatigue syndrome is a general complication after surgery. However, there is no ‘‘gold standard’’ for fatigue assessment due to the lack of objective biomarkers. In this study, a rodent model of postoperative fatigue syndrome based on partial hepatectomy was firstly established and serum metabonomic method based on ultra-high performance liquid chromatography coupled with Q-TOF mass spectrometry was applied. Partial least-squares discriminant analysis was used to identify the differential metabolites in 70% partial hepatectomy rats relative to sham rats and 30% partial hepatectomy rats, which showed 70% partial hepatectomy group was significantly distinguishable from 30% partial hepatectomy group and sham group. Eighteen serum metabolites responsible for the discrimination were identified. The levels of hypoxanthine, kynurenine, tryptophan, uric acid, phenylalanine, palmitic acid, arachidonic acid and oleic acid showed progressive elevation from sham group to 30% partial hepatectomy group to 70% partial hepatectomy group, and levels of valine, tyrosine, isoleucine, linoleyl carnitine, palmitoylcarnitine, lysophosphatidylcholine (16:0), lysophosphatidylcholine (20:3), citric acid, succinic acid and hippuric acid showed progressive declining trend from sham group to 30% partial hepatectomy group to 70% partial hepatectomy group. These potential biomarkers help to understand of etiology, pathophysiology and treatment of postoperative fatigue syndrome.
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Affiliation(s)
- Ye Lu
- Department of Anaesthesiology, Changzheng Hospital, Second Military Medical University, Shanghai 200003, China
| | - Rui Yang
- Department of Anaesthesiology, Changzheng Hospital, Second Military Medical University, Shanghai 200003, China
| | - Xin Jiang
- Department of Anaesthesiology, Changzheng Hospital, Second Military Medical University, Shanghai 200003, China
| | - Yajuan Yang
- Department of Nursing, Changzheng Hospital, Second Military Medical University, 415 Fengyang Road, Huangpu district, Shanghai 200003, China
| | - Fei Peng
- Department of Nursing, Changzheng Hospital, Second Military Medical University, 415 Fengyang Road, Huangpu district, Shanghai 200003, China
| | - Hongbin Yuan
- Department of Anaesthesiology, Changzheng Hospital, Second Military Medical University, Shanghai 200003, China
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11
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Al-Daakak ZM, Ammouri AA, Isac C, Gharaibeh H, Al-Zaru I. Symptom management strategies of Jordanian patients following coronary artery bypass grafting surgery. Int J Nurs Pract 2016; 22:375-83. [PMID: 27241589 DOI: 10.1111/ijn.12445] [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: 06/25/2015] [Revised: 02/15/2016] [Accepted: 03/22/2016] [Indexed: 11/30/2022]
Abstract
The aim of this study was to explore the symptom management strategies utilized by post coronary artery bypass graft (CABG) patients and its associations with demographic variables. A clear understanding of the use of symptom management strategies following CABG surgery may help nurses in developing educational program and interventions that help patients and their families during recovery period after discharge. A cross-sectional, descriptive design was utilized. A convenience sample of 100 Jordanian patients post CABG surgery selected from five hospitals was surveyed between November 2012 and June 2013 using the Cardiac Symptom Survey. Chi squared analyses were used to examine the associations between the symptoms management strategies and selected demographic variables. Frequency of symptom management strategies utilized by post CABG patients revealed that most frequently employed strategies were use of medications (79%), repositioning (54%) and the rest (45%). Symptom management strategies utilized for poor appetite, sleeping problem and fatigue had significant associations with demographic variables. By providing information about the symptoms expected after surgery and possible ways to manage them, will strengthen the patients psychologically and will make CABG experience within the realm of self-management and coping.
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Affiliation(s)
- Zaher Mohammed Al-Daakak
- Department of Emergency and public Safety, Ministry of Interior General Head Quarters, Abu Dhabi, United Arab Emirates
| | | | - Chandrani Isac
- College of Nursing, Sultan Qaboos University, Muscate, Oman
| | - Huda Gharaibeh
- College of Nursing, Jordan University of Science and Technology, Irbid, Jordan
| | - Ibtisam Al-Zaru
- College of Nursing, Jordan University of Science and Technology, Irbid, Jordan
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12
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Holliday EB, Dieckmann NF, McDonald TL, Hung AY, Thomas CR, Wood LJ. Relationship between fatigue, sleep quality and inflammatory cytokines during external beam radiation therapy for prostate cancer: A prospective study. Radiother Oncol 2015; 118:105-11. [PMID: 26743832 DOI: 10.1016/j.radonc.2015.12.015] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2015] [Revised: 10/22/2015] [Accepted: 12/18/2015] [Indexed: 12/21/2022]
Abstract
BACKGROUND AND PURPOSE Mechanisms of fatigue reported during radiotherapy are poorly defined but may include inflammatory cytokines and/or sleep disturbances. This prospective, longitudinal, phase II study assessed fatigue, sleep, and serum cytokine levels during radiotherapy for early-stage prostate cancer (PCa). MATERIAL AND METHODS Twenty-eight men undergoing radiotherapy for early-stage PCa wore an Actiwatch Score to record fatigue level, sleep time, onset latency, efficiency and wake after sleep onset. Serum levels of IL-1α, IL-1β, TNF-α, IL-6, IL-8, IL-10 and VEGF were measured weekly during radiotherapy. Patient reported quality of life (QOL) metrics were collected before and after treatment. Linear mixed effects models examined trajectories across treatment weeks. RESULTS Fatigue increased across treatment weeks (P<.01), and fatigue was associated with decreased patient-reported QOL. Sleep efficiency increased across treatment weeks (rate of change over time=.29, P=.03), and sleep onset latency decreased (rate of change over time=.86, P=.06). IL-6 tended to increase during treatment (P=0.09), but none of the cytokine levels or sleep variables were significantly related to fatigue trajectories. CONCLUSIONS Despite increased sleep efficiency across treatment weeks, fatigue significantly increased. Although IL-6 increased during the course of radiotherapy, cytokines levels were not associated with fatigue scores or sleep disturbance. Further studies are needed to define the mechanisms for fatigue during radiotherapy.
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Affiliation(s)
- Emma B Holliday
- The University of Texas MD Anderson Cancer Center Division of Radiation Oncology, Houston, United States
| | - Nathan F Dieckmann
- Oregon Health & Science University School of Nursing, Department of Public Health and Preventative Medicine & Department of Psychiatry, Portland, United States
| | - Tasha L McDonald
- Oregon Health & Science University Department of Radiation Medicine, Portland, United States
| | - Arthur Y Hung
- Oregon Health & Science University Department of Radiation Medicine, Portland, United States
| | - Charles R Thomas
- Oregon Health & Science University Department of Radiation Medicine, Portland, United States
| | - Lisa J Wood
- The University of Texas MD Anderson Cancer Center Division of Radiation Oncology, Houston, United States; Massachussettes General Hospital Institute of Health Professions, Boston, United States.
