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Filipovic MG, Baettig SJ, Ganter MT, Asai T, Luedi MM. Diabetes mellitus and the risk of aspiration - Safe and (ultra)sound? J Clin Anesth 2024; 96:111396. [PMID: 38267325 DOI: 10.1016/j.jclinane.2024.111396] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2023] [Accepted: 01/13/2024] [Indexed: 01/26/2024]
Affiliation(s)
- Mark G Filipovic
- Department of Anesthesiology and Pain Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.
| | - Sascha J Baettig
- Institute of Anaesthesiology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Michael T Ganter
- Institute of Anaesthesiology and Critical Care Medicine, Medical Faculty, Klinik Hirslanden Zurich, University of Zurich, Zurich, Switzerland
| | - Takashi Asai
- Department of Anesthesiology, Dokkyo Medical University, Koshigaya Hospital, 2-1-50 Minami-Koshigaya, Koshigaya, Saitama 343-8555, Japan
| | - Markus M Luedi
- Department of Anesthesiology and Pain Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland; Department of Anesthesiology, Rescue and Pain Medicine, Cantonal Hospital of St. Gallen, St. Gallen, Switzerland
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Wang XH, Wang ZY, Shan ZR, Wang R, Wang ZP. Effects of Preoperative Oral Carbohydrates on Recovery After Laparoscopic Cholecystectomy: A Meta-analysis of Randomized Controlled Trials. J Perianesth Nurs 2024:S1089-9472(24)00096-0. [PMID: 38980237 DOI: 10.1016/j.jopan.2024.03.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2023] [Revised: 03/05/2024] [Accepted: 03/10/2024] [Indexed: 07/10/2024]
Abstract
PURPOSE The objective of this meta-analysis was to evaluate the efficacy of administering preoperative oral carbohydrates (CHO) compared to a control treatment in improving postoperative recovery outcomes for patients undergoing laparoscopic cholecystectomy (LC). DESIGN A meta-analysis of randomized controlled trials. METHODS Through systematic searches in PubMed, Embase, and the Cochrane Library, randomized controlled trials focusing on preoperative oral carbohydrates for patients undergoing LC were collected. Data analysis was conducted using the Revman 5.3 software. FINDINGS The meta-analysis incorporated 19 randomized studies, with a total of 1,568 participants. Meta-analysis results indicated that patients receiving CHO reported notably lower postoperative pain compared to those fasting (P = .006) or on placebo (P = .003). Furthermore, a significant reduction in preoperative hunger was observed in the CHO group compared to the controls (P = .002). A notable difference was also identified in the postoperative Homeostasis Model Assessment-IR changes between the CHO and control groups (P = .02). No significant variations were observed in thirst, postoperative nausea and vomiting, insulin level alterations, glucose level changes, duration of hospital stay, or recovery quality. CONCLUSIONS Preoperative oral carbohydrates may alleviate hunger and pain, and attenuate postoperative insulin resistance more effectively than either overnight fasting or placebo in patients undergoing LC.
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Affiliation(s)
- Xiao-Han Wang
- School of Anesthesiology, Xuzhou Medical University, Xuzhou, Jiangsu, China
| | - Ze-Yang Wang
- School of Anesthesiology, Xuzhou Medical University, Xuzhou, Jiangsu, China
| | - Zheng-Ru Shan
- School of Anesthesiology, Xuzhou Medical University, Xuzhou, Jiangsu, China
| | - Rui Wang
- Department of Anesthesiology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu, China
| | - Zhi-Ping Wang
- Department of Anesthesiology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu, China; Jiangsu Province Key Laboratory of Anesthesiology, Xuzhou Medical University, Xuzhou, Jiangsu, China.
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Teng D, Song J, Chen H. A Short Fasting Protocol May Become a New Option for Cardiac Surgeons. Am J Med 2024; 137:e128. [PMID: 38942487 DOI: 10.1016/j.amjmed.2024.02.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2024] [Accepted: 02/25/2024] [Indexed: 06/30/2024]
Affiliation(s)
- Da Teng
- Yantai Yuhuangding Hospital Affiliated to Qingdao University, Yantai, Shandong, People's Republic of China; Qingdao University, Qingdao, Shandong, People's Republic of China
| | - Jikai Song
- Yantai Yuhuangding Hospital Affiliated to Qingdao University, Yantai, Shandong, People's Republic of China; Qingdao University, Qingdao, Shandong, People's Republic of China
| | - Hongping Chen
- Department of Cardiology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu, People's Republic of China.
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Gan HY, Liu HC, Huang HP, He M. The Prevalence and Risk Factors for Postoperative Thirst: A Systematic Review and Meta-analysis. J Perianesth Nurs 2024:S1089-9472(24)00043-1. [PMID: 38935010 DOI: 10.1016/j.jopan.2024.01.026] [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: 07/22/2023] [Revised: 01/24/2024] [Accepted: 01/30/2024] [Indexed: 06/28/2024]
Abstract
PURPOSE Thirst is a symptom of dehydration and one of the main complications affecting postoperative outcomes and comfort. Persistent water scarcity can have a detrimental effect on the cognitive function and psychology of patients. However, the current evidence about the prevalence and risk factors for postoperative thirst is not fully understood. Therefore, this study aims to investigate the prevalence and risk factors of postoperative thirst and provide guidance for clinical practice. DESIGN Systematic review and meta-analysis. METHODS We searched PubMed, Cochrane Library, Web of Science, Embase, Clinicaltrials.gov, China National Knowledge Infrastructure, and Wanfang Database. Eligible studies were evaluated using the Agency for Healthcare Research and Quality. The collected data were pooled and analyzed using Stata15.0. FINDINGS A total of 11 cross-sectional studies were included involving 20,612 patients. Eight studies reported prevalence and the pooled prevalence of postoperative thirst was 76.8% (95% confidence interval [CI]: 0.664 to 0.858). Five studies contributed to meta-syntheses of risk factors for postoperative thirst. The results indicated that sex (odds ratio [OR] = 1.44, 95% CI = 1.13 to 1.84, I2 = 80.2%, P = .006), anesthesia drug (OR = 1.48, 95% CI = 1.06 to 2.06, I2 = 94.8%, P < .001), surgical type (OR = 0.66, 95% CI = 0.49 to 0.9, I2 = 77.9%, P = .004) were statistically associated with postoperative thirst. CONCLUSIONS Our study shows a high prevalence of postoperative thirst. Sex, anesthesia drug, and surgical type are risk factors that influence postoperative thirst. Nurses and other health care professionals should routinely assess the postoperative thirst of patients and perform targeted interventions to alleviate their distressing symptoms and improve the quality of care.
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Affiliation(s)
- Hao-Yue Gan
- School of Nursing, North Sichuan Medical College, Nanchong, Sichuan, China; Operating Room of Mianyang Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Mianyang, Sichuan, China
| | - Hang-Cheng Liu
- School of Nursing, North Sichuan Medical College, Nanchong, Sichuan, China
| | - Hua-Ping Huang
- Nursing Department of Mianyang Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Mianyang, Sichuan, China
| | - Mei He
- President Office of Mianyang Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Mianyang, Sichuan, China.
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Li Y, Chen L, Su Y, Zhang X. Preoperative Oral Carbohydrates for Children: A Meta-Analysis and Systematic Review. Biol Res Nurs 2024:10998004241253536. [PMID: 38860320 DOI: 10.1177/10998004241253536] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/12/2024]
Abstract
Background: Many studies have reported the use of preoperative oral carbohydrates (CHO) in children, but the results are inconsistent. The aim of this meta-analysis is to assess the effectiveness and safety of oral CHO administration in children prior to surgery, with the goal of offering a dependable reference for clinical nursing practices and surgical interventions. Methods: Two authors searched PubMed, Clinical trials, Web of Science, Embase, Cochrane Library, China national knowledge infrastructure (CNKI), Wanfang and Weipu databases for randomized controlled trial (RCT) on the effects of preoperative oral CHO in children up to April 12, 2024. We used RevMan 5.4 software for data analysis. Results: Nine RCTs involving a total of 1279 children were included. The meta-analysis showed that there was statistical difference in the pH of gastric juice (MD = 1.54, 95%CI: 1.40-1.67, p < .001), intraoperative sedation score (MD = 0.62, 95%CI: 0.27-0.97, p < .001), and the incidence of postoperative nausea and vomiting (OR = 0.40, 95%CI: 0.20-0.80, p = .009) between the CHO and control groups. There was no statistical difference in the RGV (MD = -0.23, 95%CI: -0.47-0.01, p = .06) and the postoperative blood glucose level (MD = -0.91, 95%CI: -5.03-3.21, p = .67) between the CHO and control groups. Egger regression analysis showed that there were no publication biases amongst the synthesized outcomes (all p > .05). Conclusion: The administration of oral CHO to children before surgery is safe and practicable. There is a need for additional, well-conducted studies with more participants to further elucidate the role of preoperative CHO administration.
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Affiliation(s)
- Yan Li
- SICU, Children's Hospital of Nanjing Medical University, Nanjing, China
| | - Luxi Chen
- SICU, Children's Hospital of Nanjing Medical University, Nanjing, China
| | - Yang Su
- SICU, Children's Hospital of Nanjing Medical University, Nanjing, China
| | - Xin Zhang
- SICU, Children's Hospital of Nanjing Medical University, Nanjing, China
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Cho E, Kwak JH, Huh J, Kang IS, Ryu KH, Lee SH, Ahn JH, Choi HK, Song J. A comparative study using gastric ultrasound to evaluate the safety of shortening the fasting time before pediatric echocardiography: a randomized controlled non-inferiority study. J Anesth 2024:10.1007/s00540-024-03360-2. [PMID: 38849566 DOI: 10.1007/s00540-024-03360-2] [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: 12/04/2023] [Accepted: 05/09/2024] [Indexed: 06/09/2024]
Abstract
PURPOSE The objective of this study was to demonstrate that the gastric cross-sectional area (CSA) in the right lateral decubitus position (RLDP) during a 2-h fasting period is not larger than that during a conventional 4-h fasting period prior to pediatric echocardiography. METHODS 93 patients aged under 3 years scheduled for echocardiography under sedation were enrolled and randomly allocated into two groups; 2-h fasting vs 4-h fasting. For group 4 h (n = 46), the patients were asked to be fasted for all types of liquid for more than 4 h, while group 2 h (n = 47) were asked to be fasted for all types of liquid for 2 h before echocardiography. Gastric ultrasound was performed before echocardiography, and CSARLDP was measured. We compared CSARLDP, incidence of at-risk stomach, fasting duration, and the incidence of major (pulmonary aspiration, aspiration pneumonia) and minor complications (nausea, retching, and vomiting, apnea, and bradycardia) between two groups. RESULTS The mean difference of CSARLDP (group 2 h-group 4 h) was 0.49 (- 0.18 to 1.17) cm2, and it was within the non-inferiority margin (Δ = 2.1 cm2). There was no difference in the incidence of at-risk stomach (P = 0.514). There was no significant difference in the incidence of major and minor complications between the two groups. CONCLUSION Two-hour fasting in pediatric patients who need an echocardiography did not increase major and minor complications and CSA significantly.
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Affiliation(s)
- Eunah Cho
- Department of Anesthesiology and Pain Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Ji Hee Kwak
- Department of Pediatrics, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - June Huh
- Department of Pediatrics, Samsung Medical Center, Heart Vascular Stroke Institute, Grown-Up Congenital Heart Clinic, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, Republic of Korea
| | - I-Seok Kang
- Department of Pediatrics, Samsung Medical Center, Heart Vascular Stroke Institute, Grown-Up Congenital Heart Clinic, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, Republic of Korea
| | - Kyoung-Ho Ryu
- Department of Anesthesiology and Pain Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Sung Hyun Lee
- Department of Anesthesiology and Pain Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Jin Hee Ahn
- Department of Anesthesiology and Pain Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Hyeong-Kyeong Choi
- Department of Anesthesiology and Pain Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Jinyoung Song
- Department of Pediatrics, Samsung Medical Center, Heart Vascular Stroke Institute, Grown-Up Congenital Heart Clinic, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, Republic of Korea.
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Zhang J, Li J, Liu H, Liu J, Zhao L, Li X, Li X. Relationship between fasting prior to contrast-enhanced CT and adverse reaction in patients with allergies history. Clin Radiol 2024; 79:420-427. [PMID: 38599950 DOI: 10.1016/j.crad.2024.02.014] [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: 11/03/2023] [Revised: 01/24/2024] [Accepted: 02/16/2024] [Indexed: 04/12/2024]
Abstract
AIM To examine the relationship between fasting prior to contrast-enhanced CT (CECT) and adverse reaction (AR) in patients with allergies history. MATERIALS AND METHODS Patients with allergies history who underwent CECT from January 2014 to December 2020 (713 cases with iodinated contrast media (ICM)-related allergy history and 27045 cases with unrelated allergies history) were retrospectively analyzed. The occurrence of ICM-related AR and patient information were recorded. The relationship between fasting and AR and emetic complications was analyzed. RESULTS There was no statistical difference in the overall incidence of AR and emetic complications between fasting group and non-fasting group (P>0.05) and fasting was not an influence factor for overall AR occurrence in patients with both ICM-related and unrelated allergies history. However, the incidence of severe AR in fasting group was higher than that in non-fasting group (P=0.01) in patients with unrelated allergies history. The AR incidence in fasting group was higher than that in non-fasting group (P=0.022) when receiving abdominal examinations in patients with unrelated allergies history. There was no statistical difference in the incidence of AR with different occurrence time between fasting group and non-fasting group (P>0.05) in patients with both ICM-related and unrelated allergies history. CONCLUSIONS Fasting was associated with higher incidence of severe AR and was associated with higher AR incidence when receiving abdominal examinations in patients with unrelated allergies history. Fasting did not have effects on the occurrence time of AR in patients with allergies history. These provided new guidance for usage of ICM in patients with allergies history.
