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Ajeje ET, Gandolfi JV, Cavallari V, Silva-Jr JM, de Freitas Chaves RC, Berger-Estilita J, Lobo SM. Measurements of I-FABP and citrulline in the postoperative period of non-cardiac surgeries with gastrointestinal complications: A prospective cohort observational study. J Crit Care 2024; 81:154530. [PMID: 38335862 DOI: 10.1016/j.jcrc.2024.154530] [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: 11/28/2023] [Revised: 01/26/2024] [Accepted: 01/29/2024] [Indexed: 02/12/2024]
Abstract
BACKGROUND Acute Gastrointestinal Injury (AGI) is associated with adverse clinical outcomes, including increased mortality. We aimed to investigate the potential of citrulline and intestinal fatty acid binding protein (I-FABP) as biomarkers for early AGI diagnosis and predicting outcomes in surgical patients. METHODS Prospective cohort study involving patients who underwent non-cardiac surgeries and were admitted to Intensive Care Units. AGI diagnosis was based on specific criteria, and severity was categorised following established guidelines. Statistical analyses were performed to assess the diagnostic accuracy of the biomarkers and their association with outcomes, P significant when <0.05. RESULTS AGI was identified in 40.3% of patients with varying severity. Mortality rates were significantly higher in the AGI group in the ICU (19.4% vs. 0%, p = 0.001) and hospital (22.6% vs. 2.17%, p = 0.003). Urinary I-FABP levels on days 3 and 7 showed reasonable and good accuracy for AGI diagnosis (AUC 0.732 and 0.813, respectively). Urinary I-FABP levels on days 2 and 3 accurately predict sepsis. Urinary citrulline levels on day one predicted mortality (AUC 0.87) furthermore urinary I-FABP levels on day 2 showed reasonable accuracy (sensitivity 83.3%, specificity 92.4%). CONCLUSION Urinary I-FABP and citrulline levels are promising diagnostic and prognostic markers in ICU patients following non-cardiac surgeries.
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Affiliation(s)
- Eduarda Tebet Ajeje
- Intensive Care Division. Hospital de Base, Faculdade de Medicina de São José do Rio Preto - São José do Rio Preto (SP), Brazil
| | - Joelma Villafanha Gandolfi
- Intensive Care Division. Hospital de Base, Faculdade de Medicina de São José do Rio Preto - São José do Rio Preto (SP), Brazil
| | - Vinicius Cavallari
- Intensive Care Division. Hospital de Base, Faculdade de Medicina de São José do Rio Preto - São José do Rio Preto (SP), Brazil
| | - João Manoel Silva-Jr
- Hospital Israelita Albert Einstein- São Paulo (SP), Brazil; Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo - São Paulo (SP), Brazil
| | - Renato Carneiro de Freitas Chaves
- Hospital Israelita Albert Einstein- São Paulo (SP), Brazil; MIT Critical Data, Laboratory for Computational Physiology, Harvard-MIT Health Sciences and Technology, Massachusetts Institute of Technology, Cambridge, MA, United States
| | - Joana Berger-Estilita
- Institute of Anaesthesiology and Intensive Care, Salemspital, Hirslanden Medical Group, Schänzlistrasse 39, 3013 Bern, Switzerland; Institute for Medical Education, University of Bern, Mittelstrasse 43, 3012 Bern, Switzerland; CINTESIS, Centre for Health Technology and Services Research, Faculty of Medicine, University of Porto, Rua Dr. Plácido da Costa, s/n, 4200-450 Porto, Portugal
| | - Suzana Margareth Lobo
- Intensive Care Division. Hospital de Base, Faculdade de Medicina de São José do Rio Preto - São José do Rio Preto (SP), Brazil.