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13
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Chen WZ, Liu S, Chen FF, Zhou CJ, Yu J, Zhuang CL, Shen X, Chen BC, Yu Z. Prevention of postoperative fatigue syndrome in rat model by ginsenoside Rb1 via down-regulation of inflammation along the NMDA receptor pathway in the hippocampus. Biol Pharm Bull 2015; 38:239-47. [PMID: 25747983 DOI: 10.1248/bpb.b14-00599] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Postoperative fatigue syndrome (POFS) is a common complication which decelerates recovery after surgery. The present study investigated the anti-fatigue effect of ginsenoside Rb1 (GRb1) through the inflammatory cytokine-mediated N-methyl-D-aspartate (NMDA) receptor pathway. A POFS rat model was created by major small intestinal resection and assessed with an open field test. Real-time quantitative polymerase chain reaction, western blot analysis, high performance liquid chromatography and a transmission electron microscopic analysis were used to determine typical biochemical parameters in the hippocampus. Our results showed that POFS rats exhibited fatigue associated with an increased expression of inflammatory cytokines and NMDA receptor 1, higher (kynurenine)/(tryptophan) and (kynurenine)/(kynurenic acid) on postoperative days 1 and 3, and an increased expression of indoleamine 2,3-dioxygenase (IDO) on postoperative day 1. Degenerated neurons were found in the hippocampus of POFS rats. The NMDA receptor antagonist MK801 had a significant effect on central fatigue on postoperative day 1. GRb1 had no effect on IDO or tryptophan metabolism, but exhibited a significant effect on POFS by inhibiting the expression of inflammatory cytokines and NMDA receptor 1. These data suggested that inflammatory cytokines could activate tryptophan metabolism to cause POFS through the NMDA receptor pathway. GRb1 had an anti-fatigue effect on POFS by reducing inflammatory cytokines and NMDA receptors.
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Affiliation(s)
- Wei-Zhe Chen
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of Wenzhou Medical University
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Wang XS, Woodruff JF. Cancer-related and treatment-related fatigue. Gynecol Oncol 2014; 136:446-52. [PMID: 25458588 DOI: 10.1016/j.ygyno.2014.10.013] [Citation(s) in RCA: 105] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2014] [Revised: 10/07/2014] [Accepted: 10/11/2014] [Indexed: 12/18/2022]
Abstract
Fatigue is a distressing and persistent symptom for patients with gynecological cancer and for survivors. Debilitating cancer-related fatigue (CRF) is produced by both the disease and its treatment. Although awareness and study of CRF have grown in recent years, consistent assessment has not been a priority in routine medical practice. The pathophysiological mechanisms that induce CRF remain unclear, and effective pharmacological interventions have yet to be established. Based on the literature and our own research results, this review focuses on recent progress toward understanding the nature and causes of CRF and on several promising treatment modalities. Given the prevalence and severity of CRF in the gynecological cancer patient population, establishing standardized fatigue measurement and management methods in routine clinical oncology care is of utmost importance. Whether CRF has an underlying inflammatory cause is still hypothetical, however, and no mechanism-driven symptom intervention is currently in clinical use, even though the development of such interventions would provide patients with greater symptom control. Advancing translational and clinical fatigue research will require anatomical pathway studies and well-designed clinical investigations that focus on the development of mechanism-driven interventions based on physiological-behavioral fatigue research, implementation of guidelines for experimental designs, and discovery of biomarkers identifying individuals at high risk for CRF. Validated patient-reported outcomes measures are an essential component of such clinical studies. Because numerous subscales, unidimensional measures, and multidimensional measures exist, clinicians and researchers should consider individual circumstances, good clinical practice, and research goals as guides for choosing the most appropriate fatigue measurement tool. Additionally, education about CRF should be made available to all patients and their caregivers, as accurate and age-appropriate information about conditions like CRF can alleviate much of the stress and anxiety brought on by poor communication about this distressing condition.
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Affiliation(s)
- Xin Shelley Wang
- Department of Symptom Research, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
| | - Jeanie F Woodruff
- Department of Symptom Research, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
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Zhuang CL, Mao XY, Liu S, Chen WZ, Huang DD, Zhang CJ, Chen BC, Shen X, Yu Z. Ginsenoside Rb1 improves postoperative fatigue syndrome by reducing skeletal muscle oxidative stress through activation of the PI3K/Akt/Nrf2 pathway in aged rats. Eur J Pharmacol 2014; 740:480-7. [DOI: 10.1016/j.ejphar.2014.06.040] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2014] [Revised: 06/19/2014] [Accepted: 06/19/2014] [Indexed: 01/14/2023]
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ORMEL G, ROMUNDSTAD L, LAMBERT-JENSEN P, STUBHAUG A. Dexamethasone has additive effect when combined with ondansetron and droperidol for treatment of established PONV. Acta Anaesthesiol Scand 2011; 55:1196-205. [PMID: 22092124 DOI: 10.1111/j.1399-6576.2011.02536.x] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
BACKGROUND Prophylactic dexamethasone, ondansetron and droperidol have a documented effect on post-operative nausea and vomiting (PONV). Still, there is a lack of studies investigating the effect of adding dexamethasone to ondansetron and droperidol in order to treat established PONV. METHODS In this double-blind randomised, controlled trial, we compared triple prophylaxis for PONV consisting of dexamethasone 8 mg intravenous (IV), ondansetron 4 mg IV and droperidol 0.625 mg IV (n = 157) with placebo (n = 156) given before gynaecological day-case surgery. Subsequently, in those having PONV despite triple prophylaxis or placebo, a dose of ondansetron and droperidol plus dexamethasone was compared with the combination of ondansetron and droperidol. RESULTS Triple prophylaxis reduced acute PONV (0-6 h) (P = 0.0003) and post-discharge PONV (6-24 h) (P = 0.001) when compared with placebo. Among those suffering from PONV despite placebo or active prophylaxis (n = 80), adding dexamethasone to ondansetron and droperidol reduced acute PONV (0-6 h) (P = 0.025) as well as post-discharge nausea (6-24 h) (P = 0.04) compared with duo treatment comprising ondansetron and droperidol. In those reporting PONV despite prophylaxis (n = 12), the treatment comprising ondansetron and droperidol, with or without dexamethasone, gave a 91.7% reduction in acute PONV and an 83.6% reduction in post-discharge PONV. CONCLUSION Treatment of established PONV comprising ondansetron and droperidol, with or without dexamethasone, reduced PONV in both treatment groups. In those reporting PONV without active prophylaxis, the addition of dexamethasone resulted in a significant amplification of the PONV-reducing [corrected] effects of ondansetron and droperidol.