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Affiliation(s)
- J Zhang
- Department of Radiology, Daping Hospital, Army Medical University, No.10 Changjiang Road, Yuzong District, Chongqing 400042, China; Department of Radiology, Air Force Medical Center, Air Force Medical University, No.30 Fucheng Road, Haidian District, Beijing 100142, China
| | - J Li
- Department of Radiology, Daping Hospital, Army Medical University, No.10 Changjiang Road, Yuzong District, Chongqing 400042, China
| | - H Liu
- Department of Radiology, PLA Rocket Force Characteristic Medical Center, No. 16 Xinjiekou Outer Street, Beijing 100088, China
| | - J Liu
- Department of Radiology, Daping Hospital, Army Medical University, No.10 Changjiang Road, Yuzong District, Chongqing 400042, China
| | - L Zhao
- Department of Radiology, Daping Hospital, Army Medical University, No.10 Changjiang Road, Yuzong District, Chongqing 400042, China
| | - X Li
- Department of Radiology, Air Force Medical Center, Air Force Medical University, No.30 Fucheng Road, Haidian District, Beijing 100142, China.
| | - X Li
- Department of Radiology, Daping Hospital, Army Medical University, No.10 Changjiang Road, Yuzong District, Chongqing 400042, China.
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Li J, Liu B, Zhou QH, Ni HD, Liu MJ, Deng K. Pre-oxygenation with high-flow oxygen through the nasopharyngeal airway compared to facemask on carbon dioxide clearance in emergency adults: a prospective randomized non-blinded clinical trial. Eur J Trauma Emerg Surg 2024; 50:1051-1061. [PMID: 38148421 PMCID: PMC11249433 DOI: 10.1007/s00068-023-02418-2] [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: 08/09/2023] [Accepted: 11/29/2023] [Indexed: 12/28/2023]
Abstract
INTRODUCTION Before tracheal intubation, it is essential to provide sufficient oxygen reserve for emergency patients with full stomachs. Recent studies have demonstrated that high-flow nasal oxygen (HFNO) effectively pre-oxygenates and prolongs apneic oxygenation during tracheal intubation. Despite its effectiveness, the use of HFNO remains controversial due to concerns regarding carbon dioxide clearance. The air leakage and unknown upper airway obstruction during HFNO therapy cause reduced oxygen flow above the vocal cords, possibly weaken the carbon dioxide clearance. METHODS Patients requiring emergency surgery who had fasted < 8 h and not drunk < 2 h were randomly assigned to the high-flow group, who received 100% oxygen at 30-60 L/min through nasopharyngeal airway (NPA), or the mask group, who received 100% oxygen at 8 L/min. PaO2 and PaCO2 were measured immediately before pre-oxygenation (T0), anesthesia induction (T1), tracheal intubation (T2), and mechanical ventilation (T3). The gastric antrum's cross-sectional area (CSA) was measured using ultrasound technology at T0, T1, and T3. Details of complications, including hypoxemia, reflux, nasopharyngeal bleeding, postoperative pulmonary infection, postoperative nausea and vomiting (PONV), and postoperative nasopharyngeal pain, were recorded. The primary outcomes were PaCO2 measured at T1, T2, and T3. The secondary outcomes included PaO2 at T1, T2, and T3, CSA at T1 and T3, and complications happened during this trial. RESULTS Pre-oxygenation was administered by high-flow oxygen through NPA (n = 58) or facemask (n = 57) to 115 patients. The mean (SD) PaCO2 was 32.3 (6.7) mmHg in the high-flow group and 34.6 (5.2) mmHg in the mask group (P = 0.045) at T1, 45.0 (5.5) mmHg and 49.4 (4.6) mmHg (P < 0.001) at T2, and 47.9 (5.1) mmHg and 52.9 (4.6) mmHg (P < 0.001) at T3, respectively. The median ([IQR] [range]) PaO2 in the high-flow and mask groups was 404.5 (329.1-458.1 [159.8-552.9]) mmHg and 358.9 (274.0-413.3 [129.0-539.1]) mmHg (P = 0.007) at T1, 343.0 (251.6-428.7 [73.9-522.1]) mmHg and 258.3 (162.5-347.5 [56.0-481.0]) mmHg (P < 0.001) at T2, and 333.5 (229.9-411.4 [60.5-492.4]) mmHg and 149.8 (87.0-246.6 [51.2-447.5]) mmHg (P < 0.001) at T3, respectively. The CSA in the high-flow and mask groups was 371.9 (287.4-557.9 [129.0-991.2]) mm2 and 386.8 (292.0-537.3 [88.3-1651.7]) mm2 at T1 (P = 0.920) and 452.6 (343.7-618.4 [161.6-988.1]) mm2 and 385.6 (306.3-562.0 [105.5-922.9]) mm2 at T3 (P = 0.173), respectively. The number (proportion) of complications in the high-flow and mask groups is shown below: hypoxemia: 1 (1.7%) vs. 9 (15.8%, P = 0.019); reflux: 0 (0%) vs. 0 (0%); nasopharyngeal bleeding: 1 (1.7%) vs. 0 (0%, P = 1.000); pulmonary infection: 4 (6.9%) vs. 3 (5.3%, P = 1.000); PONV: 4 (6.9%) vs. 4 (7.0%, P = 1.000), and nasopharyngeal pain: 0 (0%) vs. 0 (0%). CONCLUSIONS Compared to facemasks, pre-oxygenation with high-flow oxygen through NPA offers improved carbon dioxide clearance and enhanced oxygenation prior to tracheal intubation in patients undergoing emergency surgery, while the risk of gastric inflation had not been ruled out. TRIAL REGISTRATION This trial was registered prospectively at the Chinese Clinical Research Registry on 26/4/2022 (Registration number: ChiCTR2200059192).
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Affiliation(s)
- Jie Li
- Jiaxing University Master Degree Cultivation Base, Zhejiang Chinese Medical University, Jiaxing, 314001, Zhejiang Province, China
- Department of Anesthesiology and Pain Research Center, The First Hospital of Jiaxing or The Affiliated Hospital of Jiaxing University, Jiaxing, 314001, Zhejiang Province, China
| | - Bin Liu
- Jiaxing University Master Degree Cultivation Base, Zhejiang Chinese Medical University, Jiaxing, 314001, Zhejiang Province, China
- Department of Anesthesiology and Pain Research Center, The First Hospital of Jiaxing or The Affiliated Hospital of Jiaxing University, Jiaxing, 314001, Zhejiang Province, China
| | - Qing-He Zhou
- Department of Anesthesiology and Pain Research Center, The First Hospital of Jiaxing or The Affiliated Hospital of Jiaxing University, Jiaxing, 314001, Zhejiang Province, China
| | - Hua-Dong Ni
- Department of Anesthesiology and Pain Research Center, The First Hospital of Jiaxing or The Affiliated Hospital of Jiaxing University, Jiaxing, 314001, Zhejiang Province, China
| | - Ming-Juan Liu
- Department of Anesthesiology and Pain Research Center, The First Hospital of Jiaxing or The Affiliated Hospital of Jiaxing University, Jiaxing, 314001, Zhejiang Province, China
| | - Kang Deng
- Department of Anesthesiology and Pain Research Center, The First Hospital of Jiaxing or The Affiliated Hospital of Jiaxing University, Jiaxing, 314001, Zhejiang Province, China.
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Gan H, Liu H, Huang H, He M. Liberal Preoperative Fasting in Adults Undergoing Elective Surgery: A Scoping Review Protocol. Anesthesiol Res Pract 2024; 2024:1519359. [PMID: 38751831 PMCID: PMC11095987 DOI: 10.1155/2024/1519359] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Revised: 04/15/2024] [Accepted: 04/26/2024] [Indexed: 05/18/2024] Open
Abstract
Background Prolonged fasting before surgery has negative effects on the physiology and psychology of patients. Preoperative liberal fasting proposes that patients can drink clear liquids before entering the operating theater, challenging the guideline strategy of a two-hour preoperative liquid fast for adults. In recent years, there have been an increasing number of studies on liberal preoperative fasting in adults. However, currently there is no consensus on the safe amount of fluid consumed, adverse effects, or benefits of this new policy. Objective This scoping review protocol will map the existing evidence of liberal preoperative fasting in adults undergoing elective surgery for clinical practice, to summarize more scientific evidence to healthcare professionals when providing perioperative care. Methods and Analysis. The methodology will follow the six steps of the Arksey and O'Malley methodological framework and be guided by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Review. A comprehensive search of six databases will be performed from their inception to 31 May 2023 to identify suitable English studies. Two trained investigators will independently screen and extract the data, and any disagreements will be judged by a third investigator. The results of the study will be presented as graphs or tables. Ethics and Dissemination. This scoping review only examines literature in the database, without reference to human or animal studies, and therefore does not require ethical approval. The findings of this scoping review will be published in peer-reviewed journals or presented at conferences. The Registration Number. This scoping review has been registered in the Open Science Framework (https://doi.org/10.17605/OSF.IO/PMW7C).
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Affiliation(s)
- Haoyue Gan
- School of Nursing, North Sichuan Medical College, Nanchong, Sichuan, China
- Mianyang Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Mianyang, Sichuan, China
| | - Hangcheng Liu
- School of Nursing, North Sichuan Medical College, Nanchong, Sichuan, China
- Mianyang Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Mianyang, Sichuan, China
| | - Huaping Huang
- Mianyang Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Mianyang, Sichuan, China
| | - Mei He
- Mianyang Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Mianyang, Sichuan, China
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Aguilar-Nascimento JED, Ribeiro Junior U, Portari-Filho PE, Salomão AB, Caporossi C, Colleoni Neto R, Waitzberg DL, Campos ACL. PERIOPERATIVE CARE IN DIGESTIVE SURGERY: THE ERAS AND ACERTO PROTOCOLS - BRAZILIAN COLLEGE OF DIGESTIVE SURGERY POSITION PAPER. ARQUIVOS BRASILEIROS DE CIRURGIA DIGESTIVA : ABCD = BRAZILIAN ARCHIVES OF DIGESTIVE SURGERY 2024; 37:e1794. [PMID: 38716919 PMCID: PMC11072254 DOI: 10.1590/0102-672020240001e1794] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Accepted: 01/17/2024] [Indexed: 05/12/2024]
Abstract
BACKGROUND The concept introduced by protocols of enhanced recovery after surgery modifies perioperative traditional care in digestive surgery. The integration of these modern recommendations components during the perioperative period is of great importance to ensure fewer postoperative complications, reduced length of hospital stay, and decreased surgical costs. AIMS To emphasize the most important points of a multimodal perioperative care protocol. METHODS Careful analysis of each recommendation of both ERAS and ACERTO protocols, justifying their inclusion in the multimodal care recommended for digestive surgery patients. RESULTS Enhanced recovery programs (ERPs) such as ERAS and ACERTO protocols are a cornerstone in modern perioperative care. Nutritional therapy is fundamental in digestive surgery, and thus, both preoperative and postoperative nutrition care are key to ensuring fewer postoperative complications and reducing the length of hospital stay. The concept of prehabilitation is another key element in ERPs. The handling of crystalloid fluids in a perfect balance is vital. Fluid overload can delay the recovery of patients and increase postoperative complications. Abbreviation of preoperative fasting for two hours before anesthesia is now accepted by various guidelines of both surgical and anesthesiology societies. Combined with early postoperative refeeding, these prescriptions are not only safe but can also enhance the recovery of patients undergoing digestive procedures. CONCLUSIONS This position paper from the Brazilian College of Digestive Surgery strongly emphasizes that the implementation of ERPs in digestive surgery represents a paradigm shift in perioperative care, transcending traditional practices and embracing an intelligent approach to patient well-being.
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Affiliation(s)
| | - Ulysses Ribeiro Junior
- Universidade de São Paulo, Faculty of Medicine, Department of Gastroenterology - São Paulo (SP), Brazil
| | | | - Alberto Bicudo Salomão
- Universidade Federal de São Paulo, Escola Paulista de Medicina, Department of Surgery - São Paulo (SP), Brazil
| | - Cervantes Caporossi
- Centro Universitário de Varzea Grande, Department of Surgery - Varzea Grande (MT), Brazil
| | - Ramiro Colleoni Neto
- Universidade Federal de São Paulo, Escola Paulista de Medicina, Department of Surgery - São Paulo (SP), Brazil
| | - Dan Linetzky Waitzberg
- Universidade de São Paulo, Faculty of Medicine, Department of Gastroenterology - São Paulo (SP), Brazil
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Toptas T, Ureyen I, Kahraman A, Gokkaya M, Yalcin N, Alci A, Kole MC, Kandemi̇r S, Goksu M, Akgul N, Dogan S. Impact of preoperative carbohydrate loading on postoperative course and morbidity in debulking surgery for epithelial ovarian cancer. Exp Ther Med 2024; 27:181. [PMID: 38515650 PMCID: PMC10952341 DOI: 10.3892/etm.2024.12469] [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: 10/01/2023] [Accepted: 02/16/2024] [Indexed: 03/23/2024] Open
Abstract
Despite the theoretical benefits, the favorable effect of preoperative carbohydrate loading on postoperative morbidity remains controversial. Most of the outcomes reported in the literature are derived from non-gynecologic surgery data, with only one study involving a limited number of patients specifically in gynecological oncology. The present study aimed to investigate the impact of carbohydrate loading, as a single element of enhanced recovery after surgery protocols, on postoperative course and morbidity in patients undergoing debulking surgery for epithelial ovarian cancer (EOC). The present study was a non-randomized, prospective cohort trial enrolling patients with EOC who underwent surgery between June 2018 and December 2021. An oral carbohydrate supplement with a dose of 50 g was given to patients 2-3 h before anesthesia. Data on postoperative course and morbidity were collected and compared with data of a historical cohort including consecutive patients who underwent surgery without a carbohydrate loading between January 2015 and June 2018. Analyses were performed on a total of 162 patients, including 72 patients in the carbohydrate loading group and 90 patients in the control group. Median length of hospital stay (11 days vs. 11 days; P=0.555), postoperative days 1-7 serum c-reactive protein levels (P=0.213), 30-day readmission (11.6% vs. 11.5%, P=0.985), 30-day relaparotomy (2.8% vs. 3.4%, P=0.809) and 30-day morbidity (48.6% vs. 46.7%; P=0.805) were comparable between the cohorts. No significant differences in grades of morbidities were identified between the cohorts (P=0.511). Multivariate analysis revealed that the sole independent risk factor for any postoperative morbidity was operative time. In conclusion, based on the results of the present study, postoperative course and morbidity seemed to be unaffected by carbohydrate loading in patients undergoing debulking surgery for EOC.