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Dai F, Zhang R, Deng R, Wang G, Guo H, Guo C. Regular use of low-dose of opioids after gastrointestinal surgery may lead to postoperative gastrointestinal tract dysfunction in children: a Chinese national regional health center experience sharing. BMC Gastroenterol 2023; 23:369. [PMID: 37907841 PMCID: PMC10617101 DOI: 10.1186/s12876-023-02999-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Accepted: 10/14/2023] [Indexed: 11/02/2023] Open
Abstract
BACKGROUND The need for pain management is increasing in pediatrics, but the side effects of overuse or abuse of analgesics can be harmful to children's health and even life-threatening in severe cases. METHODS Patients who underwent resection of Meckel's diverticulum at the Children's Hospital of Chongqing Medical University from July 1, 2019, to July 1, 2022, were included in this study. Opioids were administered through patient-controlled analgesia (PCA). Based on the preoperative choices made by the legal guardians, patients were stratified into two groups: PCA Group (PCAG) and Non-PCA Group (NPCAG). Data pertaining to the clinical characteristics and prognoses of these patients were subsequently collected and analyzed to assess the impact of opioid administration. RESULTS In the study, a total of 126 patients were enrolled, with 72 allocated to the Patient-Controlled Analgesia Group (PCAG) and 54 to the Non-Patient-Controlled Analgesia Group (NPCAG). When compared to the NPCAG, the PCAG exhibited a longer duration of postoperative fasting (median 72 vs. 62 h, p = 0.044) and increased utilization of laxatives (12[16.7%] vs. 2[3.7%], p = 0.022). However, the PCAG also experienced higher incidences of intestinal stasis and abnormal intestinal dilation (13[18.1%] vs. 3[5.6%], p = 0.037). No statistically significant differences were observed in pain assessments at the conclusion of the surgical procedure (0 vs. 1[1.9%], p = 0.429) or within the first 24 h postoperatively (16[22.2%] vs. 18[33.3%], p = 0.164). Additionally, NPCAG patients did not necessitate increased administration of rescue analgesics (2[2.8%] vs. 4[7.4%], p = 0.432). CONCLUSIONS The administration of opioids did not demonstrably ameliorate postoperative pain but was associated with a heightened incidence of postoperative gastrointestinal tract dysfunction. The retrospective nature of the current research should be considered and should be clarified further.
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Affiliation(s)
- Fangyu Dai
- Department of Pediatrics, Chongqing health center for women and children, Chongqing, P.R. China
- Anesthesiology Class 1, Chongqing Medical University, 2020, Chongqing, P.R. China
- Department of Pediatric General Surgery, Children's Hospital, Chongqing Medical University, Chongqing, P.R. China
| | - Rensen Zhang
- Department of Pediatrics, Chongqing health center for women and children, Chongqing, P.R. China
- Department of Pediatric General Surgery, Children's Hospital, Chongqing Medical University, Chongqing, P.R. China
- Department of Anesthesiology, Children's Hospital of Chongqing Medical University, Chongqing, P.R. China
| | - Ruyu Deng
- Department of Respiratory Medicine, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics, Children's Hospital of Chongqing Medical University, Chongqing, P.R. China
| | - Guoyong Wang
- Department of Pediatrics, Chongqing health center for women and children, Chongqing, P.R. China
- Department of Pediatric General Surgery, Children's Hospital, Chongqing Medical University, Chongqing, P.R. China
| | - Hongjie Guo
- Department of Anesthesiology, Children's Hospital of Chongqing Medical University, Chongqing, P.R. China
| | - Chunbao Guo
- Anesthesiology Class 1, Chongqing Medical University, 2020, Chongqing, P.R. China.
- Department of Pediatrics, Women and Children's Hospital of Chongqing Medical University, Chongqing, P.R. China.
- Department of Pediatric General Surgery, Women and Children's Hospital of Chongqing Medical University, 120 Longshan Road, Yubei District, 401147, Chongqing, Chongqing, P.R. China.
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Dewey MM, Kodali A, Jiao Y, Drobish JK. Outcomes in pediatric liver transplant recipients receiving bilateral continuous erector spinae plane blocks. Pediatr Transplant 2023; 27:e14558. [PMID: 37288575 DOI: 10.1111/petr.14558] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Revised: 04/06/2023] [Accepted: 05/30/2023] [Indexed: 06/09/2023]
Abstract
BACKGROUND Regional anesthesia allows for opioid-sparing and enhanced recovery after many major surgeries. Erector spinae blockade, with reduced bleeding risk and the option for continuous infusion, offers an opportunity to promote this principle in pediatric liver transplant patients. Our goal was to evaluate pain scores, opioid use, and return of bowel function following continuous ESP blockade in pediatric liver transplant recipients. METHODS This retrospective cohort study included extubated patients who received a liver transplant at St. Louis Children's Hospital from July 2016 to July 2021. The control group, which did not meet the criteria for ESP blockade and received standard analgesia regimens, was compared to the group receiving continuous ESP blockade. Measured outcomes included pain scores, opioid consumption through postoperative day two, date of first bowel movement, and length of stay in the ICU and the hospital. RESULTS Patient demographics between control and ESP groups showed no significant differences. Pain scores between control and ESP groups also showed no significant differences. Intraoperative and postoperative opioid requirements, studied in oral morphine equivalents per kilogram (OME/kg), were significantly lower for patients with ESP blockade. Time to first bowel movement was also significantly earlier for the ESP group. No significant differences were found in length of ICU or hospital stay. There were no safety concerns or complications related to ESP blockade. CONCLUSIONS Use of continuous ESP blockade resulted in reduced opioid consumption through postoperative day two and earlier return of bowel function.