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Affiliation(s)
- G. ORMEL
- Department of Anaesthesiology; Oslo University Hospital Rikshospitalet; Oslo; Norway
| | - L. ROMUNDSTAD
- Department of Anaesthesiology; Oslo University Hospital Rikshospitalet; Oslo; Norway
| | - P. LAMBERT-JENSEN
- Department of Anaesthesiology; Oslo University Hospital Rikshospitalet; Oslo; Norway
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Zhang XD, Chen BC, Dong QT, Andersson R, Pan XD, Tan SJ, Ye XZ, Yao JG, Yu Z. Establishment and assessments of a new model for the postoperative fatigue syndrome by major small intestinal resection in rats. Scand J Gastroenterol 2011; 46:1302-9. [PMID: 21854092 DOI: 10.3109/00365521.2011.610001] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVE Postoperative fatigue syndrome (POFS) is a general and main complication after surgery. However, there is no stable and standardized animal model for POFS. The aim of the present study was to establish a rodent model of POFS by small intestinal resection, with POFS evaluated by acknowledged physical and behavioral methods. MATERIAL AND METHODS Forty-two Sprague-Dawley rats were randomly divided into four groups according to the length of a "middle" small intestinal resection: 0% (sham group; i.e., laparotomy alone), 10%, 40% and 70% groups, with corresponding lengths of small intestinal resections. Following surgery, the general state of health was evaluated. Tail suspension test, open field test and Morris water maze test were used to evaluate the degree of POFS. Serum albumin, transferrin, prealbumin and fibronectin were measured to assess the nutritional status, and superoxide dismutase (SOD) and malondialdehyde (MDA) were also measured. RESULTS As compared with the other three groups, the 70% small intestinal resection group showed the worst general state of health, decreased strength of the tail suspension test and decreased score of Morris water maze test (p < 0.05) after operation. All rats in whom the small intestinal resection was done demonstrated a certain degree of malnutrition and behavior of depression, and the 70% resection group had the lowest levels of transferrin, prealbumin and fibronectin as compared with the other groups (p < 0.05), as well as decreased SOD and increased MDA in serum (p < 0.05). CONCLUSIONS Resection of 70% of the small intestine resulted in typical characteristics of POFS. As this procedure is simple, stable and easily reproducible, it may serve as a model for research on POFS.
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Affiliation(s)
- Xiao-Dong Zhang
- Department of Gastrointestinal Surgery, The First Affiliated Hospital, Wenzhou Medical College, Wenzhou, China
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van Venrooij LMW, Verberne HJ, de Vos R, Borgmeijer-Hoelen MMMJ, van Leeuwen PAM, de Mol BAJM. Postoperative loss of skeletal muscle mass, complications and quality of life in patients undergoing cardiac surgery. Nutrition 2011; 28:40-5. [PMID: 21621393 DOI: 10.1016/j.nut.2011.02.007] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2010] [Revised: 12/20/2010] [Accepted: 02/12/2011] [Indexed: 02/09/2023]
Abstract
OBJECTIVE The objective of this study was to describe postoperative undernutrition in terms of postoperative losses of appendicular skeletal muscle mass (ASMM) with respect to complications, quality of life, readmission, and 1-y mortality after cardiac surgery. METHODS Patients undergoing cardiac surgery were prospectively followed. ASMM was measured 2 wk before and 2 mo after surgery using dual-energy X-ray absorptiometry. ASMM consists of arm skeletal muscle mass (SMM) and leg SMM. The association between ≥5% of ASMM decrease and postoperative outcome was analyzed using the chi-square test. A similar approach was used to analyze arm SMM and leg SMM decreases separately. RESULTS Twenty-nine patients were included (23 male, 34.5% ≥65 y old). Postoperatively, seven patients (24.1%) lost ≥5% ASMM. When analyzed separately, a ≥5% decrease in leg SMM was associated with a decrease in experienced vitality (odds ratio 13.0, 95% confidence interval 1.32-128.11, P = 0.03). In contrast, a ≥5% loss of arm SMM was associated with fewer in-hospital complications (odds ratio 0.20, 95% confidence interval 0.04-0.98, P = 0.04). These patients were characterized by a higher preoperative fat-free mass index (kilograms per meter squared; P = 0.01). CONCLUSIONS The results suggest that a preoperatively higher fat-free mass index indicates better ability to cope with operative stress, resulting in fewer complications. In addition, postoperative loss of muscle mass was associated with decreased vitality. We advocate further research investigating the effect of preoperative and postoperative nutritional intervention combined with physical exercise programs to increase lean body mass and thereby improve postoperative recovery after cardiac surgery.
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Affiliation(s)
- Lenny M W van Venrooij
- Department of Dietetics, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.
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Kahokehr AA, Sammour T, Sahakian V, Zargar-Shoshtari K, Hill AG. Influences on length of stay in an enhanced recovery programme after colonic surgery. Colorectal Dis 2011; 13:594-9. [PMID: 20128839 DOI: 10.1111/j.1463-1318.2010.02228.x] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
AIM Enhanced recovery after surgery (ERAS) programmes have been shown to accelerate and enhance functional recovery after colonic surgery. We analysed prospectively collected data to investigate potentially modifiable factors that may influence the length of stay (LOS) in the ERAS setting at a single institution. METHOD Between October 2005 and November 2008, prospective data were collected on consecutive patients who underwent elective colonic surgery without a stoma. Patients with rectal cancer, those unable to participate in preoperative ERAS components because of their inability to communicate effectively in English, those with cognitive impairment and those with an American Society of Anesthesiologists (ASA) grade of ≥ 4 were excluded. Statistical analyses were performed using the Mann-Whitney U-test and Cox regression modelling. RESULTS A total of 100 (79 malignancies) patients underwent elective colon resection during the study period. There were 57 right-sided, 41 left-sided and two total colectomies. The median age of the patients was 67.5 (range 31-92) years and the median day stay was 4 (range 3-46) days. Factors with significant correlations for reduced LOS were female gender, the surgeon, operative severity, high-dependency unit (HDU) admission and incision type favouring laparoscopic and transverse approaches. Age, operation site, indication for surgery and body mass index were not significant predictors of hospital stay. Gender, operative severity, HDU admission and surgeon did not have any independent correlation with LOS; in contrast to the ASA score and the type of incision, which did. CONCLUSION Lower ASA score, transverse incision laparotomy and laparoscopy correlated independently with reduced postoperative LOS within the ERAS setting.