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Affiliation(s)
- Tayfun Toptas
- Department of Gynecologic Oncology, Saglik Bilimleri University Antalya Training and Research Hospital, Antalya 07100, Turkey
| | - Isin Ureyen
- Department of Gynecologic Oncology, Saglik Bilimleri University Antalya Training and Research Hospital, Antalya 07100, Turkey
| | - Alper Kahraman
- Department of Gynecologic Oncology, Saglik Bilimleri University Antalya Training and Research Hospital, Antalya 07100, Turkey
| | - Mustafa Gokkaya
- Department of Gynecologic Oncology, Saglik Bilimleri University Antalya Training and Research Hospital, Antalya 07100, Turkey
| | - Necim Yalcin
- Department of Gynecologic Oncology, Saglik Bilimleri University Antalya Training and Research Hospital, Antalya 07100, Turkey
| | - Aysun Alci
- Department of Gynecologic Oncology, Saglik Bilimleri University Antalya Training and Research Hospital, Antalya 07100, Turkey
| | - Merve Cakir Kole
- Department of Gynecologic Oncology, Saglik Bilimleri University Antalya Training and Research Hospital, Antalya 07100, Turkey
| | - Selim Kandemi̇r
- Department of Gynecologic Oncology, Saglik Bilimleri University Antalya Training and Research Hospital, Antalya 07100, Turkey
| | - Mehmet Goksu
- Department of Gynecologic Oncology, Saglik Bilimleri University Antalya Training and Research Hospital, Antalya 07100, Turkey
| | - Nedim Akgul
- Department of General Surgery, Saglik Bilimleri University Antalya Training and Research Hospital, Antalya 07100, Turkey
| | - Selen Dogan
- Department of Gynecologic Oncology, Akdeniz University Medical School, Antalya 07070, Turkey
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12
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Chao NT, Karwoski AS, Pitsenbarger LT, Som MN, Dunlap E, Nagarsheth KH. Preoperative Nil Per Os Duration Predicts Mortality and Ambulation Following Below-Knee Amputation. Am Surg 2024:31348241244633. [PMID: 38561237 DOI: 10.1177/00031348241244633] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/04/2024]
Abstract
BACKGROUND Routine use of nil per os (NPO) prior to procedures has been associated with dehydration and malnutrition leading to patient discomfort. We aim to examine how duration of NPO status affects postoperative outcomes in patients undergoing elective below-knee amputation (BKA). METHODS We performed a retrospective chart review of 92 patients who underwent elective BKA between 2014-2022 for noninfectious indications. We performed statistical analysis using Chi-square tests, t-tests, and linear/logistic regression with odds ratio using P < .05 as our significance level. RESULTS The mean age was 48.0 ± 16.7 years, and there were 64 (70%) male patients and 41 (45%) Black patients. Mean NPO duration was 12.9 ± 4.7 hours. Patients with longer NPO duration were associated with increased rates of postoperative stroke (P = .03). Patients with shorter NPO duration had significantly lower mean BUN on postoperative day (POD) 1 (14.5, P < .001) and POD 3 (14.1, P < .001) compared to preoperative mean BUN (16.8), however this normalized by POD 7 (19.2, P = .26). There were no changes in postoperative renal function based on baseline kidney disease status or associated with longer NPO duration. Shorter NPO duration was a predictor of increased likelihood of 1-year follow-up (OR: 2.9 [1.24-6.79], P = .01), independent ambulation (OR: 2.7 [1.03-7.34], P = .04), and decreased mortality (OR: .11 [.013-.91], P = .04). CONCLUSION While NPO duration does not appear to result in postoperative renal dysfunction, prolonged NPO duration predicts worse rates of follow-up, ambulation, and survival and is associated with increased stroke rates.
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Affiliation(s)
- Natalie T Chao
- University of Maryland School of Medicine, Baltimore, MD, USA
| | | | | | - Maria N Som
- University of Maryland School of Medicine, Baltimore, MD, USA
| | - Eleanor Dunlap
- University of Maryland School of Medicine, Baltimore, MD, USA
- Department of Surgery, Vascular Division, University of Maryland Medical Center, Baltimore, MD, USA
| | - Khanjan H Nagarsheth
- University of Maryland School of Medicine, Baltimore, MD, USA
- Department of Surgery, Vascular Division, University of Maryland Medical Center, Baltimore, MD, USA
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13
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Wang X, Zhuang J, Cheng J, Wang Z, Sheng J, Guo S, Wang R, Wang Z. Effect of preoperative oral carbohydrates on insulin resistance in patients undergoing laparoscopic cholecystectomy: a randomized controlled trial. Langenbecks Arch Surg 2024; 409:77. [PMID: 38411704 PMCID: PMC10899310 DOI: 10.1007/s00423-024-03268-1] [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: 11/06/2023] [Accepted: 02/20/2024] [Indexed: 02/28/2024]
Abstract
PURPOSE The present research seeks to clarify the consequences of two specific preoperative oral carbohydrate (POC) amounts on insulin resistance (IR) and stomach evacuation in laparoscopic cholecystectomy (LC) patients. METHODS A total of 129 patients set for elective LC procedures were randomly assigned to a control group (C, n = 45), a 200 mL POC group (P1, n = 42), and a 400 mL POC group (P2, n = 42). The C group was fasted from midnight until surgery, whereas the P1 and P2 groups received their respective carbohydrate volumes 2-4 h before anesthesia. Fasting blood glucose, insulin, and glucagon concentrations were measured at three junctures. IR metrics were derived by employing the homeostasis model assessment. Gastric volume was measured before anesthesia using gastric ultrasound. Inter-group comparisons included IR indicators, subjective comfort scores, and hemodynamic data. RESULTS At T2, the C group exhibited reduced glucose concentrations compared to the P2 group (4.73 ± 0.64 vs. 5.26 ± 1.02 mmol/L, p < 0.05). The Perlas grading indicated that grade 1 was more prevalent in the P2 group than in the P1 and C groups (18 [42.9%] vs. 6 [14.3%] and 1 [2.2%], p < 0.05). Additionally, thirst and hunger metrics for the P2 group were notably reduced compared to the C group at both T2 and T3. CONCLUSION Administering either 200 mL or 400 mL of carbohydrates 2-4 h pre-surgery had no detectable impact on IR or gastric volume in LC patients. TRIAL REGISTRATION ChiCTR, ChiCTR2200065648. Registered January 13, 2023, http://www.chictr.org.cn .
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Affiliation(s)
- Xiaohan Wang
- Xuzhou Medical University, Xuzhou, 221004, Jiangsu, China
| | - Jingwen Zhuang
- Xuzhou Medical University, Xuzhou, 221004, Jiangsu, China
| | - Jianxin Cheng
- Xuzhou Medical University, Xuzhou, 221004, Jiangsu, China
| | - Zeyang Wang
- Xuzhou Medical University, Xuzhou, 221004, Jiangsu, China
| | - Jingyi Sheng
- Xuzhou Medical University, Xuzhou, 221004, Jiangsu, China
| | - Shanshan Guo
- Xuzhou Medical University, Xuzhou, 221004, Jiangsu, China
| | - Rui Wang
- Department of Anesthesiology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, 221002, Jiangsu, China
| | - Zhiping Wang
- Jiangsu Province Key Laboratory of Anesthesiology, Xuzhou Medical University, 209 Tongshan Road, Xuzhou, 221004, Jiangsu, China.
- Department of Anesthesiology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, 221002, Jiangsu, China.
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14
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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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15
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Rigo EF, Colet R, Backes GT, Zeni J, Hsu AKW. Validation of a popsicle as a clear fluid to abbreviate preoperative fasting. Clin Nutr ESPEN 2024; 59:154-157. [PMID: 38220369 DOI: 10.1016/j.clnesp.2023.12.003] [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: 05/05/2023] [Revised: 11/15/2023] [Accepted: 12/05/2023] [Indexed: 01/16/2024]
Abstract
BACKGROUND & AIMS This study is based on the development and validation of a popsicle to reduce preoperative fasting time. METHODS The study was carried out in two stages, pre-clinical and clinical validation. The first stage consisted of producing a water-based, fat-free, high-calorie fruit-flavored popsicle, characterized by proximal composition and sensory analysis. In the second stage, clinical validation was performed in patients aged between 18 and 65 years before elective surgery, evaluating the incidence of aspiration during anesthesia and the patient's experience in relation to hunger, thirst, anxiety and palatability of the popsicle. RESULTS The results of the study showed that the use of popsicle 2 h before the surgical procedure did not cause any adverse reaction in patients and in the anesthetic procedure. Furthermore, the full acceptability of the product by the participants and the control of thirst and satiety during the preoperative period were observed. CONCLUSIONS The present study showed that with the use of popsicles it was possible to reduce safely the preoperative fasting time to up to 2 h before the surgical procedure.
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Affiliation(s)
- Eduardo Fabian Rigo
- Medical School, Universidade Regional Integrada do Alto Uruguai e Missões, URI Erechim, Av. Sete de Setembro, 1621, 99709-910, Erechim, RS, Brazil.
| | - Rosicler Colet
- Department of Food Engineering, Universidade Regional Integrada do Alto Uruguai e Missões, URI Erechim, Av. Sete de Setembro, 1621, 99709-910, Erechim, RS, Brazil.
| | - Geciane Toniazzo Backes
- Department of Food Engineering, Universidade Regional Integrada do Alto Uruguai e Missões, URI Erechim, Av. Sete de Setembro, 1621, 99709-910, Erechim, RS, Brazil.
| | - Jamile Zeni
- Department of Food Engineering, Universidade Regional Integrada do Alto Uruguai e Missões, URI Erechim, Av. Sete de Setembro, 1621, 99709-910, Erechim, RS, Brazil.
| | - André Keng Wei Hsu
- Medical School, Universidade Regional Integrada do Alto Uruguai e Missões, URI Erechim, Av. Sete de Setembro, 1621, 99709-910, Erechim, RS, Brazil.
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16
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Daly S, Mohamed O, Loughrey J, Kearsley R, Drew T. 'Sip 'til Send': a prospective study of the effect of a liberal fluid fasting policy on patient reported and haemodynamic variables at elective caesarean delivery. Int J Obstet Anesth 2024; 57:103956. [PMID: 38030525 DOI: 10.1016/j.ijoa.2023.103956] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Revised: 10/16/2023] [Accepted: 11/05/2023] [Indexed: 12/01/2023]
Affiliation(s)
- S Daly
- Department of Anaesthesia, Rotunda Hospital, Dublin, Ireland
| | - O Mohamed
- Department of Anaesthesia, Rotunda Hospital, Dublin, Ireland
| | - J Loughrey
- Department of Anaesthesia, Rotunda Hospital, Dublin, Ireland
| | - R Kearsley
- Department of Anaesthesia, Rotunda Hospital, Dublin, Ireland
| | - T Drew
- Department of Anaesthesia, Rotunda Hospital, Dublin, Ireland.
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17
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Huang S, Liao Z, Chen A, Wang J, Xu X, Zhang L. Effect of carotid corrected flow time combined with perioperative fluid therapy on preventing hypotension after general anesthesia induction in elderly patients: a prospective cohort study. Int J Surg 2024; 110:799-809. [PMID: 37983823 PMCID: PMC10871564 DOI: 10.1097/js9.0000000000000863] [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: 08/10/2023] [Accepted: 10/22/2023] [Indexed: 11/22/2023]
Abstract
BACKGROUND Hypotension often occurs following the induction of general anesthesia in elderly patients undergoing surgery and can lead to severe complications. This study assessed the effect of carotid corrected flow time (FTc) combined with perioperative fluid therapy on preventing hypotension after general anesthesia induction in elderly patients. MATERIALS AND METHODS The prospective cohort study was divided into two parts. The first part (Part I) consisted of 112 elderly patients. Carotid FTc was measured using Color Doppler Ultrasound 5 min before anesthesia induction. Hypotension was defined as a decrease of greater than 30% in systolic blood pressure (SBP) or a decrease of greater than 20% in mean arterial pressure (MAP) from baseline, or an absolute SBP below 90 mmHg and MAP below 60 mmHg within 3 min after induction of general anesthesia. The predictive value of carotid FTc was determined using receiver operating characteristic (ROC) curve. The second part (Part II) consisted of 65 elderly patients. Based on the results in Part I, elderly patients with carotid FTc below the optimal cut-off value received perioperative fluid therapy at a volume of 8 ml/kg of balanced crystalloids (lactated Ringer's solution) in 30 min before induction. The effect of carotid FTc combined with perioperative fluid therapy was assessed by comparing observed incidence of hypotension after induction. RESULTS The area under the ROC for carotid FTc to predict hypotension after induction was 0.876 [95% confidence interval (CI) 0.800-0.952, P <0.001]. The optimal cut-off value was 334.95 ms (sensitivity of 87.20%; specificity of 82.20%). The logistic regression analysis revealed that carotid FTc is an independent predictor for post-induction hypotension in elderly patients. The incidence of post-induction hypotension was significantly lower ( P <0.001) in patients with carotid FTc less than 334.95 ms who received perioperative fluid therapy (35.71%) compared to those who did not (92.31%). CONCLUSIONS Carotid FTc combined with the perioperative fluid therapy could significantly reduce the incidence of hypotension after the induction of general anesthesia in elderly patients.
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Affiliation(s)
- Shishi Huang
- Department of Anesthesiology, Fujian Medical University Union Hospital, Fuzhou
| | - Zhenqi Liao
- Department of Anesthesiology, Fujian Medical University Union Hospital, Fuzhou
| | - Andi Chen
- Department of Anesthesiology, Shengli Clinical Medical College of Fujian Medical University, Fujian Provincial Hospital, Fuzhou, People’s Republic of China
| | - Jiali Wang
- Department of Anesthesiology, Fujian Medical University Union Hospital, Fuzhou
| | - Xiaodong Xu
- Department of Anesthesiology, Fujian Medical University Union Hospital, Fuzhou
| | - Liangcheng Zhang
- Department of Anesthesiology, Fujian Medical University Union Hospital, Fuzhou
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18
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Håkansson I, Ahlander BM, Höök A, Kihlberg J. Retrospective comparison between MRI examinations during radiographer-administered intranasal sedation or general anesthesia. Radiography (Lond) 2024; 30:296-300. [PMID: 38071937 DOI: 10.1016/j.radi.2023.11.021] [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: 07/17/2023] [Revised: 11/20/2023] [Accepted: 11/26/2023] [Indexed: 01/15/2024]
Abstract
INTRODUCTION In order for young children to be able to undergo a Magnetic Resonance Imaging (MRI) examination, general anesthesia is often required. The aim of this study was to compare the image quality, times, and costs of the examinations of infant brains performed with MRI either during sedation with dexmedetomidine administered by radiographers or anesthesia with propofol administered by anesthesia staff. METHODS This study was a quantitative retrospective study of 27 consecutive standard brain examinations performed under sedation or anesthesia, involving 15 children under sedation and 12 under anesthesia. The age of the children was from 0.5 to five years old. The image quality was evaluated by three radiologists experienced in pediatric MRI examinations. Information such as examination time and the expense of the examination was also collected. RESULTS There was no statistically significant difference in the general image quality, but one image series was assessed to have significantly better image quality under sedation than under anesthesia, but all images had very high quality. However, it emerged that children under anesthesia were at the hospital on average 55 min longer and the scanner room was occupied 20 min longer on average. The anesthesia examinations were three times more expensive. CONCLUSION This study demonstrated equivalent image quality between sedation and anesthesia. In addition, sedation was less time-consuming and had a lower price, partly because no extra anesthetic staff were required. The use of intranasal sedation offers a possibility to expand the competence area for radiographers. IMPLICATIONS FOR PRACTICE If radiographers learn to perform intranasal sedation, examinations can be performed in less time, at a third of the staff costs while maintaining image quality.