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Affiliation(s)
- Megan M Dewey
- Department of Anesthesiology, Division of Pediatric Anesthesiology, St. Louis Children's Hospital, Washington University in St. Louis School of Medicine, St. Louis, Missouri, USA
| | - Ahalya Kodali
- Department of Anesthesiology, Division of Pediatric Anesthesiology, St. Louis Children's Hospital, Washington University in St. Louis School of Medicine, St. Louis, Missouri, USA
| | - York Jiao
- Department of Anesthesiology, Division of Pediatric Anesthesiology, St. Louis Children's Hospital, Washington University in St. Louis School of Medicine, St. Louis, Missouri, USA
| | - Julie K Drobish
- Department of Anesthesiology, Division of Pediatric Anesthesiology, St. Louis Children's Hospital, Washington University in St. Louis School of Medicine, St. Louis, Missouri, USA
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Lin D, Ou Y, Li L, Wu K, Zhang Q, Yan J, Kuang K, Peng D. Acupuncture for postoperative gastrointestinal dysfunction in cancer: a systematic review and meta-analysis. Front Oncol 2023; 13:1184228. [PMID: 37361600 PMCID: PMC10289226 DOI: 10.3389/fonc.2023.1184228] [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: 03/16/2023] [Accepted: 05/26/2023] [Indexed: 06/28/2023] Open
Abstract
Background Postoperative gastrointestinal dysfunction (PGD) in cancer is the commonest and most severe postoperative complication in patients with cancer. Acupuncture has been widely used for PGD in cancer. This study aimed to evaluate the efficacy and safety of acupuncture for PGD in cancer. Methods We comprehensively searched eight randomised controlled trials (RCTs) of acupuncture for PGD in cancer published until November 2022. Time to first flatus (TFF) and time to first defecation (TFD) were the primary outcomes, and time to bowel sound recovery (TBSR) and the length of hospital stay (LOS) were the secondary outcomes. The Cochrane Collaboration Risk of Bias Tool was used to assess the quality of the RCTs, and the Grading of Recommendations Assessment, Development, and Evaluations (GRADE) system was used to evaluate the certainty of the evidence. The meta-analysis was performed using RevMan 5.4, and a publication bias test was performed using Stata 15.1. Results Sixteen RCTs involving 877 participants were included in this study. The meta-analysis indicated that acupuncture could effectively reduce the TFF, TFD, and TBSR compared with routine treatment (RT), sham acupuncture, and enhanced recovery after surgery (ERAS). However, acupuncture did not shorten the LOS compared with RT and ERAS. The subgroup analysis revealed that acupuncture could significantly reduce the TFF and TFD. Acupuncture effectively reduced the TFF and TFD in all cancer types included in this review. Besides, local acupoints in combination with distal acupoints could reduce the TFF and TFD, and distal-proximal acupoints could significantly reduce the TFD. No trial reported adverse events of acupuncture. Conclusions Acupuncture is an effective and relatively safe modality for treating PGD in cancer. We anticipate that there will be more high-quality RCTs involving more acupuncture techniques and cancer types, focusing on combining acupoints for PGD in cancer, further determining the effectiveness and safety of acupuncture for PGD in patients with cancer outside China. Systematic review registration https://www.crd.york.ac.uk/prospero, identifier CRD42022371219.