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Affiliation(s)
- A A Kahokehr
- Department of Surgery, South Auckland Clinical School, University of Auckland, Middlemore Hospital, Auckland, New Zealand.
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Jensen MB, Houborg KB, Nørager CB, Henriksen MG, Laurberg S. Postoperative changes in fatigue, physical function and body composition: an analysis of the amalgamated data from five randomized trials on patients undergoing colorectal surgery. Colorectal Dis 2011; 13:588-93. [PMID: 20148922 DOI: 10.1111/j.1463-1318.2010.02232.x] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
AIM Changes in postoperative fatigue, physical function and body composition were described in patients after open colorectal surgery, and factors that predicted postoperative fatigue 1 month after surgery were identified. METHOD Data from five clinical intervention studies from 1991 to 2005 were amalgamated. Patients (n = 385) were examined preoperatively, at discharge and 1 month postoperatively. The level of fatigue was scored subjectively from 1 'fit' to 10 'fatigued' on a modified visual analogue scale and by objective measurements of hand grip and knee extension strength, work capacity, weight, lean body mass and fat mass. A logistic regression analysis was used to identify the predictors of a high fatigue score 1 month postoperatively. RESULTS Preoperatively, only 17% had a high fatigue score (≥ 5.5), whereas 65 and 30% had a high fatigue score at discharge and 1 month postoperatively, respectively. Postoperatively, there was a significant fall in physical performance, weight, lean body mass and fat mass that did not normalize by 1 month. High preoperative and discharge fatigue scores, major complications and the loss of lean body mass significantly increased the risk of fatigue 1 month postoperatively. CONCLUSION Open colorectal surgery was associated with a significant increase in postoperative fatigue and a decline in physical performance, weight and lean body mass. Major complications, a high perioperative fatigue score and the loss of lean body mass increased the risk of long-term fatigue.
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Affiliation(s)
- M B Jensen
- Surgical Research Unit, Department of Surgery P, Aarhus University Hospital, Aarhus, Denmark.
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Pain management in the elderly and cognitively impaired patient: the role of regional anesthesia and analgesia. Curr Opin Anaesthesiol 2009; 22:594-9. [DOI: 10.1097/aco.0b013e32833020dc] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
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Schulz PS, Zimmerman L, Pozehl B, Barnason S, Nieveen J. Symptom management strategies used by elderly patients after coronary artery bypass surgery. Appl Nurs Res 2009; 24:65-73. [PMID: 20974054 DOI: 10.1016/j.apnr.2009.03.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2008] [Revised: 02/06/2009] [Accepted: 03/24/2009] [Indexed: 11/24/2022]
Abstract
The purpose of this secondary analysis was to describe symptom management strategies used by elderly patients (n = 236) 3 and 6 weeks after coronary artery bypass surgery (CABS). Three weeks after surgery, the most frequently used strategies were rest to manage shortness of breath (53%) and fatigue (53%), medications for incision pain (24%), and repositioning for swelling (35%) and sleep disturbance (18%). Overall, fewer patients experiencing sleep disturbances (39%), incision pain (39%), swelling (46%), and appetite problems (17%) reported using a strategy to manage their symptom. Nurses must assist patients in symptom identification and problem solving to accomplish effective symptom management.
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Affiliation(s)
- Paula S Schulz
- UNMC College of Nursing – Lincoln Division, Commerce Court, Lincoln, NE 68588-0220, USA.
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Allvin R, Ehnfors M, Rawal N, Svensson E, Idvall E. Development of a questionnaire to measure patient-reported postoperative recovery: content validity and intra-patient reliability. J Eval Clin Pract 2009; 15:411-9. [PMID: 19366398 DOI: 10.1111/j.1365-2753.2008.01027.x] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
AIMS AND OBJECTIVES In this study we describe the development of a short, easy-to-use questionnaire to measure postoperative recovery and evaluate its content validity and intra-patient reliability. The questionnaire is designed to evaluate the progress of postoperative recovery and the long-term follow-up of possible effects of interventions during recovery. METHODS The study involved four steps. (1) A conceptualization and item definitions were based on a theoretical framework and a description of patients' postoperative recovery from the perspective of patients, registered nurses and surgeons; (2) Content validity of items was tested through expert judgements; (3) A test run of the questionnaire was performed to confirm its feasibility and workload requirement; and (4) The stability of the questionnaire was evaluated through intra-patient reliability assessment. RESULTS As a result of the operationalization process of the concept postoperative recovery, five dimensions (physical symptoms, physical functions, psychological, social, activity) and 19 items were identified. Each item was formulated as a statement in the questionnaire. Content validity was judged to be high. After the pre-test of the questionnaire a revision with refinements in the layout was made. The vast majority of items showed a high level of intra-patient reliability. CONCLUSION Based on a theoretical framework and empirical data, we developed a short and easy-to-use tentative questionnaire to measure patient-reported postoperative recovery. Initial support for content validity was established. The vast majority of items showed a high level of test-retest reliability.
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Affiliation(s)
- Renée Allvin
- Department of Anaesthesiology and Intensive Care, Orebro University Hospital, Orebro, Sweden.
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Barnason S, Zimmerman L, Nieveen J, Schulz P, Miller C, Hertzog M, Rasmussen D. Relationships between fatigue and early postoperative recovery outcomes over time in elderly patients undergoing coronary artery bypass graft surgery. Heart Lung 2008; 37:245-56. [PMID: 18620100 DOI: 10.1016/j.hrtlng.2007.09.003] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2007] [Revised: 09/04/2007] [Accepted: 09/06/2007] [Indexed: 11/30/2022]
Abstract
BACKGROUND Despite successful coronary artery bypass graft (CABG) surgery, some patients continue to experience fatigue after their surgery. OBJECTIVE The purpose of this secondary analysis study was to examine the relationships of fatigue and early recovery outcomes (psychosocial and physiologic functioning, and physical activity) over time (6 weeks and 3 months) among older adult subjects, age 65 years and older, after CABG surgery. Comparison groups were those subjects who had fatigue at 3 weeks after surgery and nonfatigued subjects. DESIGN A prospective, comparative design was used for this secondary analysis study. SAMPLE Subjects in this study were drawn from the control group of subjects enrolled in the larger parent study. Subjects (N = 119) were dichotomized into fatigue (n = 66) and nonfatigued (n = 53) groups on the basis of their 3-week self-reports of postoperative fatigue. RESULTS At 6 weeks after surgery, fatigued subjects had significantly (P < .05) more impaired psychosocial functioning (role-emotional [t = 1.9], social [t = 2.6], and mental [t = 1.9] functioning) on the basis of the Medical Outcome Study Short Form 36. They had significantly (P < .005) higher mean hospital anxiety (t = -3.6) and depression (t = -2.9) subscale scores, respectively. Anxiety (t = -2.3, P < .05) remained significantly (P < .05) impaired at 3 months. At 6 weeks, role physical functioning, measured by the Medical Outcome Study Short Form 36, was significantly impaired (t = 2.4, P < .01). There were no significant differences in physical activity variables as measured by an RT3 accelerometer (Stayhealthy, Inc., Monrovia, CA) and self-report diary. CONCLUSIONS Persistent fatigue can hamper early recovery after CABG surgery. Tailored interventions are needed to address fatigue management and improve patient outcomes.