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Affiliation(s)
- I Håkansson
- Ryhov County Hospital, Department of Radiology, Jönköping, Sweden
| | - B-M Ahlander
- Department of Natural Science and Biomedicine, School of Health and Welfare, Jönköping University, Gjuterigatan 5, SE-553 18, Jönköping, Sweden
| | - A Höök
- Department of Anaesthesiology and Intensive Care in Linköping, and Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - J Kihlberg
- Department of Radiology in Linköping, and Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden.
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19
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Yoon SH, Lee HJ. Challenging issues of implementing enhanced recovery after surgery programs in South Korea. Anesth Pain Med (Seoul) 2024; 19:24-34. [PMID: 38311352 PMCID: PMC10847003 DOI: 10.17085/apm.23096] [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: 08/02/2023] [Revised: 10/25/2023] [Accepted: 12/22/2023] [Indexed: 02/08/2024] Open
Abstract
This review discusses the challenges of implementing enhanced recovery after surgery (ERAS) programs in South Korea. ERAS is a patient-centered perioperative care approach that aims to improve postoperative recovery by minimizing surgical stress and complications. While ERAS has demonstrated significant benefits, its successful implementation faces various barriers such as a lack of manpower and policy support, poor communication and collaboration among perioperative members, resistance to shifting away from outdated practices, and patient-specific risk factors. This review emphasizes the importance of understanding these factors to tailor effective strategies for successful ERAS implementation in South Korea's unique healthcare setting. In this review, we aim to shed light on the current status of ERAS in South Korea and identify key barriers. We hope to encourage Korean anesthesiologists to take a leading role in adopting the ERAS program as the standard for perioperative care. Ultimately, our goal is to improve the surgical outcomes of patients using this proactive approach.
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Affiliation(s)
- Soo-Hyuk Yoon
- Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul, Korea
| | - Ho-Jin Lee
- Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul, Korea
- Department of Anesthesiology and Pain Medicine, Seoul National University College of Medicine, Seoul, Korea
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20
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Joshi GP. Anesthetic Considerations in Adult Patients on Glucagon-Like Peptide-1 Receptor Agonists: Gastrointestinal Focus. Anesth Analg 2024; 138:216-220. [PMID: 37874648 DOI: 10.1213/ane.0000000000006810] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2023]
Affiliation(s)
- Girish P Joshi
- From the Department of Anesthesiology and Pain Management, University of Texas Southwestern Medical Center, Dallas, Texas
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21
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Wrobel JR, Magin JC, Williams D, An X, Acton JD, Doyal AS, Jia S, Krakowski JC, Serrano R, Grant SA, Flynn DN, McLean DJ. Comparing preoperative fasting and ultrasound-measured intravascular volume status in elective surgery, enhanced recovery patients versus inpatient, urgent surgery patients and the ability of IVC collapsibility to predict post-induction hypotension. J Perioper Pract 2023:17504589231215932. [PMID: 38149485 DOI: 10.1177/17504589231215932] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2023]
Abstract
Hypotension following induction of general anaesthesia has been shown to result in increased complications and mortality postoperatively. Patients admitted to the hospital undergoing urgent surgery are often fasted from fluids for significant periods compared to elective patients subject to Enhanced Recovery After Surgery protocols despite guidelines stating that a two-hour fast is sufficient. The aim of this prospective, observational study was to compare fasting times and intravascular volume status between elective surgery patients subject to enhanced recovery protocols and inpatient, urgent surgery patients and to assess differences in the incidence of post-induction hypotension. Fasting data was obtained by questionnaire in the preoperative area in addition to inferior vena cava collapsibility index, a non-invasive measure of intravascular volume. Blood pressure readings and drug administration for the ten minutes following induction were obtained from patients' charts. Inpatients undergoing urgent surgery were fasted significantly longer than enhanced recovery patients and had lower intravascular volume. However, no difference was found in the incidence of post-induction hypotension.
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Affiliation(s)
| | | | | | - Xinming An
- UNC School of Medicine, Chapel Hill, NC, USA
| | | | | | - Shawn Jia
- UNC School of Medicine, Chapel Hill, NC, USA
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22
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Zhu J, Jin XQ, Li XY, Sun L, Peng Y. The association between oral carbohydrate intake before orthopedic surgery for osteoporotic fractures and outcomes in elderly patients. J Orthop Surg Res 2023; 18:966. [PMID: 38098008 PMCID: PMC10722799 DOI: 10.1186/s13018-023-04458-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2023] [Accepted: 12/10/2023] [Indexed: 12/17/2023] Open
Abstract
BACKGROUND Oral carbohydrate (CHO) intake is a safe method with effective clinical results in various surgical patients before surgery. Nevertheless, due to a lack of adequate clinical data, it is not frequently utilized in older patients undergoing orthopedic surgery for osteoporotic fractures (OPFs), especially in China. The purpose of the present study was to examine the relationship between preoperative oral CHO consumption and outcomes in elderly patients undergoing surgical treatment for OPFs. METHODS This retrospective cohort study was conducted at a single Chinese institution and included a total of 879 elderly patients (median age: 71 years; range: 50-99 years) who underwent OPF surgery. Various exclusion criteria were established as follows: (a) the necessity for urgent surgical intervention; (b) the existence of hypoglycemia, hyperglycemia, or diabetes mellitus with blood glucose levels lower than 2.8 mmol/L; (c) a medical history of gastrointestinal motility disorders or delayed gastric emptying; (d) the utilization of local anesthesia; (e) a Charlson comorbidity index (CCI) score over 2; and (f) an American Society of Anesthesiologists (ASA) score exceeding 3. After propensity score (PS) matching, 264 patients from each cohort were included in the analysis. The primary outcome was the all-cause mortality rate within 60 days post-surgery, while secondary outcomes included the length of hospital stay (LOS), hospitalization costs, intraoperative and postoperative blood transfusions, and the incidence of postoperative nausea and vomiting (PONV) and aspiration. The relationship between preoperative oral CHO intake and outcomes was evaluated using multivariate regression analysis. RESULTS After PS matching, preoperative oral CHO intake was negatively associated with 60-day mortality in the fully adjusted model (odds ratio 0.35; 95% confidence interval 0.12-0.97; P-value: 0.04). Patients who received preoperative oral CHO intake also had a shorter LOS and lower hospitalization costs than those who did not receive CHO intake. However, none of the models showed a significant association between CHO intake and PONV or blood transfusion risk. Furthermore, no cases of aspiration were observed in either cohort. CONCLUSIONS Preoperative oral CHO intake may be associated with reduced mortality risk and improved outcomes in elderly patients undergoing surgical treatment for OPFs. However, it is important to acknowledge the limitations of our study, including its retrospective nature, potential unmeasured confounding variables, the small sample size, incomplete data on important variables such as duration of surgery and inflammatory markers, and the limited generalizability due to the participation of only one institution. Future research with larger sample sizes and a broader range of events is warranted to validate and enhance the validity of our findings, particularly in assessing long-term results and understanding the underlying mechanisms.
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Affiliation(s)
- Jing Zhu
- Department of Nursing, Affiliated Kunshan Hospital of Jiangsu University, Suzhou, Jiangsu, China
| | - Xue-Qin Jin
- Department of Nursing, Affiliated Kunshan Hospital of Jiangsu University, Suzhou, Jiangsu, China
| | - Xiao-Yan Li
- Department of Nursing, Affiliated Kunshan Hospital of Jiangsu University, Suzhou, Jiangsu, China
| | - Li Sun
- Department of Nursing, Affiliated Kunshan Hospital of Jiangsu University, Suzhou, Jiangsu, China
| | - Yuan Peng
- Intensive Care Unit, Affiliated Kunshan Hospital of Jiangsu University, No. 566 East of Qianjin Road, Suzhou, Jiangsu, China.
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Baettig SJ, Filipovic MG, Hebeisen M, Meierhans R, Ganter MT. Pre-operative gastric ultrasound in patients at risk of pulmonary aspiration: a prospective observational cohort study. Anaesthesia 2023; 78:1327-1337. [PMID: 37587543 DOI: 10.1111/anae.16117] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/26/2023] [Indexed: 08/18/2023]
Abstract
Point-of-care gastric sonography offers an objective approach to assessing individual pulmonary aspiration risk before induction of general anaesthesia. We aimed to evaluate the potential impact of routine pre-operative gastric ultrasound on peri-operative management in a cohort of adult patients undergoing elective or emergency surgery at a single centre. According to pre-operative gastric ultrasound results, patients were classified as low risk (empty, gastric fluid volume ≤ 1.5 ml.kg-1 body weight) or high risk (solid, mixed or gastric fluid volume > 1.5 ml.kg-1 body weight) of aspiration. After sonography, examiners were asked to indicate changes in aspiration risk management (none; more conservative; more liberal) to their pre-defined anaesthetic plan and to adapt it if patient safety was at risk. We included 2003 patients, 1246 (62%) of which underwent elective and 757 (38%) emergency surgery. Among patients who underwent elective surgery, 1046/1246 (84%) had a low-risk and 178/1246 (14%) a high-risk stomach, with this being 587/757 (78%) vs. 158/757 (21%) among patients undergoing emergency surgery, respectively. Routine pre-operative gastric sonography enabled changes in anaesthetic management in 379/2003 (19%) of patients, with these being a more liberal approach in 303/2003 (15%). In patients undergoing elective surgery, pre-operative gastric sonography would have allowed a more liberal approach in 170/1246 (14%) and made a more conservative approach indicated in 52/1246 (4%), whereas in patients undergoing emergency surgery, 133/757 (18%) would have been managed more liberally and 24/757 (3%) more conservatively. We showed that pre-operative gastric ultrasound helps to identify high- and low-risk situations in patients at risk of aspiration and adds useful information to peri-operative management. Our data suggest that routine use of pre-operative gastric ultrasound may improve individualised care and potentially impact patient safety.
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Affiliation(s)
- S J Baettig
- Institute of Anaesthesiology, Kantonsspital Winterthur, Winterthur, Switzerland
| | - M G Filipovic
- Department of Anaesthesiology and Pain Medicine, Inselspital Berne University Hospital, University of Berne, Berne, Switzerland
| | - M Hebeisen
- Department of Biostatistics, Institute of Epidemiology, Biostatistics and Prevention, University of Zurich, Zurich, Switzerland
| | - R Meierhans
- Department of Anaesthesiology, Kantonsspital Winterthur, Winterthur, Switzerland
| | - M T Ganter
- Institute of Anaesthesiology and Critical Care Medicine, Medical Faculty, Klinik Hirslanden Zurich | University of Zurich, Zurich, Switzerland
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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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Jones PM, Hobai IA, Murphy PM. Anesthesia and glucagon-like peptide-1 receptor agonists: proceed with caution! Can J Anaesth 2023; 70:1281-1286. [PMID: 37466910 DOI: 10.1007/s12630-023-02550-y] [Citation(s) in RCA: 15] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Revised: 06/23/2023] [Accepted: 06/23/2023] [Indexed: 07/20/2023] Open
Affiliation(s)
- Philip M Jones
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic Florida, 4500 San Pablo Road, Jacksonville, FL, 32224, USA.
| | - Ion A Hobai
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Patricia M Murphy
- Department of Anesthesiology and Pain Medicine, Toronto General Hospital, University Health Network, Toronto, ON, Canada
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Chen X, Chang C, Yuan X, Yang J, Li K. Efficacy and safety of preoperative chewing gum for undergoing elective surgery: A meta-analysis of randomised controlled trials. J Clin Nurs 2023; 32:4295-4310. [PMID: 36691328 DOI: 10.1111/jocn.16604] [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: 08/18/2022] [Revised: 11/07/2022] [Accepted: 12/05/2022] [Indexed: 01/25/2023]
Abstract
AIMS AND OBJECTIVES This meta-analysis aimed to investigate the safety and feasibility of preoperative chewing gum in adult patients undergoing elective surgery. BACKGROUND Postoperative chewing gum has been shown to be safe and effective for most surgeries, while the safety and efficacy of preoperative chewing gum are still controversial. DESIGN A meta-analysis of randomised controlled trials was performed. NO PATIENT OR PUBLIC CONTRIBUTION This was a meta-analysis involving no people or animals. METHODS The literature search was performed in 9 databases from inception to July 2022. Randomised controlled trials that compared the safety and efficacy of preoperative chewing gum and preoperative chewing no gum in adult patients undergoing elective surgery were included. The study was reported in compliance with PRISMA statement. TRIAL REGISTRATION PROSPERO CRD42022330223. RESULTS Fourteen trials involving 1433 adult patients who undergo elective surgery were pooled in this meta-analysis. The results showed that preoperative chewing gum group resulted in no significant difference in gastric pH (p = .13) and gastric fluid volume (p = .25) compared with non-gum-chewing group. In comparison with the non-gum-chewing group, the gum-chewing group was associated with shorter preoperative thirst score (p = .02), lower incidence of postoperative nausea (p = .0004), lower incidence of postoperative sore throat, lower incidence of postoperative hoarseness, lower postoperative pain score, shorter first postoperative anal exhaust time (p < .00001), shorter first postoperative defecation time (p < .00001) and shorter hospital days (p = .02). CONCLUSIONS Preoperative chewing gum was associated with lower discomforts and complication rates, without increasing gastric pH and gastric fluid volume. This strategy may be an innovative, feasible and safe choice for elective surgery in adults. RELEVANCE TO CLINICAL PRACTICE This study's results could be used as an evidence for the implementation of preoperative chewing gum in perioperative care for adult patients undergoing elective surgery.