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Affiliation(s)
| | | | | | | | | | | | | | - Dezhong Peng
- School of Acupuncture and Tuina, Chengdu University of Traditional Chinese Medicine, Chengdu, China
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Jiang M, Zhang X, Zhang Y, Liu Y, Geng R, Liu H, Sun Y, Wang B. The Effects of Perioperative Probiotics on Postoperative Gastrointestinal Function in Patients with Brain Tumors: A Randomized, Placebo-Controlled Study. Nutr Cancer 2023; 75:1132-1142. [PMID: 37139872 DOI: 10.1080/01635581.2023.2178929] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/24/2023]
Abstract
The incidence of postoperative gastrointestinal dysfunction among neurosurgical patients is as high as 80%. Probiotics help to maintain gastrointestinal barrier defense, provide competitive adherence to mucus and epithelial cells, and regulate gastrointestinal motility. Therefore, the purpose of this study was to investigate whether probiotics enhance gastrointestinal health after craniotomy in patients with brain tumors. This study was a 15-day, prospective, randomized, double-blind, placebo-controlled trial for patients being treated with elective craniotomy for brain tumors. Participants were randomly divided into the probiotics group (4 g probiotics, twice daily) and placebo group. The primary outcome was the time of first stool after surgery. The secondary outcomes included assessments of the gastrointestinal function, changes in gastrointestinal permeability and clinical outcomes. We enrolled a total of 200 participants (probiotics: 100; placebo: 100) and followed the principles of intention-to-treat analysis. The time of first stool and flatus were significantly shorter in the probiotics group compared to the placebo group (P < 0.001, respectively). No significant trends were observed for any other of the secondary outcome variables. Our findings suggest that probiotics can improve the gastrointestinal mobility of patients received craniotomy, and this improvement cannot be explained by changes in gastrointestinal permeability.
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Affiliation(s)
- Mengyang Jiang
- Department of Anesthesiology, Sanbo Brain Hospital, Capital Medical University, Beijing, China
| | - Xiaoyu Zhang
- Department of Anesthesiology, Sanbo Brain Hospital, Capital Medical University, Beijing, China
- Beijing Key Laboratory of Clinical Epidemiology, School of Public Health, Capital Medical University, Beijing, China
| | - Yiqiang Zhang
- Department of Anesthesiology, Sanbo Brain Hospital, Capital Medical University, Beijing, China
| | - Yang Liu
- Department of Anesthesiology, Sanbo Brain Hospital, Capital Medical University, Beijing, China
| | - Ran Geng
- Zhongke Yikang Biological Technology Company, Beijing, China
| | - Haixia Liu
- Zhongke Yikang Biological Technology Company, Beijing, China
| | - Yongxing Sun
- Department of Anesthesiology, Sanbo Brain Hospital, Capital Medical University, Beijing, China
| | - Baoguo Wang
- Department of Anesthesiology, Sanbo Brain Hospital, Capital Medical University, Beijing, China
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Schäfer ST, Andres C. [Update on fast-track concepts in operative medicine : Improved outcome and higher patient satisfaction through interdisciplinary multimodal treatment concepts]. DIE ANAESTHESIOLOGIE 2023; 72:81-88. [PMID: 36536174 DOI: 10.1007/s00101-022-01234-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 11/07/2022] [Indexed: 12/24/2022]
Abstract
BACKGROUND Enhanced recovery after surgery (ERAS) protocols have been propagated in general surgery since the mid-1990s due to medical and health economic advantages for patients as well as hospitals. A comprehensive implementation in Germany is not yet established, although the demographic change requires more than ever concepts for the safe treatment of multimorbid frail patients. The aim of this review is to present modern ERAS concepts, to discuss an extension to prehabilitation measures for frail patients and to present aspects of structural feasibility. MATERIAL AND METHOD A selective literature search in the PubMed database was performed and national as well as international guidelines up to the cut-off date of 1 July 2022 were considered. RESULTS From an anesthesiological point of view, preoperative optimization, individual anesthesia management and postoperative analgesia are prioritized. The implementation of ERAS protocols requires a high degree of interdisciplinarity and needs in addition to medical know-how, appropriate information systems and structures. Modern ERAS concepts can reduce hospital costs and improve patient outcome. CONCLUSION The implementation of ERAS protocols is beneficial for patients as well as economically and should be further promoted. In addition, the benefit of an extension of ERAS concepts, e.g. in older multimorbid patients, should be further scientifically analyzed.