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Affiliation(s)
- Susan Barnason
- University of Nebraska Medical Center, College of Nursing-Lincoln Division, 1230 O Street, STE 131, PO Box 880220, Lincoln, NE 68588-0220, USA
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Zargar-Shoshtari K, Paddison JS, Booth RJ, Hill AG. A prospective study on the influence of a fast-track program on postoperative fatigue and functional recovery after major colonic surgery. J Surg Res 2008; 154:330-5. [PMID: 19118844 DOI: 10.1016/j.jss.2008.06.023] [Citation(s) in RCA: 54] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2008] [Revised: 06/05/2008] [Accepted: 06/17/2008] [Indexed: 01/08/2023]
Abstract
INTRODUCTION Enhanced Recovery After Surgery (ERAS) programs have demonstrated significant reduction in hospital stay for patients undergoing colonic surgery; however, their impact on long-term outcomes, such as postoperative fatigue (POF), has not been fully established. AIM To assess the impact of an ERAS program on POF and recovery following elective open colonic surgery. METHOD In a prospective study, 26 consecutive patients undergoing open colonic surgery under a conventional care plan were compared with 26 consecutive patients in an ERAS program. RESULTS Demographic and clinical characteristics were comparable at baseline. The median duration of total hospital stay (4 versus 7 d, P < 0.001), rates of urinary tract infections (P = 0.028) and ileus (P = 0.042) were significantly smaller in the ERAS group. Postoperatively, POF significantly increased in both groups. However, peak POF score was significantly lower in the ERAS group (P = 0.001). In the first 30 d after surgery, Fatigue Consequence scores were also significantly smaller in the ERAS group. Overall, the total fatigue experience (P = 0.035) and the total fatigue impact (P = 0.005) were significantly smaller in the ERAS group. CONCLUSION The impact of ERAS programs may extend beyond the commonly reported short-term outcomes, and ERAS may accelerate overall recovery and return to normal function.
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The anxiety- and pain-reducing effects of music interventions: a systematic review. AORN J 2008; 87:780-807. [PMID: 18395022 DOI: 10.1016/j.aorn.2007.09.013] [Citation(s) in RCA: 344] [Impact Index Per Article: 21.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2007] [Revised: 08/24/2007] [Accepted: 09/09/2007] [Indexed: 01/08/2023]
Abstract
Musical interventions have been used in health care settings to reduce patient pain, anxiety, and stress, although the exact mechanism of these therapies is not well understood. This article provides a systematic review of 42 randomized controlled trials of the effects of music interventions in perioperative settings. Music intervention had positive effects on reducing patients' anxiety and pain in approximately half of the reviewed studies. Further research into music therapy is warranted in light of the low cost of implementation and the potential ability of music to reduce perioperative patient distress.
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Paddison JS, Booth RJ, Fuchs D, Hill AG. Peritoneal inflammation and fatigue experiences following colorectal surgery: a pilot study. Psychoneuroendocrinology 2008; 33:446-54. [PMID: 18258374 DOI: 10.1016/j.psyneuen.2007.12.011] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2007] [Revised: 12/20/2007] [Accepted: 12/23/2007] [Indexed: 11/18/2022]
Abstract
OBJECTIVE The effect of post-surgical inflammation, as indicated by peritoneal cytokines and neopterin, was assessed on the duration and characteristics of post-surgical fatigue (PSF) experiences. BACKGROUND During the weeks following major colorectal surgery, many patients report experiencing substantial fatigue but the physiological factors contributing to this are not well understood. Because cytokines, particularly pro-inflammatory cytokines, have been found to be important in fatigue-related experiences in experimental systems, they may well be important mediators of PSF. METHODS In 27 patients following colorectal surgery, cytokines and neopterin (a relatively stable immune activation marker) were measured in 24-h peritoneal drain fluid and in serum 2, 5 and 14 days post-operatively. Patient fatigue was assessed using the Identity-Consequence Fatigue Scale questionnaire pre-operatively and 2, 5, 14, 30 and 60 days after surgery. RESULTS Using linear mixed model analysis controlling for age, gender and ASA score, the trajectory of fatigue experience during the first 2 months of surgical recovery was significantly related to intra-peritoneal concentrations of IL-6, IL-10 and TNF-alpha during the first 24h after surgery, while the trajectory of fatigue impacts was related only to IL-6 and TNF-alpha concentrations. Moreover, correlations between neopterin, and post-operative peritoneal (within 24h of surgery) and serum cytokine concentrations permitted neopterin to be used as a surrogate inflammation marker. Patients with elevated neopterin concentrations during the initial weeks following surgery reported significantly more severe and sustained PSF. CONCLUSIONS Locally occurring inflammatory responses may influence reports of fatigue following major surgery in a sustained manner, and, as a consequence, reducing inflammation may be effective in reducing PSF.
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Affiliation(s)
- Johanna S Paddison
- Department of Molecular Medicine and Pathology, The University of Auckland, Auckland, New Zealand
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Allvin R, Ehnfors M, Rawal N, Idvall E. Experiences of the postoperative recovery process: an interview study. Open Nurs J 2008; 2:1-7. [PMID: 19319214 PMCID: PMC2582826 DOI: 10.2174/1874434600802010001] [Citation(s) in RCA: 54] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2007] [Revised: 11/15/2007] [Accepted: 11/30/2007] [Indexed: 01/05/2023] Open
Abstract
Few researchers have described postoperative recovery from a broad, overall perspective. In this article the authors describe a study focusing on patient and staff experiences of postoperative recovery using a qualitative descriptive design to obtain a description of the phenomenon. They performed 10 individual interviews with patients who had undergone abdominal or gynecological surgery and 7 group interviews with registered nurses working on surgical and gynecological wards and in primary care centers, surgeons from surgical and gynecological departments, and in-patients from a gynecological ward. The authors analyzed data using qualitative content analysis. Postoperative recovery is described as a Dynamic Process in an Endeavour to Continue With Everyday Life. This theme was further highlighted by the categories Experiences of the core of recovery and Experiences of factors influencing recovery. Knowledge from this study will help caregivers support patients during their recovery from surgery.