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Affiliation(s)
- Xinrong Chen
- West China School of Nursing /West China Hospital, Sichuan University, Chengdu, Sichuan Province, China
| | - Chengting Chang
- West China School of Nursing /West China Hospital, Sichuan University, Chengdu, Sichuan Province, China
| | - Xingzhu Yuan
- West China School of Nursing /West China Hospital, Sichuan University, Chengdu, Sichuan Province, China
| | - Jie Yang
- Department of Gastrointestinal Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan Province, China
| | - Ka Li
- West China School of Nursing /West China Hospital, Sichuan University, Chengdu, Sichuan Province, China
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Bloc S, Alfonsi P, Belbachir A, Beaussier M, Bouvet L, Campard S, Campion S, Cazenave L, Diemunsch P, Di Maria S, Dufour G, Fabri S, Fletcher D, Garnier M, Godier A, Grillo P, Huet O, Joosten A, Lasocki S, Le Guen M, Le Saché F, Macquer I, Marquis C, de Montblanc J, Maurice-Szamburski A, Nguyen YL, Ruscio L, Zieleskiewicz L, Caillard A, Weiss E. Guidelines on perioperative optimization protocol for the adult patient 2023. Anaesth Crit Care Pain Med 2023; 42:101264. [PMID: 37295649 DOI: 10.1016/j.accpm.2023.101264] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
OBJECTIVE The French Society of Anesthesiology and Intensive Care Medicine [Société Française d'Anesthésie et de Réanimation (SFAR)] aimed at providing guidelines for the implementation of perioperative optimization programs. DESIGN A consensus committee of 29 experts from the SFAR was convened. A formal conflict-of-interest policy was developed at the outset of the process and enforced throughout. The entire guidelines process was conducted independently of any industry funding. The authors were advised to follow the principles of the Grading of Recommendations Assessment, Development and Evaluation (GRADE) system to guide assessment of quality of evidence. METHODS Four fields were defined: 1) Generalities on perioperative optimization programs; 2) Preoperative measures; 3) Intraoperative measures and; 4) Postoperative measures. For each field, the objective of the recommendations was to answer a number of questions formulated according to the PICO model (population, intervention, comparison, and outcomes). Based on these questions, an extensive bibliographic search was carried out using predefined keywords according to PRISMA guidelines and analyzed using the GRADE® methodology. The recommendations were formulated according to the GRADE® methodology and then voted on by all the experts according to the GRADE grid method. As the GRADE® methodology could have been fully applied for the vast majority of questions, the recommendations were formulated using a "formalized expert recommendations" format. RESULTS The experts' work on synthesis and application of the GRADE® method resulted in 30 recommendations. Among the formalized recommendations, 19 were found to have a high level of evidence (GRADE 1±) and ten a low level of evidence (GRADE 2±). For one recommendation, the GRADE methodology could not be fully applied, resulting in an expert opinion. Two questions did not find any response in the literature. After two rounds of rating and several amendments, strong agreement was reached for all the recommendations. CONCLUSIONS Strong agreement among the experts was obtained to provide 30 recommendations for the elaboration and/or implementation of perioperative optimization programs in the highest number of surgical fields.
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Affiliation(s)
- Sébastien Bloc
- Clinical Research Department, Ambroise Pare Hospital Group, Neuilly-sur-Seine, France; Department of Anesthesiology, Clinique Drouot Sport, Paris, France.
| | - Pascal Alfonsi
- Department of Anesthesia, University of Paris Descartes, Groupe Hospitalier Paris Saint-Joseph, 185 rue Raymond Losserand, F-75674 Paris Cedex 14, France
| | - Anissa Belbachir
- Service d'Anesthésie Réanimation, UF Douleur, Assistance Publique Hôpitaux de Paris, APHP.Centre, Site Cochin, Paris, France
| | - Marc Beaussier
- Department of Digestive, Oncologic and Metabolic Surgery, Institut Mutualiste Montsouris, Université de Paris, 42 Boulevard Jourdan, 75014, Paris, France
| | - Lionel Bouvet
- Department of Anaesthesia and Intensive Care, Hospices Civils de Lyon, Hôpital Femme Mère Enfant, Lyon, France
| | | | - Sébastien Campion
- AP-HP, Groupe Hospitalier Universitaire APHP-Sorbonne Université, site Pitié-Salpêtrière, Département d'Anesthésie-Réanimation, F-75013 Paris, France; Sorbonne Université, INSERM, UMRS1158 Neurophysiologie Respiratoire Expérimentale et Clinique, F-75005 Paris, France
| | - Laure Cazenave
- Department of Anaesthesia and Critical Care, Hospices Civils de Lyon, Lyon, France; Groupe Jeunes, French Society of Anaesthesia and Intensive Care Medicine (SFAR), 75016 Paris, France
| | - Pierre Diemunsch
- Unité de Réanimation Chirurgicale, Service d'Anesthésie-réanimation Chirurgicale, Pôle Anesthésie-Réanimations Chirurgicales, Samu-Smur, Hôpital de Hautepierre, Hôpitaux Universitaires de Strasbourg, 1, Avenue Molière, 67098 Strasbourg Cedex, France
| | - Sophie Di Maria
- Department of Anaesthesiology and Critical Care, AP-HP, Hôpital Pitié-Salpêtrière, Paris, France
| | - Guillaume Dufour
- Service d'Anesthésie-Réanimation, CHU de Pitié-Salpêtrière, 47-83, Boulevard de l'Hôpital, 75013 Paris, France
| | - Stéphanie Fabri
- Faculty of Economics, Management & Accountancy, University of Malta, Malta
| | - Dominique Fletcher
- Université de Versailles-Saint-Quentin-en-Yvelines, Assistance Publique-Hôpitaux de Paris, Hôpital Ambroise-Paré, Service d'Anesthésie, 9, Avenue Charles-de-Gaulle, 92100 Boulogne-Billancourt, France
| | - Marc Garnier
- Sorbonne Université, GRC 29, DMU DREAM, Service d'Anesthésie-Réanimation et Médecine Périopératoire Rive Droite, Paris, France
| | - Anne Godier
- Department of Anaesthesiology and Critical Care, European Georges Pompidou Hospital, Assistance Publique-Hôpitaux de Paris, France
| | | | - Olivier Huet
- CHU de Brest, Anesthesia and Intensive Care Unit, Brest, France
| | - Alexandre Joosten
- Department of Anesthesiology, Erasme Hospital, Université Libre de Bruxelles, Brussels, Belgium; Department of Anesthesiology and Intensive Care, Hôpitaux Universitaires Paris-Sud, Université Paris-Sud, Université Paris-Saclay, Paul Brousse Hospital, Assistance Publique Hôpitaux de Paris (APHP), Villejuif, France
| | | | - Morgan Le Guen
- Paris Saclay University, Department of Anaesthesia and Pain Medicine, Foch Hospital, 92150 Suresnes, France
| | - Frédéric Le Saché
- Department of Anesthesiology, Clinique Drouot Sport, Paris, France; DMU DREAM Department of Anesthesiology and Critical Care, Pitié-Salpêtrière Hospital, Paris, France
| | - Isabelle Macquer
- Bordeaux University Hospitals, Bordeaux, Anaesthesia and Intensive Care Medicine Department, Bordeaux, France
| | - Constance Marquis
- Clinique du Sport, Département d'Anesthésie et Réanimation, Médipole Garonne, 45 rue de Gironis - CS 13 624, 31036 Toulouse Cedex 1, France
| | - Jacques de Montblanc
- Departments of Anesthesiology and Intensive Care Paris-Saclay University, Bicêtre Hospital, Assistance Publique Hôpitaux de Paris, Le Kremlin-Bicêtre, France
| | | | - Yên-Lan Nguyen
- Anesthesiology and Critical Care Medicine Department, Cochin Academic Hospital, APHP, Université de Paris, 75014 Paris, France
| | - Laura Ruscio
- Departments of Anesthesiology and Intensive Care Paris-Saclay University, Bicêtre Hospital, Assistance Publique Hôpitaux de Paris, Le Kremlin-Bicêtre, France; INSERM U 1195, Université Paris-Saclay, Saint-Aubin, Île-de-France, France
| | - Laurent Zieleskiewicz
- Service d'Anesthésie Réanimation, Hôpital Nord, AP-HM, Marseille, Aix Marseille Université, C2VN, France
| | - Anaîs Caillard
- Centre Hospitalier Universitaire La Cavale Blanche Université de Bretagne Ouest, Anaesthesiology, Critical Care and Perioperative Medicine Department, Brest, France
| | - Emmanuel Weiss
- Department of Anaesthesiology and Critical Care, Beaujon Hospital, DMU Parabol, AP-HP, Nord, Clichy, France; University of Paris, Paris, France; Inserm UMR_S1149, Centre for Research on Inflammation, Paris, France
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Zhang SM, Chen J, Li H, Guo MF, Han N, Sun JS, Zhang CF, Su L. Clinical application of enhanced recovery after surgery concept in laparoscopic treatment of pediatric acute appendicitis. Pediatr Surg Int 2023; 39:178. [PMID: 37041392 PMCID: PMC10089994 DOI: 10.1007/s00383-023-05439-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/01/2023] [Indexed: 04/13/2023]
Abstract
BACKGROUND This study assesses whether enhanced recovery after surgery (ERAS) is beneficial in treating acute appendicitis in pediatrics by laparoscopic techniques. METHOD The children with acute appendicitis (n = 116) were divided into the ERAS group (n = 54) and the control group (n = 62). Then the preoperative data, intraoperative observation indexes, and postoperative data were analyzed. RESULTS There was no significant difference in preoperative data and intraoperative observation indexes between the two groups. C-reactive protein (CRP) and white blood cell (WBC) in the ERAS group were significantly lower than those in the control group 3 days after the operation. Moreover, no significant difference in the visual analog score (VAS) between the two groups 3 days after the operation, but the other postoperative observation indexes in the ERAS group were significantly better than those in the control group. Nausea and vomiting in the ERAS group were significantly lower than those in the control group, with no significant difference in other complications between the two groups. CONCLUSION ERAS could improve children's comfort, reduce some postoperative complications, reduce hospitalization expenses, and speed up recovery from acute appendicitis treated by laparoscopy. Therefore, it has clinical application value.
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Affiliation(s)
- Shao-Min Zhang
- Department of Clinical Medicine, Jining Medical University, N45 Jianshe South Road Rencheng District, Jining, 272013, Shandong Province, China
| | - Jie Chen
- Department of Clinical Medicine, Jining Medical University, N45 Jianshe South Road Rencheng District, Jining, 272013, Shandong Province, China
| | - Hui Li
- Department of Clinical Medicine, Jining Medical University, N45 Jianshe South Road Rencheng District, Jining, 272013, Shandong Province, China
| | - Meng-Fu Guo
- Department of Hernia and Pediatric Surgery, Quzhou People's Hospital, Smart New City Minjiang Avenue No. 100, Quzhou, 324000, Zhejiang Province, China
| | - Nuan Han
- Department of Pediatric Surgery, Affiliated Hospital of Jining Medical University, N89 Guhuai Road, Jining, 272029, Shandong Province, China
| | - Jin-Song Sun
- Department of Pediatric Surgery, Affiliated Hospital of Jining Medical University, N89 Guhuai Road, Jining, 272029, Shandong Province, China
| | - Chong-Fang Zhang
- Department of Pediatric Surgery, Affiliated Hospital of Jining Medical University, N89 Guhuai Road, Jining, 272029, Shandong Province, China
| | - Lin Su
- Department of Pediatric Surgery, Affiliated Hospital of Jining Medical University, N89 Guhuai Road, Jining, 272029, Shandong Province, China.
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Echeverría NI, Scandurra AG, Acosta CM, Meschino GJ, Suarez Sipmann F, Tusman G. Photoplethysmography waveform analysis for classification of vascular tone and arterial blood pressure: Study based on neural networks. REVISTA ESPANOLA DE ANESTESIOLOGIA Y REANIMACION 2023; 70:209-217. [PMID: 36868265 DOI: 10.1016/j.redare.2022.01.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Accepted: 01/09/2022] [Indexed: 03/02/2023]
Abstract
BACKGROUND To test whether a Shallow Neural Network (S-NN) can detect and classify vascular tone dependent changes in arterial blood pressure (ABP) by advanced photopletysmographic (PPG) waveform analysis. METHODS PPG and invasive ABP signals were recorded in 26 patients undergoing scheduled general surgery. We studied the occurrence of episodes of hypertension (systolic arterial pressure (SAP) >140 mmHg), normotension and hypotension (SAP < 90 mmHg). Vascular tone according to PPG was classified in two ways: 1) By visual inspection of changes in PPG waveform amplitude and dichrotic notch position; where Classes I-II represent vasoconstriction (notch placed >50% of PPG amplitude in small amplitude waves), Class III normal vascular tone (notch placed between 20-50% of PPG amplitude in normal waves) and Classes IV-V-VI vasodilation (notch <20% of PPG amplitude in large waves). 2) By an automated analysis, using S-NN trained and validated system that combines seven PPG derived parameters. RESULTS The visual assessment was precise in detecting hypotension (sensitivity 91%, specificity 86% and accuracy 88%) and hypertension (sensitivity 93%, specificity 88% and accuracy 90%). Normotension presented as a visual Class III (III-III) (median and 1st-3rd quartiles), hypotension as a Class V (IV-VI) and hypertension as a Class II (I-III); all p < .0001. The automated S-NN performed well in classifying ABP conditions. The percentage of data with correct classification by S-ANN was 83% for normotension, 94% for hypotension, and 90% for hypertension. CONCLUSIONS Changes in ABP were correctly classified automatically by S-NN analysis of the PPG waveform contour.
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Affiliation(s)
- N I Echeverría
- Laboratorio de Bioingeniería, ICYTE-CONICET, Facultad de Ingeniería, Universidad Nacional de Mar del Plata, Buenos Aires, Argentina
| | - A G Scandurra
- Laboratorio de Bioingeniería, ICYTE-CONICET, Facultad de Ingeniería, Universidad Nacional de Mar del Plata, Buenos Aires, Argentina
| | - C M Acosta
- Departamento de Anestesiología, Hospital Privado de Comunidad, Mar del Plata, Buenos Aires, Argentina
| | - G J Meschino
- Laboratorio de Bioingeniería, ICYTE-CONICET, Facultad de Ingeniería, Universidad Nacional de Mar del Plata, Buenos Aires, Argentina
| | - F Suarez Sipmann
- Laboratorio Hedenstierna, Departamento de Ciencias quirúrgicas, Universidad de Uppsala, Uppsala, Sweden; Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Madrid, Spain; Departamento de Cuidados Críticos, Hospital Universitario de La Princesa, Madrid, Spain
| | - G Tusman
- Departamento de Anestesiología, Hospital Privado de Comunidad, Mar del Plata, Buenos Aires, Argentina.