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Affiliation(s)
- Simon Thomas Schäfer
- Klinik für Anaesthesiologie, LMU Klinikum, Ludwig-Maximilians-Universität München, Marchioninistr. 15, 81377, München, Deutschland.
| | - Cordula Andres
- Klinik für Anaesthesiologie, LMU Klinikum, Ludwig-Maximilians-Universität München, Marchioninistr. 15, 81377, München, Deutschland
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Zhang Z, Hu B, Li J, Yang H, Liu L, Song Y, Yang X. Incidence and Risk Factors for Postoperative Ileus after Posterior Surgery in Adolescent Idiopathic Scoliosis. Orthop Surg 2023; 15:704-712. [PMID: 36600645 PMCID: PMC9977602 DOI: 10.1111/os.13644] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Revised: 12/06/2022] [Accepted: 12/06/2022] [Indexed: 01/06/2023] Open
Abstract
OBJECTIVE Postoperative ileus (POI) is a relatively common complication after spinal fusion surgery, which can lead to delayed recovery, prolonged length of stay and increased medical costs. However, little is known about the incidence and risk factors of POI after corrective surgery for patients with adolescent idiopathic scoliosis (AIS). This study was performed to report the incidence of POI and identify the independent risk factors for POI after postoperative corrective surgery. METHODS In this retrospective cohort study, A total of 318 patients with AIS who underwent corrective surgery from April 2015 to February 2021 were enrolled and divided into two groups: those with POI and those without POI. The Student's t test, Mann-Whitney U test, and Pearson's chi-square test were used to compare the two groups regarding patient demographics and preoperative characteristics (age, sex and the major curve type), intraoperative and postoperative parameters (lowest instrumented vertebra [LIV], number of screws, and length of stay), radiographic parameters (T5-12 thoracic kyphosis [TK], T10-L2 thoracolumbar kyphosis and height [TLK and T10-L2 height], L1-S1 lumbar lordosis [LL], and L1-5 height). Then, a multivariate logistic regression analysis was used to identify independent risk factors for POI, and a receiver operating characteristic (ROC) curve was performed to assess the predictive values of these risk factors. RESULTS Forty-two (13.2%) of 318 patients who developed POI following corrective surgery were identified. The group with POI had a significantly longer length of stay, more lumbar screws, higher proportions of a major lumbar curve and lumbar anterior screw breech, and a lower LIV. Among radiographic parameters, the mean lumbar Cobb angle at baseline, the changes in the lumbar Cobb angle, and T10-L2 and L1-5 height from before to after surgery were significantly larger in the group with POI than in the group without POI. Multivariate logistic regression analysis showed that large changes in T10-L2 (odds ratio [OR] =2.846, P = 0.007) and L1-5 height (OR = 31.294, p = 0.000) and lumbar anterior screw breech (OR = 5.561, P = 0.006) were independent risk factors for POI. The cutoff values for the changes in T10-L2 and L1-5 height were 1.885 cm and 1.195 cm, respectively. CONCLUSION In this study, we identified that large changes in T10-L2 and L1-5 height and lumbar anterior screw breech were independent risk factors for POI after corrective surgery. Improving the accuracy of pedicle screw placement might reduce the incidence of POI, and greater attention should be given to patients who are likely to have large changes in T10-L2 and L1-5 height after corrective surgery.
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Affiliation(s)
- Zhuang Zhang
- Department of Orthopaedic Surgery, Orthopaedic Research Institute, West China HospitalSichuan UniversityChengduChina
| | - Bo‐wen Hu
- Department of Orthopaedic Surgery, Orthopaedic Research Institute, West China HospitalSichuan UniversityChengduChina
| | - Jing‐chi Li
- Department of Orthopaedic Surgery, Orthopaedic Research Institute, West China HospitalSichuan UniversityChengduChina
| | - Hui‐liang Yang
- Department of Orthopaedic Surgery, Orthopaedic Research Institute, West China HospitalSichuan UniversityChengduChina
| | - Li‐min Liu
- Department of Orthopaedic Surgery, Orthopaedic Research Institute, West China HospitalSichuan UniversityChengduChina
| | - Yue‐ming Song
- Department of Orthopaedic Surgery, Orthopaedic Research Institute, West China HospitalSichuan UniversityChengduChina
| | - Xi Yang
- Department of Orthopaedic Surgery, Orthopaedic Research Institute, West China HospitalSichuan UniversityChengduChina