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Affiliation(s)
- R Allvin
- Department of Anesthesiology and Intensive Care, Orebro University Hospital, Sweden
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Rittler P, Jacobs R, Demmelmair H, Kuppinger D, Braun S, Koletzko B, Jauch KW, Hartl WH. Dynamics of albumin synthesis after major rectal operation. Surgery 2007; 141:660-6. [PMID: 17462467 DOI: 10.1016/j.surg.2006.09.018] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2005] [Revised: 09/06/2006] [Accepted: 09/10/2006] [Indexed: 10/23/2022]
Abstract
BACKGROUND Major abdominal operations were found to be associated with long-lasting metabolic changes, such as accelerated release of stress hormones and carbohydrate turnover. It is unknown currently whether acute changes of hepatic protein metabolism persist in a similar way. We wanted to determine the long-term dynamics of albumin synthesis and its relationship to whole body protein breakdown and albumin concentration after major rectal operations. METHODS We used stable isotope tracer techniques to determine albumin synthesis and whole body protein breakdown (rate of appearance of leucine, Ra) in postoperative patients about 1 week after low anterior rectal resection and also during convalescence (about 4 months after operation), and in healthy controls. Consecutive blood sampling was carried out during continuous isotope infusion (1-[(13)C]-leucine, 0.16 micromol/kg min). RESULTS Serum albumin concentrations were close to the lower normal limit in patients early after operation but were comparable to controls in convalescent patients. Simultaneously, albumin synthesis was increased in the early postoperative phase (0.53 +/- 0.0.5%/h) compared with convalescent patients (0.32 +/- 0.04) and controls (0.28 +/- 0.04) (P < .01 each). A significant inverse correlation could be found between plasma albumin concentration and corresponding rates of albumin synthesis. Early after operation patients showed an increased leucine Ra (3.25 +/- 0.23 micromol/kg min) that was greater than that of convalescent patients (2.37 +/- 0.06 micromol/kg min, P < .05). Leucine Ra in both patient groups were greater than the rates in controls (2.01 +/- 0.07 micromol/kg min, P < .01) Albumin synthesis correlated weakly with whole body protein breakdown rate. CONCLUSIONS Albumin synthesis and total body protein breakdown are increased after major abdominal operation, but albumin synthesis returns to control values only during convalescence. Hypoalbuminemia after rectal operations may be associated with high rates of albumin synthesis and is, therefore, not necessarily an indicator of insufficient hepatic function or poor nutritional status in that particular situation.
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Affiliation(s)
- Peter Rittler
- Department of Surgery, Klinikum Grosshadern, Ludwig-Maximilian University Munich, Germany
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Tops M, van Peer JM, Wijers AA, Korf J. Acute cortisol administration reduces subjective fatigue in healthy women. Psychophysiology 2006; 43:653-6. [PMID: 17076823 DOI: 10.1111/j.1469-8986.2006.00458.x] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Treatment with cortisol has been found to decrease fatigue and increase feelings of vigor in both patients and healthy male subjects. We obtained self-reports of mood before 35 mg cortisol or placebo ingestion, 70 min later, and after the healthy female subjects performed cognitive tasks for 1 h in a double-blind within-subject study. Cortisol decreased fatigue, increased vigor, and tended to decrease tension. Effects on fatigue were largest after task performance, when fatigue had increased, suggesting that improvement of fatigue by cortisol is observed when subjects are fatigued. This is the first study to demonstrate improvements in fatigue in healthy female subjects; this is particularly relevant because of the high prevalence of hypocortisolimic fatigue syndromes in women and recent evidence that many psychiatric disorders may involve stress-induced hypocortisolemia that is responsive to cortisol replacement.
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Affiliation(s)
- Mattie Tops
- Department of Experimental and Work Psychology, University of Groningen, 9712 TS Groningen, The Netherlands.
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Paddison JS, Booth RJ, Hill AG, Cameron LD. Comprehensive assessment of peri-operative fatigue: development of the Identity-Consequence Fatigue Scale. J Psychosom Res 2006; 60:615-22. [PMID: 16731236 DOI: 10.1016/j.jpsychores.2005.08.008] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2005] [Indexed: 10/24/2022]
Abstract
OBJECTIVE Fatigue is one of the complaints most widely reported during peri-operative periods. However, despite its prevalence, the aetiology of this fatigue remains poorly understood. Recent meta-analysis suggests that the limited applicability of existing fatigue measures is contributing to the current lack of understanding. This research therefore sought to use a rigorous analytic process to develop a comprehensive measure of fatigue suitable for use with recovering surgical patients. METHODS Content analysis was undertaken to investigate the structure of 55 items initially generated. Self-report questionnaires were then distributed to surgical out-patients, and the 177 responses analysed using principal components analysis. Once item selection was finalized, the convergent and discriminant validity of the new measure was assessed. RESULTS The new measure, the Identity-Consequence Fatigue Scale (ICFS), has 28 items and five subscales. All subscales show high internal reliability, and reentry of deleted items showed that the finalized items form a robust component structure. Discriminant validity analysis confirmed that all ICFS subscales are distinctive from depression and anxiety. Convergent validity analysis confirmed the extent to which the ICFS assesses Fatigue-Consequences is a unique feature of the new measure. CONCLUSION The ICFS has a clear and stable structure that offers more comprehensive assessment of fatigue than provided by the measures most widely used in postsurgical fatigue (PSF) literature to date.