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Romario UF, Ascari F, De Pascale S, Bencini L, Cocozza E, Cotsoglou C, Degiuli M, Palma G, Ferrari G, Lucianetti A, Marchesi F, Merigliano S, Millo P, Navarra G, Petri R, Portolani N, Puzziello A, Rosati R, Weindelmayer J, Ercolani G, De Palma G. Implementation of the ERAS program in gastric surgery: a nationwide survey in Italy. Updates Surg 2023; 75:141-148. [PMID: 36307670 PMCID: PMC9616397 DOI: 10.1007/s13304-022-01400-8] [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: 05/19/2022] [Accepted: 10/04/2022] [Indexed: 01/14/2023]
Abstract
Enhanced recovery after surgery (ERAS) programs have been developed by combining several evidence-based techniques for perioperative care, with the intention of reducing the stress response and organ dysfunction, thus allowing improved clinical results. ERAS programs have been widely adopted for colorectal surgery; however, their adoption for upper gastrointestinal surgery has been challenging even though good results have been reported in the literature. Our intent was to investigate the adoption of ERAS programs for resective gastric surgery in Italy. A survey was conducted among 20 departments of surgery belonging to the Italian Group for Research on Gastric Cancer (GC). Analysis of our survey showed that several evidence-based practices and many items of the ERAS guidelines for gastric surgery are not implemented in real practice in Italian centers dedicated to GC. This situation may be related to the hesitation of surgeons to introduce radical changes to the traditional postoperative management after gastrectomy. A multidisciplinary approach to the perioperative care of these patients is not routinely applied in many Italian centers. A strict collaboration of all clinicians involved in the perioperative care of patients undergoing gastrectomy for GC is key for the future implementation of ERAS in gastric surgery in our departments.
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Affiliation(s)
- Uberto Fumagalli Romario
- grid.15667.330000 0004 1757 0843Digestive Surgery, European Institute of Oncology, IRCCS, Via Ripamonti 435, Milan, Italy
| | - Filippo Ascari
- grid.15667.330000 0004 1757 0843Digestive Surgery, European Institute of Oncology, IRCCS, Via Ripamonti 435, Milan, Italy
| | - Stefano De Pascale
- grid.15667.330000 0004 1757 0843Digestive Surgery, European Institute of Oncology, IRCCS, Via Ripamonti 435, Milan, Italy
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Zhang S, He L, Yu Y, Yuan X, Yang T, Yan F, Xu F, Zhang Y, Pan S, Zhang H, Chen Z, Xie L, Wu R, Feng W, Yao Y. Effects of pre-operative oral carbohydrates on insulin resistance and postoperative recovery in diabetic patients undergoing coronary artery bypass grafting: study protocol for a prospective, single-blind, randomized controlled trial. Trials 2022; 23:1067. [PMID: 36581874 PMCID: PMC9801544 DOI: 10.1186/s13063-022-07042-w] [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: 10/23/2022] [Accepted: 12/19/2022] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Preoperative carbohydrates (CHO) supplement has been widely investigated in nondiabetic patients undergoing a variety of surgeries. It has been proved that preoperative CHO could alleviate postoperative insulin resistance (IR) and improve patients' well-being in nondiabetic patients. However, it remains controversial whether preoperative CHO could yield similar effects in diabetic patients. Till now, seldom has the administration of preoperative CHO been investigated in diabetic patients and there are limited studies reporting IR and postoperative recovery of diabetic patients undergoing cardiac surgery. METHODS AND ANALYSIS We present a prospective, single-center, single-blind, randomized, no-treatment controlled trial of preoperative CHO on diabetic patients undergoing off-pump coronary artery bypass grafting (OPCAB). A total of 62 patients will be enrolled and randomized to either Group CHO or Group control (CTRL). Patients in Group CHO will consume CHO fluid containing 50 g carbohydrates orally the evening before surgery (20:00-24:00) while their counterparts in Group CTRL will be fasted after 20:00 the evening before surgery. The primary endpoint is postoperative IR assessed via homeostasis model assessment (HOMA). The secondary endpoints are postoperative levels of potential mediators relating to IR including inflammatory factors and stress reaction characterized by serum cortisol. Exploratory endpoints are in-hospital clinical endpoints. Continuous variables will be compared by Student's t-test or Mann-Whitney U test. Categorical variables will be compared with χ2 test or Fisher's exact test. All tests in the present study are two-tailed and P<0.05 is considered statistically significant. All analyses will be performed with R 4.0.4. DISCUSSION This is the first prospective randomized controlled trial of preoperative CHO in diabetic patients undergoing cardiac surgery, with the hypothesis that preoperative CHO could improve postoperative IR and promote postoperative recovery. The research may assist in improving the clinical outcomes of diabetic patients undergoing OPCAB. TRIAL REGISTRATION The trial has been prospectively registered with ClinicalTrials.gov ( https://register. CLINICALTRIALS gov ) and Chinese Clinical Trial Registry ( http://www.chictr.org.cn ). Registry number is NCT05540249 and ChiCTR2000029664 respectively. Registered on Sept. 14, 2022. CLINICAL TRIALS UNIT Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China.
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Affiliation(s)
- Shicheng Zhang
- grid.415105.40000 0004 9430 5605Department of Adult Cardiac Surgery, Fuwai Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College/National Center for Cardiovasular Diseases, Beijing, China
| | - Lixian He
- grid.508308.6Department of Anesthesiology, Fuwai Yunnan Cardiovascular Hospital, Kunming, Yunnan Province China ,grid.415105.40000 0004 9430 5605Department of Anesthesiology, Fuwai Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College/National Center for Cardiovascular Diseases, Beijing, China
| | - Yiping Yu
- grid.415105.40000 0004 9430 5605Department of Anesthesiology, Fuwai Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College/National Center for Cardiovascular Diseases, Beijing, China
| | - Xin Yuan
- grid.415105.40000 0004 9430 5605Department of Adult Cardiac Surgery, Fuwai Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College/National Center for Cardiovasular Diseases, Beijing, China
| | - Tao Yang
- grid.415105.40000 0004 9430 5605Department of Adult Cardiac Surgery, Fuwai Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College/National Center for Cardiovasular Diseases, Beijing, China
| | - Fuxia Yan
- grid.415105.40000 0004 9430 5605Department of Anesthesiology, Fuwai Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College/National Center for Cardiovascular Diseases, Beijing, China
| | - Fei Xu
- grid.415105.40000 0004 9430 5605Department of Adult Cardiac Surgery, Fuwai Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College/National Center for Cardiovasular Diseases, Beijing, China
| | - Yan Zhang
- grid.415105.40000 0004 9430 5605Department of Adult Cardiac Surgery, Fuwai Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College/National Center for Cardiovasular Diseases, Beijing, China
| | - Shiwei Pan
- grid.415105.40000 0004 9430 5605Department of Adult Cardiac Surgery, Fuwai Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College/National Center for Cardiovasular Diseases, Beijing, China
| | - Huaijun Zhang
- grid.415105.40000 0004 9430 5605Department of Adult Cardiac Surgery, Fuwai Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College/National Center for Cardiovasular Diseases, Beijing, China
| | - Zujun Chen
- grid.415105.40000 0004 9430 5605Department of Intensive Care Unit, Fuwai Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College/National Center for Cardiovascular Diseases, Beijing, China
| | - Lu Xie
- grid.415105.40000 0004 9430 5605Department of Adult Cardiac Surgery, Fuwai Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College/National Center for Cardiovasular Diseases, Beijing, China
| | - Rong Wu
- grid.415105.40000 0004 9430 5605Department of Intensive Care Unit, Fuwai Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College/National Center for Cardiovascular Diseases, Beijing, China
| | - Wei Feng
- grid.415105.40000 0004 9430 5605Department of Adult Cardiac Surgery, Fuwai Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College/National Center for Cardiovasular Diseases, Beijing, China
| | - Yuntai Yao
- grid.415105.40000 0004 9430 5605Department of Anesthesiology, Fuwai Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College/National Center for Cardiovascular Diseases, Beijing, China
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Effect of Preoperative Oral Carbohydrate on Patients Undergoing Gynecological Laparoscopic Surgery With Different Fasting Times: A Randomized Control Study. J Perianesth Nurs 2022; 37:858-864. [PMID: 35811226 DOI: 10.1016/j.jopan.2022.01.009] [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: 07/18/2021] [Revised: 01/18/2022] [Accepted: 01/22/2022] [Indexed: 11/24/2022]
Abstract
PURPOSE This study aimed to investigate the effect of preoperative oral carbohydrates (POC) on patients undergoing gynecological laparoscopic surgery with different fasting times. DESIGN A randomized control study. METHODS Two hundred patients were randomly divided into F group (first operation without carbohydrates intake), S group (second operation without carbohydrates intake), Fpo group (first operation with POC intake), and Spo group (second operation with POC intake). The visual analog scale (VAS) of thirst and hunger, perioperative buffer excess (BE), electrolyte and glucose levels, as well as insulin resistance (IR) were compared. Time to first flatus, hospital stay, and eating time were also recorded. FINDINGS POC reduces the aggravation of thirst and hunger discomfort during the perioperative period. Abnormal perioperative BE and lactate levels were found in patients of F and S groups, while those in the Fpo and Spo groups almost returned to normal. Patients in all groups had preoperative hypokalemia, and those in the Fpo and Spo groups recovered quickly to normal intraoperatively. IR in patients in the Fpo and Spo groups retured to preoperative levels after surgery while, those in the F and S groups persisted until 48 hour postoperatively. No significant differences in postoperative nausea and vomiting, time to first flatus, time of first eating, and postoperative hospital stay were found among the four groups. CONCLUSION POC accelerates postoperative recovery in patients undergoing gynecological laparoscopy with different fasting times.
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Shrestha A, Dani M, Kemp P, Fertleman M. Acute Sarcopenia after Elective and Emergency Surgery. Aging Dis 2022; 13:1759-1769. [PMID: 36465176 PMCID: PMC9662269 DOI: 10.14336/ad.2022.0404] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Accepted: 04/04/2022] [Indexed: 04/12/2024] Open
Abstract
Sarcopenia is an increasingly recognised condition of loss of muscle mass and function. The European Working Group on Sarcopenia in Older People 2 (EWSOP2) updated their definition in 2018, emphasising the importance of low muscle strength in diagnosis. Acute sarcopenia has been arbitrarily defined as sarcopenia lasting less than 6 months. This review highlights the pathophysiology involved in muscle wasting following surgery, focussing on hormonal factors, inflammation, microRNAs, and oxidative stress. Biomarkers such as GDF-15, IGF-1 and various microRNAs may predict post-surgical muscle loss. The impact of existing sarcopenia on various types of surgery and incident muscle wasting following surgery is also described. The gaps in research found include the need for longitudinal studies looking in changes in muscle strength and quantity following surgery. Further work is needed to examine if biomarkers are replicated in other surgery to consolidate existing theories on the pathophysiology of muscle wasting.
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Affiliation(s)
- Alvin Shrestha
- Cutrale Perioperative and Ageing group, Imperial College London, London SW7 2BX, United Kingdom
| | - Melanie Dani
- Cutrale Perioperative and Ageing group, Imperial College London, London SW7 2BX, United Kingdom
| | - Paul Kemp
- National Lung and Health Institute, Imperial College London, London SW7 2BX, United Kingdom
| | - Michael Fertleman
- Cutrale Perioperative and Ageing group, Imperial College London, London SW7 2BX, United Kingdom
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Liddle C. Preoperative fasting: exploring guidelines and evidence to ensure consistent, high-quality care. Nurs Stand 2022; 37:77-82. [PMID: 36377391 DOI: 10.7748/ns.2022.e12033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/28/2022] [Indexed: 11/16/2022]
Abstract
Many nurses will still be familiar with the instruction 'nil by mouth from midnight' traditionally given to patients preparing to undergo surgery. National and international guidelines now promote much shorter preoperative fasting times, encapsulated in the '2-4-6 rule' - two hours for clear fluids, four hours for breast milk and six hours for solids. The latest evidence appears to show that these fasting times are in need of revision. Furthermore, there are inconsistencies in how guidelines are implemented. This article explores the guidelines and literature on preoperative fasting in adults and children to determine what the evidence is and what changes could be made to ensure consistent, high-quality patient care.
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Effect of Preoperative Oral Carbohydrates on Insulin Resistance in Older Adults Who Underwent Total Hip or Knee Arthroplasty: A Prospective Randomized Trial. J Am Acad Orthop Surg 2022; 30:971-978. [PMID: 35576534 DOI: 10.5435/jaaos-d-21-00656] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Accepted: 04/04/2022] [Indexed: 02/01/2023] Open
Abstract
INTRODUCTION Preoperative carbohydrate drinks are recommended to reduce fasting time before surgery. Older adults are at risk of pulmonary aspiration and hyperglycemia after consuming carbohydrate drinks because of increased insulin resistance and delayed gastric emptying. We investigated the effects of oral carbohydrate drinks on perioperative insulin resistance, metabolic responses, and gastric volume in older adults. METHODS Fifty-six patients (aged more than 65 years) were randomly assigned to the control or carbohydrate (CHO) group. The CHO group received 400 mL of a carbohydrate drink 2 to 3 hours before anesthesia. The control group was allowed clear fluid intake 2 hours before anesthesia. Blood glucose and insulin levels were measured before intake of the carbohydrate drink and 1 hour postoperatively. Gastric volume was measured before spinal anesthesia. Insulin resistance was calculated using the homeostasis model assessment for insulin resistance. RESULTS Homeostasis model assessment for insulin resistance was not different between the control and CHO groups preoperatively (2.5 versus 3.3, P = 0.156) or postoperatively (2.6 versus 2.4, P = 0.817). Preoperative gastric volume was comparable between the control and CHO groups (35.5 versus 30.8 mL, P = 0.696). DISCUSSION Preoperative oral consumption of carbohydrates did not affect insulin resistance or gastric volume in older adults undergoing total knee or hip arthroplasty. Preoperative carbohydrate loading is safe in older adults undergoing total knee or hip arthroplasty. DATA AVAILABILITY The data that support the findings of this study are available from the corresponding author on reasonable request. CLINICAL TRIAL REGISTRATION ClinicalTrials.gov (No. NCT04206189).
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Beels M, Stevens S, Saldien V. Perioperative fluid management in children: an updated review. ACTA ANAESTHESIOLOGICA BELGICA 2022. [DOI: 10.56126/73.3.03] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/05/2022]
Abstract
Background: Perioperative fluid management in children has been a major topic for debate.
Objectives: Our aim is to review the current evidence on perioperative fluid management in children including: type of fluid, administration rates, preoperative fluid intake and monitoring techniques.
Design: Narrative review.
Method: Following the PRISMA-S guidelines we performed a search (2010-March 2022) in databases Medline (through PubMed) and Cochrane Library. 4297 citations were found and screened by two independent researchers. After screening, 64 articles were withheld for our review.
Results: The perioperative administration of isotonic fluids is safer than hypotonic solutions, concerning the development of hyponatremia. A balanced isotonic solution with 1-2,5% glucose should be used as perioperative maintenance IV fluid in children (1 month to 18 years). Colloids can be used in children when inadequate effect in volume correction is achieved with crystalloids. The preferred synthetic colloid for children is a third generation HES in a balanced solution. To date, most clinicians use the “4-2-1 rule” for calculating fluid rate. This may not be the optimal fluid rate, as little research has been done. Preoperative fasting for clear fluids should be limited to 1 hour, children should even be encouraged to drink up until 1 hour before induction. Respiratory variation of aortic blood flow peak velocity (ΔVpeak) with echocardiography is currently the most reliable technique for evaluating fluid responsiveness in children.
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Abstract
OBJECTIVE A gap between clinical practice and evidence is common. The present multicentre study was designed to explore the actual postoperative fasting practice, including the instructed fasting time from the ward staff and the actual postoperative fasting time. DESIGN Multicentre survey. SETTING Four tertiary hospitals in Shenzhen City, China. PARTICIPANTS A total of 988 patients completed a survey on instructed and actual postoperative fasting. OUTCOMES All patients received postoperative instructed fasting time from the ward staff. The median instructed fasting time for fluids from ward staff was 6 hours (IQR, 4-6 hours), and the median instructed fasting time for solid food was also 6 hours (IQR 5-6 hours) after surgery. The actual postoperative fasting time, including fluid and solid food intake, was significantly longer than the time recommended by the ward staff (both p<0.001). RESULTS The median time to postoperative first flatus (FFL) was 16.5 hours (IQR 8-25.5 hours), and the median time to postoperative first faeces (FFE) was 41 hours (IQR 25-57 hours). The fasting time was significantly shorter than the time to FFL and the time to FFE, regardless of surgery type or anaesthesia type (all p<0.001). Postoperative nausea and vomiting (PONV) occurred in 23.6% of patients. After surgery, 58.70% of patients reported thirst, and 47.47% reported hunger. No ileus occurred. CONCLUSION Approximately half of the patients reported thirst and hunger postoperatively. Patients initiated oral intake earlier than the time to FFL or FFE without increasing serious complications. This study may support the rationale for interventions targeting postoperative oral intake time in future studies.
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Affiliation(s)
- Lifei Lai
- Department of Anesthesiology, The Seventh Affiliated Hospital of Sun Yat-sen University, Shenzhen, China
| | - Lianghua Zeng
- Department of Anesthesiology, Shenzhen Qianhai Shekou Free Trade Zone Hospital, Shenzhen, China
| | - Zhijing Yang
- Department of Anesthesiology, Shenzhen University General Hospital, Shenzhen, China
| | - Yingling Zheng
- Department of Anesthesiology, Integrated Traditional Chinese and Western Medicine Hospital, Shenzhen, China
| | - Qianqian Zhu
- Department of Anesthesiology, The Seventh Affiliated Hospital of Sun Yat-sen University, Shenzhen, China
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Sidhu NS. 'Water challenge' to improve diagnostic accuracy in gastric point-of-care ultrasound. Anaesth Rep 2022; 10:e12192. [PMID: 36353141 PMCID: PMC9635564 DOI: 10.1002/anr3.12192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/18/2022] [Indexed: 11/06/2022] Open
Affiliation(s)
- N. S. Sidhu
- Department of Anaesthesia and Perioperative MedicineNorth Shore HospitalAucklandNew Zealand
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Ruslan N, Smith AF. The thirst for improvement: ensuring shorter and safer pre-operative fasting times in children. Anaesthesia 2022; 77:743-747. [PMID: 35545991 DOI: 10.1111/anae.15751] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/23/2022] [Indexed: 11/27/2022]
Affiliation(s)
- N Ruslan
- Department of Anaesthesia, Royal Lancaster Infirmary, Lancaster, UK
| | - A F Smith
- Department of Anaesthesia, Royal Lancaster Infirmary, Lancaster, UK
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Martins DS, Piper HG. Nutrition considerations in pediatric surgical patients. Nutr Clin Pract 2022; 37:510-520. [PMID: 35502496 DOI: 10.1002/ncp.10855] [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: 12/28/2021] [Revised: 03/15/2022] [Accepted: 03/30/2022] [Indexed: 11/11/2022] Open
Abstract
Children who require surgical interventions are subject to physiologic stress, necessitating a period of healing when nutrition needs may temporarily change. Providing appropriate nutrition to children before and after surgery is an important part of minimizing surgical morbidity. There is a clear link between poor nutrition and surgical outcomes, therefore providing good reason for ensuring an appropriate nutrition plan is in place for children requiring surgery. This review will address recent research investigating nutrition considerations for pediatric surgical patients with a focus on practical tools to guide decision making in the preoperative, intraoperative, and postoperative periods.
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Affiliation(s)
| | - Hannah G Piper
- Division of Pediatric Surgery, University of British Columbia/BC Children's Hospital, Vancouver, BC, Canada
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Roy S, Kothari N, Goyal S, Sharma A, Kumar R, Kaloria N, Bhatia P. Preoperative assessment of inferior vena cava collapsibility index by ultrasound is not a reliable predictor of post-spinal anesthesia hypotension. BRAZILIAN JOURNAL OF ANESTHESIOLOGY (ELSEVIER) 2022:S0104-0014(22)00051-3. [PMID: 35430190 PMCID: PMC10362455 DOI: 10.1016/j.bjane.2022.04.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Revised: 03/25/2022] [Accepted: 04/06/2022] [Indexed: 06/14/2023]
Abstract
BACKGROUND Post-spinal anesthesia hypotension is of common occurrence, and it hampers tissue perfusion. Several preoperative factors determine patient susceptibility to hypotension. This study aimed to assess the effectiveness of the Inferior Vena Cava Collapsibility Index (IVCCI) for predicting intraoperative hypotension. METHODS One hundred twenty-nine adult patients who were scheduled for elective surgical procedures after administration of spinal (intrathecal) anesthesia were included in the study. Ultrasound evaluation of the Inferior Vena Cava (IVC) was done in the preoperative area, and the patients were shifted to the Operating Room (OR) for spinal anesthesia. An independent observer recorded the change in blood pressure after spinal anesthesia inside the OR. RESULTS Twenty-five patients developed hypotension (19.37%). Baseline systolic blood pressure and mean blood pressures were statistically higher in those patients who developed hypotension (p = 0.001). The logistic regression analysis for IVCCI and the incidence of hypotension showed r2 of 0.025. Receiver Operating Characteristic (ROC) curve analysis demonstrated the Area Under the Curve (AUC) of 0.467 (95% Confidence Interval, 0.338 to 0.597; p = 0.615). CONCLUSIONS Preoperative evaluation of IVCCI is not a good predictor for the occurrence of hypotension after spinal anesthesia.
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Affiliation(s)
- Shayak Roy
- All India Institute of Medical Sciences (AIIMS), Department of Anaesthesiology & Critical Care, Jodhpur, India
| | - Nikhil Kothari
- All India Institute of Medical Sciences (AIIMS), Department of Anaesthesiology & Critical Care, Jodhpur, India
| | - Shilpa Goyal
- All India Institute of Medical Sciences (AIIMS), Department of Anaesthesiology & Critical Care, Jodhpur, India
| | - Ankur Sharma
- All India Institute of Medical Sciences (AIIMS), Department of Anaesthesiology & Critical Care, Jodhpur, India.
| | - Rakesh Kumar
- All India Institute of Medical Sciences (AIIMS), Department of Anaesthesiology & Critical Care, Jodhpur, India
| | - Narender Kaloria
- All India Institute of Medical Sciences (AIIMS), Department of Anaesthesiology & Critical Care, Jodhpur, India
| | - Pradeep Bhatia
- All India Institute of Medical Sciences (AIIMS), Department of Anaesthesiology & Critical Care, Jodhpur, India
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Guarracino F, Bertini P. Perioperative hypotension: causes and remedies. JOURNAL OF ANESTHESIA, ANALGESIA AND CRITICAL CARE 2022; 2:17. [PMCID: PMC10245539 DOI: 10.1186/s44158-022-00045-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Accepted: 04/04/2022] [Indexed: 06/24/2023]
Abstract
Background Arterial hypotension is common in patients during surgery and those admitted to the intensive care unit (ICU) postoperatively. Perioperative arterial hypotension reportedly significantly affects surgical patients’ outcomes. Blood pressure level is the most crucial factor that influences organ perfusion. Hypoperfusion and organ dysfunction are correlated based on their severity associated with hypotension. As several factors can cause intraoperative hypotension, anesthetists must promptly identify the etiology for appropriate treatment and revert the patient’s hemodynamic profile. Objectives This review discusses the concept of perioperative hypotension, identifies its effects in clinical situations, and provides remedies and techniques to predict and avoid its significant consequences. Conclusions The primary determinant of organ perfusion is blood pressure. On the other hand, profound hypotension is common in surgical patients and is connected to hypoperfusion and organ failure. Currently, hypotension is addressed once low blood pressure levels are recorded. Early detection of oncoming hypotension or its clinical prediction is of paramount importance in allowing the clinician to treat hypotension and reduce the incidence and length of hypotensive episodes promptly and aggressively.
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Affiliation(s)
- Fabio Guarracino
- Department of Anaesthesia and Critical Care Medicine, Azienda Ospedaliero Universitaria Pisana, Via Paradisa 2, 56123 Pisa, Italy
| | - Pietro Bertini
- Department of Anaesthesia and Critical Care Medicine, Azienda Ospedaliero Universitaria Pisana, Via Paradisa 2, 56123 Pisa, Italy
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Garutti I, Cabañero A, Vicente R, Sánchez D, Granell M, Fraile CA, Real Navacerrada M, Novoa N, Sanchez-Pedrosa G, Congregado M, Gómez A, Miñana E, Piñeiro P, Cruz P, de la Gala F, Quero F, Huerta LJ, Rodríguez M, Jiménez E, Puente-Maestu L, Aragon S, Osorio-Salazar E, Sitges M, Lopez Maldonado MD, Rios FT, Morales JE, Callejas R, Gonzalez-Bardancas S, Botella S, Cortés M, Yepes MJ, Iranzo R, Sayas J. Recommendations of the Society of Thoracic Surgery and the Section of Cardiothoracic and Vascular Surgery of the Spanish Society of Anesthesia, Resuscitation and Pain Therapy, for patients undergoing lung surgery included in an intensified recovery program. REVISTA ESPANOLA DE ANESTESIOLOGIA Y REANIMACION 2022; 69:208-241. [PMID: 35585017 DOI: 10.1016/j.redare.2021.02.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Accepted: 02/04/2021] [Indexed: 06/15/2023]
Abstract
In recent years, multidisciplinary programs have been implemented that include different actions during the pre, intra and postoperative period, aimed at reducing perioperative stress and therefore improving the results of patients undergoing surgical interventions. Initially, these programs were developed for colorectal surgery and from there they have been extended to other surgeries. Thoracic surgery, considered highly complex, like other surgeries with a high postoperative morbidity and mortality rate, may be one of the specialties that most benefit from the implementation of these programs. This review presents the recommendations made by different specialties involved in the perioperative care of patients who require resection of a lung tumor. Meta-analyzes, systematic reviews, randomized and non-randomized controlled studies, and retrospective studies conducted in patients undergoing this type of intervention have been taken into account in preparing the recommendations presented in this guide. The GRADE scale has been used to classify the recommendations, assessing on the one hand the level of evidence published on each specific aspect and, on the other hand, the strength of the recommendation with which the authors propose its application. The recommendations considered most important for this type of surgery are those that refer to pre-habilitation, minimization of surgical aggression, excellence in the management of perioperative pain and postoperative care aimed at providing rapid postoperative rehabilitation.