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Affiliation(s)
- Johanna S Paddison
- Department of Molecular Medicine and Pathology, The University of Auckland, Auckland, New Zealand
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Romundstad L, Breivik H, Roald H, Skolleborg K, Haugen T, Narum J, Stubhaug A. Methylprednisolone reduces pain, emesis, and fatigue after breast augmentation surgery: a single-dose, randomized, parallel-group study with methylprednisolone 125 mg, parecoxib 40 mg, and placebo. Anesth Analg 2006; 102:418-25. [PMID: 16428536 DOI: 10.1213/01.ane.0000194358.46119.e1] [Citation(s) in RCA: 73] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
We compared methylprednisolone 125 mg IV (n = 68) and parecoxib 40 mg IV (n = 68) with placebo (n = 68) given before breast augmentation surgery in a randomized, double-blind parallel group study. Surgery was performed under local anesthesia combined with propofol/fentanyl sedation. Methylprednisolone and parecoxib decreased pain at rest and dynamic pain intensity from 1 to 6 h after surgery compared with placebo (mean summed pain intensity(1-6 h): methylprednisolone [17.25; 95% confidence interval [CI], 14.85-19.65] versus placebo [21.7; 95% CI, 19.3-24.1]; P < 0.03; parecoxib [15.25; 95% CI, 13.25-17.25] versus placebo; P < 0.001; mean summed dynamic pain intensity(1-6 h): methylprednisolone [22.7; 95% CI, 20.1-23.3] versus placebo [28.4; 95% CI, 26.0-30.8]; P < 0.01; parecoxib [20.9; 95% CI, 18.6-23.2] versus placebo; P < 0.001). Both rescue drug consumption and actual pain (all observations before and after rescue) during the first 6 h were similar in the two active drug groups and significantly reduced compared with placebo. Using a composite score of actual pain intensity and rescue analgesic use, the active drugs were significantly superior to placebo (P < 0.001 for both active drugs). Postoperative nausea and vomiting was reduced after methylprednisolone administration (incidence, 30%), but not after parecoxib (incidence, 37%), during the first 24 h compared with placebo (incidence, 60%; P < 0.001). Fatigue was reduced by methylprednisolone (incidence, 44%), but not by parecoxib (incidence, 59%), compared with placebo (incidence, 66%; P < 0.05). In conclusion, methylprednisolone 125 mg IV given before breast augmentation surgery had analgesic and rescue analgesic-sparing effects comparable with those of parecoxib 40 mg IV. Methylprednisolone, but not parecoxib, reduced nausea, vomiting, and fatigue.
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Affiliation(s)
- Luis Romundstad
- Department Group of Clinical Medicine, University of Oslo, Norway.
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Chuang D, Power SE, Dunbar PR, Hill AG. Central nervous system interleukin-8 production following neck of femur fracture. ANZ J Surg 2005; 75:813-6. [PMID: 16174000 DOI: 10.1111/j.1445-2197.2005.03530.x] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
AIM To establish a proinflammatory cytokine profile of the cerebrospinal fluid (CSF) following trauma. BACKGROUND Trauma is associated with a postinjury syndrome consisting of loss of weight and nitrogen, pyrexia, anorexia and fatigue. It has been proposed that cytokines are pathophysiologically involved in this syndrome but the site of action of these is unclear. Previous work in head injury models, supported by animal work, has suggested that one important site of action is the central nervous system (CNS). METHODS Women who had sustained neck of femur fractures were enrolled (trauma group). CSF was collected at the time of spinal anaesthetic. Women undergoing elective lower limb surgery were recruited as controls. CSF and serum were assayed for Interleukin (IL) 1, 2, 4, 6, 8, 10, 12, interferon gamma, and tumour necrosis factor by cytometric bead array. RESULTS In the trauma group, IL-8 was elevated in the CSF but not in the serum, while IL-6 was elevated in the serum but not in the CSF. IL-1beta, associated with elevated IL-12, was also detected in the serum of three of 11 trauma patients but none of the nine controls. No other cytokines were consistently detected. CONCLUSIONS This study raises the possibility that IL-8, acting in the CNS, plays a role in the postinjury syndrome. It is unclear as to the mechanism by which CNS IL-8 is produced in trauma but a physiological role is supported by the known ability of the CNS to produce IL-8 and the presence of receptors for its action in the CNS.
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Affiliation(s)
- Danny Chuang
- South Auckland Clinical School, University of Auckland, Auckland, New Zealand
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Abstract
PURPOSE OF REVIEW An overview is provided that discusses brain dysfunctions in intensive care unit patients in the context of psychoneuroimmunology. Recent findings are discussed within the context of the relationship between behavioural aspects and immune functions. The concept of 'sickness behaviour' is introduced to understand the more differential aspects of stress, fatigue and mood. RECENT FINDINGS Psychoneuroimmunology is a relatively new field of study that investigates interactions between behaviour and the immune system, mediated by the nervous system. 'Sickness behaviour' describes behavioural changes or reactions of an (infected) organism to cope with illness. Sickness behaviour should be seen as an adaptation to an infection that also influences the process of recovery or further illness. SUMMARY There are plausible explanations of how psychological factors (such as aspects of mood) might influence immunity and immune system-mediated disease. There is substantial evidence that psychological factors can influence both cellular and humoral indicators of immune status and function. There are consistent and convincing reports of links between stress and disease onset and progression.
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Affiliation(s)
- Thomas Uhlig
- Clinic of Anesthesiology and Intensive Care Medicine, Friedrich Schiller Universität, Jena, Germany.
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Affiliation(s)
- Karen C Nielsen
- Department of Anesthesiology, Duke University Medical Center, Durham, NC 27710, USA
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Abstract
OBJECTIVE To assess whether the fatigue commonly reported by patients following surgery is partly a result of somatization and/or cognitive-behavioral factors. METHODS One hundred eighty-three patients completed questionnaires before surgery and then 2 days, 3 weeks and 6 months afterward. Multiple regressions were used to assess which of the following factors were important in predicting self-reported postoperative fatigue, controlling for preoperative fatigue and for various demographic and surgical variables: negative mood, history of mood disorder, preoperative expectations of fatigue, preoperative worry or optimism about surgery, preoperative beliefs about the benefits of activity or rest, self-reported postoperative activity, self-reported cardiovascular deconditioning, and availability of social support. RESULTS Controlling for demographic and surgical variables and preoperative fatigue, postoperative fatigue showed significant associations with negative mood at each stage of follow-up (p < .001) and was significantly predicted by history of mood disorder at 2 days postoperatively (p = .02). Higher fatigue expectations were self-fulfilling at 3 weeks after surgery (p = .02), whereas preoperative belief in physical activity as being beneficial to recovery predicted reduced fatigue at 6 months (p < .001). Finally, self-reported breathlessness after exercise, an indicator of cardiovascular deconditioning, was also significantly associated with greater fatigue at 6 months (p = .02). CONCLUSION The results indicate that psychological processes may well be relevant in the etiology of postoperative fatigue. In particular, the results relating to mood and expectations suggest that somatization may be particularly important in the first few weeks following surgery, whereas cognitive-behavioral factors and cardiovascular deconditioning may be more important in determining later-stage recovery.
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Affiliation(s)
- G James Rubin
- Section of General Hospital Psychiatry, Division of Psychological Medicine, Institute of Psychiatry and Guy's, King's and St. Thomas' School of Medicine, King's College London, London, UK.