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Affiliation(s)
- I Garutti
- Servicio Anestesia y Reanimación, Hospital General Universitario Gregorio Marañón, Madrid, Spain; Departamento de Farmacología y Toxicología, Facultad de Medicina, Universidad Complutense de Madrid, Madrid, Spain.
| | - A Cabañero
- Servicio de Cirugía Torácica, Hospital Universitario Ramón y Cajal, Madrid, Spain
| | - R Vicente
- Servicio de Anestesia y Reanimación, Hospital La Fe, Valencia, Spain
| | - D Sánchez
- Servicio de Cirugía Torácica, Hospital Clínic, Barcelona, Spain
| | - M Granell
- Servicio de Anestesia y Reanimación, Hospital General, Valencia, Spain
| | - C A Fraile
- Servicio de Cirugía Torácica, Hospital Universitari Arnau de Vilanova, Lleida, Spain
| | - M Real Navacerrada
- Servicio de Anestesia y Reanimación, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - N Novoa
- Servicio de Cirugía Torácica, Complejo Asistencial Universitario de Salamanca (CAUS), Instituto de Investigación Biomédica de Salamanca (IBSAL), Salamanca, Spain
| | - G Sanchez-Pedrosa
- Servicio Anestesia y Reanimación, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - M Congregado
- Servicio de Cirugía Torácica, Hospital Virgen de la Macarena, Sevilla, Spain
| | - A Gómez
- Unitat de Rehabilitació Cardiorespiratòria, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - E Miñana
- Servicio de Anestesia y Reanimación, Hospital de la Ribera, Alzira, Valencia, Spain
| | - P Piñeiro
- Servicio Anestesia y Reanimación, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - P Cruz
- Servicio Anestesia y Reanimación, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - F de la Gala
- Servicio Anestesia y Reanimación, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - F Quero
- Servicio de Cirugía Torácica, Hospital Universitario Virgen de las Nieves, Granada, Spain
| | - L J Huerta
- Servicio de Cirugía Torácica, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - M Rodríguez
- Servicio de Cirugía Torácica, Clínica Universidad de Navarra, Madrid, Spain
| | - E Jiménez
- Fisioterapia Respiratoria, Hospital Universitario A Coruña, La Coruña, Spain
| | - L Puente-Maestu
- Servicio de Neumología, Hospital General Universitario Gregorio Marañón, Facultad de Medicina, Universidad Complutense de Madrid, Madrid, Spain
| | - S Aragon
- Servicio de Anestesia, Reanimación y Tratamiento del Dolor, Hospital Clínico Universitario, Valencia, Spain
| | - E Osorio-Salazar
- Servicio de Anestesia y Reanimación, Hospital Universitari Arnau de Vilanova, Lleida, Spain
| | - M Sitges
- Bloc Quirúrgic i Esterilització, Hospital del Mar, Parc de Salut Mar, Barcelona, Spain
| | | | - F T Rios
- Servicio de Anestesia y Reanimación, Hospital La Fe, Valencia, Spain
| | - J E Morales
- Servicio de Anestesia y Reanimación, Hospital General, Valencia, Spain
| | - R Callejas
- Servicio de Anestesia, Reanimación y Tratamiento del Dolor, Hospital Clínico Universitario, Valencia, Spain
| | - S Gonzalez-Bardancas
- Servicio de Anestesia y Reanimación, Complejo Hospitalario Universitario A Coruña, La Coruña, Spain
| | - S Botella
- Servicio de Anestesia y Reanimación, Hospital La Fe, Valencia, Spain
| | - M Cortés
- Servicio de Anestesia y Reanimación, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - M J Yepes
- Servicio de Anestesia y Reanimación, Clínica Universidad de Navarra, Navarra, Pamplona, Spain
| | - R Iranzo
- Servicio de Anestesia y Reanimación, Hospital Universitario Puerta de Hierro, Majadahonda, Madrid, Spain
| | - J Sayas
- Servicio de Neumología, Hospital General Universitario Gregorio Marañón, Facultad de Medicina, Universidad Complutense de Madrid, Madrid, Spain
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44
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Bang YJ, Lee JH, Kim CS, Lee YY, Min JJ. Anxiolytic effects of chewing gum during preoperative fasting and patient-centered outcome in female patients undergoing elective gynecologic surgery: randomized controlled study. Sci Rep 2022; 12:4165. [PMID: 35264684 PMCID: PMC8907183 DOI: 10.1038/s41598-022-07942-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Accepted: 01/06/2022] [Indexed: 11/09/2022] Open
Abstract
Although previous studies reported that chewing gum during the preoperative fasting has the benefits of alleviating anxiety and dry mouth, preoperative chewing gum has yet to be accepted as a standard practice due to conventional anesthetic custom. Our study aimed to prospectively evaluate the effects of gum chewing on preoperative anxiety and patient's discomfort in female patients undergoing gynecologic surgery. Ninety-four patients were enrolled and randomized either into conventional fasting group (control group) or chewing gum with fasting group (gum group). The control group was instructed to fast from 3 p.m. on the day before surgery. The gum group performed preoperative fasting in the same manner, but was encouraged to chew gum freely during the fasting period. The primary endpoint was the degree of preoperative anxiety. For the evaluation of preoperative anxiety, Amsterdam preoperative anxiety and information scale (APAIS) was used. Preoperative gastric fluid volume and acidity were also measured as the secondary outcomes. Preoperative anxiety using APAIS was significantly lower in the gum group compared to the control group (control group vs. gum group: 20.9 vs. 17.8, p = 0.009). However, there was no significant difference in the gastric fluid analysis between the groups. In the female patients for elective gynecologic surgery, chewing gum during the preoperative fasting period helped to alleviate preoperative anxiety without additional increase of pulmonary aspiration risks.Trial registration: KCT0004422 (05/11/2019, https://cris.nih.go.kr ; registration number).
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Affiliation(s)
- Yu Jeong Bang
- Department of Anesthesiology and Pain Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, Korea
| | - Jong-Hwan Lee
- Department of Anesthesiology and Pain Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, Korea
| | - Chung Su Kim
- Department of Anesthesiology and Pain Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, Korea
| | - Yoo-Young Lee
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jeong-Jin Min
- Department of Anesthesiology and Pain Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, Korea.
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Kim HJ, Choi YS, Jin JH, Lee B. Management of pulmonary aspiration due to undiagnosed achalasia during induction of general anesthesia: a case report with literature review - A case report -. Anesth Pain Med (Seoul) 2022; 17:239-244. [PMID: 35280041 PMCID: PMC9091672 DOI: 10.17085/apm.21102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2021] [Accepted: 12/24/2021] [Indexed: 11/17/2022] Open
Abstract
Background Intraoperative pulmonary aspiration is a rare but potentially fatal complication associated with various risk factors. Preoperative recognition of these risk factors can prevent aspiration events during general anesthesia or facilitate prompt corrective measures in patients experiencing this complication. Case A 70-year-old female patient with hypertension underwent bilateral total knee arthroplasty under general anesthesia. Despite using a midnight nothing-per-oral (NPO) protocol, an unpredictable intraoperative aspiration event occurred during anesthesia induction. A detailed evaluation of the patient’s medical history and subsequent diagnostic imaging examinations indicated achalasia. She was treated for aspiration pneumonia for 2 weeks. After 2 months, rescheduled total knee arthroplasty was performed under spinal anesthesia without any complications. Conclusions Obtaining the patient’s medical history and assessing the risk factors are important to prevent unpredictable intraoperative pulmonary aspiration. High-risk patients should undergo adequate preoperative fasting and regional anesthesia or rapid-sequence intubation should be considered for safe induction of general anesthesia.
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Affiliation(s)
| | | | | | - Bora Lee
- Corresponding author: Bora Lee, M.D., Ph.D. Department of Anesthesiology and Pain Medicine, Severance Hospital and Anesthesia and Pain Research Institute, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul 03722, Korea Tel: 82-2-2224-3919, Fax: 82-2-2227-7897 E-mail:
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46
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A Commentary on "Preoperative carbohydrate loading with individualized supplemental insulin in diabetic patients undergoing gastrointestinal surgery: A randomized trial" (Int. J. Surg. 2022;98:106215). Int J Surg 2022; 99:106251. [PMID: 35158081 DOI: 10.1016/j.ijsu.2022.106251] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Accepted: 02/03/2022] [Indexed: 11/23/2022]
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47
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Liu H, Zhao L, Liu J, Lan F, Cai L, Fang J, Li X. Change the preprocedural fasting policy for contrast-enhanced CT: results of 127,200 cases. Insights Imaging 2022; 13:29. [PMID: 35201528 PMCID: PMC8873329 DOI: 10.1186/s13244-022-01173-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2021] [Accepted: 02/03/2022] [Indexed: 12/19/2022] Open
Abstract
Objectives To analyze the relationship between the dietary preparation status prior to contrast-enhanced CT (CECT) and adverse drug reactions (ADR) and emetic complications. Methods Non-emergency adult patients who underwent routine CECT in our hospital from January 2019 to December 2020 were retrospectively analyzed. Stratified dietary preparation regimens were implemented for different clinical scenarios. The relationship between actual dietary preparation status and ADR and emetic complications was analyzed.
Results A total of 127,200 cases were enrolled, including 49,676 cases in the fasting group (57 years ± 13, 56.79% men) and 77,524 cases in the non-fasting group (60 years ± 13, 54.55% men). No statistical difference was found in the overall incidence of ADR (0.211% vs. 0.254%, p = 0.126) or emetic complications (0.030% vs. 0.046%, p = 0.158) between the two groups, and no aspiration pneumonia or death occurred. For patients with an ICM-ADR history, the ADR incidence in non-fasting group was significantly lower than fasting group (2.424% vs. 12.371%, p = 0.002). For patients with hypertension, injection dose ≥ 100 mL, injection rate ≥ 5 mL/s, and Iopromide 370 usage, non-fasting was associated with higher ADR incidence (p < 0.05). 36.67% of the patients experienced unnecessary excessive fasting in practice. Excessive fasting (≥ 10 h) and more water ingestion (≥ 500 mL) within 1 h prior to CECT were associated with higher ADR incidence (p < 0.05). Conclusion Unrestricted food ingestion would not increase the overall risk of ADR and emetic complications. For some special patient subgroups, non-fasting, excessive fasting, and more water ingestion were associated with higher ADR incidence. Supplementary Information The online version contains supplementary material available at 10.1186/s13244-022-01173-z.
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Affiliation(s)
- Heng Liu
- Department of Radiology, Daping Hospital, Army Medical University, No. 10 Changjiang Road, Yuzhong District, Chongqing, 400042, China.,Department of Radiology, PLA Rocket Force Characteristic Medical Center, No. 16 Xinjiekou Outer Street, Beijing, 100088, China
| | - Li Zhao
- Department of Radiology, Daping Hospital, Army Medical University, No. 10 Changjiang Road, Yuzhong District, Chongqing, 400042, China
| | - Junling Liu
- Department of Radiology, Daping Hospital, Army Medical University, No. 10 Changjiang Road, Yuzhong District, Chongqing, 400042, China
| | - Fang Lan
- Department of Radiology, Daping Hospital, Army Medical University, No. 10 Changjiang Road, Yuzhong District, Chongqing, 400042, China
| | - Li Cai
- Department of Radiology, Daping Hospital, Army Medical University, No. 10 Changjiang Road, Yuzhong District, Chongqing, 400042, China
| | - Jingqin Fang
- Department of Radiology, Daping Hospital, Army Medical University, No. 10 Changjiang Road, Yuzhong District, Chongqing, 400042, China.
| | - Xue Li
- Department of Radiology, Daping Hospital, Army Medical University, No. 10 Changjiang Road, Yuzhong District, Chongqing, 400042, China.
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48
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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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49
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Liu H, Liu Y, Zhao L, Li X, Zhang W. Preprocedural fasting for contrast-enhanced CT: when experience meets evidence. Insights Imaging 2021; 12:180. [PMID: 34865183 PMCID: PMC8643287 DOI: 10.1186/s13244-021-01131-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Accepted: 11/17/2021] [Indexed: 12/12/2022] Open
Abstract
Traditional preparatory fasting policy prior to iodinated contrast media (ICM) assisted contrast-enhanced CT (CECT) examinations lacks methodologically acceptable evidence. Considering the possible negative effects of preprocedural fasting, the latest European Society of Urogenital Radiology guidelines V10.0 and American Committee of Radiology 2021 guidelines clearly state that preprocedural fasting is not recommended prior to routine intravenous ICM administration. This comprehensive and detailed Review presents the current global dietary preparation policies, potential harm of excessive fasting, and a systematical and well-bedded description of practice advancements of dietary preparation. The evidences revealed that there has been no single instance of vomiting-associated aspiration pneumonia due to the undemanding implementation of preparatory fasting prior to CECT yet. Non-fasting would not increase the incidence of emetic symptoms and the risk of aspiration pneumonia. Not every patient should undergo all CECT examinations without preparatory fasting. There is still much more refinement to be done on the preparatory fasting policy. Changes in traditional preparatory fasting policy will make positive and significant implications on clinical practice. This Review aims to provide operational guidance and suggestions for practitioners and policymakers, motivate efficient, reasonable, safe and normative ICM usage, and achieve optimal patient clinical benefits and high-quality radiological care practices.
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Affiliation(s)
- Heng Liu
- Department of Radiology, PLA Rocket Force Characteristic Medical Center, No. 16 Xinjiekou Outer Street, Beijing, 100088, China.,Department of Radiology, Daping Hospital, Army Medical University, No. 10 Changjiang Road, Yuzhong District, Chongqing, 400042, China
| | - Yu Liu
- Beijing Advanced Innovation Center for Big Data-Based Precision Medicine, School of Biological Science and Medical Engineering, Beihang University, Beijing, 100191, China
| | - Li Zhao
- Department of Radiology, Daping Hospital, Army Medical University, No. 10 Changjiang Road, Yuzhong District, Chongqing, 400042, China
| | - Xue Li
- Department of Radiology, Daping Hospital, Army Medical University, No. 10 Changjiang Road, Yuzhong District, Chongqing, 400042, China.
| | - Weiguo Zhang
- Department of Radiology, Daping Hospital, Army Medical University, No. 10 Changjiang Road, Yuzhong District, Chongqing, 400042, China. .,Chongqing Clinical Research Center for Imaging and Nuclear Medicine, Chongqing, 400042, China.
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50
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Rollins KE, Lobo DN, Joshi GP. Enhanced recovery after surgery: Current status and future progress. Best Pract Res Clin Anaesthesiol 2021; 35:479-489. [PMID: 34801211 DOI: 10.1016/j.bpa.2020.10.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Accepted: 10/07/2020] [Indexed: 12/20/2022]
Abstract
Enhanced Recovery After Surgery (ERAS) pathways were first introduced almost a quarter of a century ago and represent a paradigm shift in perioperative care that reduced postoperative complications and hospital length of stay, improved postoperative quality of life, and reduced overall healthcare costs. Gradual recognition of the generalizability of the interventions and transferable improvements in postoperative outcomes, led them to become standard of care for several surgical procedures. In this article, we critically review the current status of ERAS pathways, address related controversies, and propose measures for future progress.
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Affiliation(s)
- Katie E Rollins
- Gastrointestinal Surgery, Nottingham Digestive Diseases Centre, National Institute for Health Research (NIHR) Nottingham Biomedical Research Centre, Nottingham University Hospitals NHS Trust and University of Nottingham, Queen's Medical Centre, Nottingham, UK
| | - Dileep N Lobo
- Gastrointestinal Surgery, Nottingham Digestive Diseases Centre, National Institute for Health Research (NIHR) Nottingham Biomedical Research Centre, Nottingham University Hospitals NHS Trust and University of Nottingham, Queen's Medical Centre, Nottingham, UK; MRC Versus Arthritis Centre for Musculoskeletal Ageing Research, School of Life Sciences, University of Nottingham, Queen's Medical Centre, Nottingham, UK
| | - Girish P Joshi
- Department of Anesthesiology and Pain Management, University of Texas Southwestern Medical Center, Dallas, TX, USA.
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