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Montgomery GH, Bovbjerg DH. Presurgery distress and specific response expectancies predict postsurgery outcomes in surgery patients confronting breast cancer. Health Psychol 2004; 23:381-7. [PMID: 15264974 DOI: 10.1037/0278-6133.23.4.381] [Citation(s) in RCA: 87] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Prior to scheduled surgery, patients frequently experience particularly high levels of distress and expect a variety of postsurgery symptoms. Surgery patients who confront breast cancer are no exception. It has been suggested that such presurgery distress and response expectancies are predictive of postsurgery outcomes. To test the contribution of presurgery distress and expectancies to common postsurgery symptom outcomes (pain, nausea, fatigue, and discomfort), 63 female patients undergoing breast cancer surgery were recruited to a prospective study. Results indicated that presurgery distress uniquely contributed to patients' postsurgery nausea, fatigue, and discomfort; specific expectancies uniquely contributed to pain intensity, pain unpleasantness, and fatigue (ps < .05). Consistent with expectancy theory, associations between response expectancies and postsurgery outcomes were not due to presurgery distress.
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Affiliation(s)
- Guy H Montgomery
- Integrative Behavioral Medicine Program and Biobehavioral Medicine Program, Ruttenberg Cancer Center, Mount Sinai School of Medicine, New York, NY 10029-6574, USA.
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Rubin GJ, Hardy R, Hotopf M. A systematic review and meta-analysis of the incidence and severity of postoperative fatigue. J Psychosom Res 2004; 57:317-26. [PMID: 15507259 DOI: 10.1016/s0022-3999(03)00615-9] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2003] [Accepted: 10/12/2003] [Indexed: 12/12/2022]
Abstract
OBJECTIVE Postoperative fatigue is common following major abdominal surgery. Less is known about its prevalence in other surgical subgroups, and about its long-term prognosis. A systematic review of prospective cohort studies was conducted to clarify these issues. METHOD Studies were identified from an extensive literature search. Overall estimates of pre- to postoperative change in fatigue severity and the incidence of clinically significant postoperative fatigue were calculated using meta-analyses. RESULTS Eighty-one cohorts were identified. Type of surgery was found to be a possible predictor of fatigue severity, with major abdominal, gynaecological, cardiac and minor surgery apparently associated with greater fatigue than orthopaedic surgery. Limited data were available regarding the long-term persistence of postoperative fatigue. CONCLUSION Postoperative fatigue appears to be an important problem following only certain forms of surgery. Why this is so remains unclear, and further work using better fatigue questionnaires is now required to confirm these differences.
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Affiliation(s)
- G James Rubin
- Section of General Hospital Psychiatry, Division of Psychological Medicine, Guy's, King's and St Thomas' School of Medicine, UK.
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Elder MJ. An eye for fatigation. Clin Exp Ophthalmol 2004; 32:126-30. [PMID: 15068426 DOI: 10.1111/j.1442-9071.2004.00802.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Mark J Elder
- Department of Ophthalmology, Christchurch Hospital, Christchurch, New Zealand.
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Abstract
BACKGROUND Little research has examined the recovery patterns of older adults who have had major abdominal surgery. OBJECTIVE To determine whether pain, depression, and fatigue are significant factors in the return of older adults who had major abdominal surgery to functional status and self-perception of recovery in the first 3 months after discharge from the hospital. METHODS A correlational predictive study involved adults 60 years of age or older who had undergone major abdominal surgery. Data were collected during hospitalization (n = 192), then 3 to 5 days (n = 141), 1 month (n = 132), and 3 months after discharge to home (n = 126) using the Brief Pain Inventory, the Geriatric Depression Scale-Short Form, the Modified Fatigue Symptom Checklist, the Enforced Social Dependency Scale, and the Self-Perception of Recovery Scale. RESULTS Multiple regression analysis indicated that pain, depression, and fatigue are significantly related to patients' self-perception of recovery and functional status. Pain, depression, and fatigue explain 13.4% of the variation in functional status at 3 to 5 days, 30.8% at 1 month, and 29.1% at 3 months after discharge. These three factors also explain 5.6% of the variation in self-perception of recovery during hospitalization, 12.3% at 3 to 5 days, 33.2% at 1 month, and 16.1% at 3 months after discharge. CONCLUSIONS Pain, depression, and fatigue are important factors to consider in the provision of care to abdominal surgery patients with a relatively uncomplicated postoperative course. Specific interventions to reduce pain, depression, and fatigue need to be evaluated for their impact on the postoperative recovery of older adults.
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Affiliation(s)
- Margarete Lieb Zalon
- University of Scranton, Department of Nursing, Scranton, Pennsylvania 18510-4549, USA.
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Abstract
Many studies of patients with long-standing chronic fatigue syndrome (CFS) have found alterations to the hypothalamo-pituitary-adrenal (HPA) axis, including mild hypocortisolism, heightened negative feedback and blunted responses to challenge. However, recent prospective studies of high-risk cohorts suggest that there are no HPA axis changes present during the early stages of the genesis of fatiguing illnesses. Moreover, HPA axis changes can be reversed by modifying behavioural features of the illness, such as inactivity, deconditioning and sleep disturbance. Nevertheless, raising levels of cortisol pharmacologically can temporarily alleviate symptoms of fatigue. This article presents the case that there is no specific change to the HPA axis in CFS and that the observed changes are of multifactorial aetiology, with some factors occurring as a consequence of the illness. Nevertheless, the HPA axis might play a role in exacerbating or perpetuating symptoms late on in the course of the illness.
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Affiliation(s)
- Anthony J Cleare
- Section of Neurobiology of Mood Disorders, Division of Psychological Medicine, The Institute of Psychiatry, London, SE5 8AF, UK.
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Abstract
Surgical injury can be followed by pain, nausea, vomiting and ileus, stress-induced catabolism, impaired pulmonary function, increased cardiac demands, and risk of thromboembolism. These problems can lead to complications, need for treatment in hospital, postoperative fatigue, and delayed convalescence. Development of safe and short-acting anaesthetics, improved pain relief by early intervention with multimodal analgesia, and stress reduction by regional anaesthetic techniques, beta-blockade, or glucocorticoids have provided important possibilities for enhanced recovery. When these techniques are combined with a change in perioperative care a pronounced enhancement of recovery and decrease in hospital stay can be achieved, even in major operations. The anaesthetist has an important role in facilitating early postoperative recovery by provision of minimally-invasive anaesthesia and pain relief, and by collaborating with surgeons, surgical nurses, and physiotherapists to reduce risk and pain.
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Affiliation(s)
- Henrik Kehlet
- Department of Surgical Gastroenterology, Hvidovre University Hospital, DK-2650 Hvidovre, Denmark.
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