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Zhou T, Huang S, Gu C, Wang W, Gu Q, Feng S, Sun X, Wang K, Li J, Zhou J. Effect of electroacupuncture at different time points on the recovery of gastrointestinal function after surgery for gastrointestinal malignant neoplasms. JOURNAL OF ACUPUNCTURE AND TUINA SCIENCE 2022. [DOI: 10.1007/s11726-022-1338-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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Guo M, Liu S, Gao J, Han C, Yang C, Liu C. The effects of fentanyl, oxycodone, and butorphanol on gastrointestinal function in patients undergoing laparoscopic hysterectomy: a prospective, double-blind, randomized controlled trial. BMC Anesthesiol 2022; 22:53. [PMID: 35209847 PMCID: PMC8867837 DOI: 10.1186/s12871-022-01594-9] [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: 06/23/2021] [Accepted: 02/17/2022] [Indexed: 11/10/2022] Open
Abstract
Background Perioperative opioid use is associated with postoperative bowel dysfunction, which causes longer hospital stay and higher healthcare costs. This study aimed to investigate the effect of the equivalent doses of fentanyl, oxycodone, and butorphanol on bowel function in patients undergoing laparoscopic hysterectomy. Methods In this randomized controlled trial, 135 patients undergoing laparoscopic hysterectomy received postoperative intravenous patient-controlled analgesia (IV-PCA) with fentanyl 8.3 μg/kg, butorphanol 0.16 mg/kg, and oxycodone 0.5 mg/kg (1: 20: 60), respectively. The primary outcome measure was the recovery of bowel function. We also evaluated and recorded the following nine indicators: pain score, sedation level, leukocyte count, percentage of neutrophils, plasma potassium levels, time to first ambulation, postoperative side effects, patients' satisfaction, and postoperative hospital length of stay. Results The mean time to flatus was significantly prolonged in Group B (45.2 ± 11.6 h) compared with Group F (33.1 ± 11.2 h, P < 0.001) and Group O (36.2 ± 10.9 h, P = 0.001). The incidence of somnolence and dizziness prove higher in Group B (P < 0.001). No statistical difference was observed in the mean time to tolerate oral diet, time to defecation, analgesic outcome, satisfaction score, time to first ambulation, and postoperative hospital length of stay. Conclusions Compared with fentanyl and oxycodone, butorphanol prolonged the recovery of bowel function with more severe somnolence and dizziness, suggesting that butorphanol is not well suitable for IV-PCA in patients undergoing laparoscopic hysterectomy. Trial registration ClinicalTrials.gov-NCT04295109. Date of registration: March, 2020.
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Affiliation(s)
- Minna Guo
- Faculty of Anesthesiology, Changhai Hospital, Naval Medical University, Shanghai, China
| | - Shijiang Liu
- Department of Anesthesiology and Perioperative Medicine, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Jian Gao
- School of Public Health, Shanxi Medical University, Taiyuan, China
| | - Chuanbao Han
- Department of Anesthesiology and Perioperative Medicine, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Chun Yang
- Department of Anesthesiology and Perioperative Medicine, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Cunming Liu
- Department of Anesthesiology and Perioperative Medicine, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China.
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10
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Prevention and Treatment of Gastrointestinal Morbidity. Perioper Med (Lond) 2022. [DOI: 10.1016/b978-0-323-56724-4.00025-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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Rishard M, Kossinna TKM, Latiff MN, De Silva S, Asmath MHM. Pathological post-obstructive diuresis following obstructive uropathy due to constipation in the post-partum period: a case report. BMC Pregnancy Childbirth 2021; 21:742. [PMID: 34724900 PMCID: PMC8559349 DOI: 10.1186/s12884-021-04218-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Accepted: 10/15/2021] [Indexed: 12/02/2022] Open
Abstract
Background Constipation during pregnancy is not uncommon. Usually, this does not warrant extensive evaluation and settles with minor interventions or lifestyle modifications. Severe fecal impaction in chronically constipated patients can rarely lead to obstructive uropathy. Relief of obstruction can result in a diuretic phase which may be self-limiting or pathological. However, occurrence of pathological post-obstructive diuresis as a result of severe constipation is an extremely rare complication during pregnancy and puerperium which can even be fatal if not promptly diagnosed and adequately monitored and timely intervened. We describe the management of a pathological post-obstructive diuresis which occurred in the immediate postpartum period after treatment of severe constipation and obstructive uropathy. Case presentation A woman who had undergone an emergency caesarean section due to deep transverse arrest 1 week ago, presented with fecal impaction and anuria. On relief of urinary obstruction which had developed secondary to fecal impaction, she developed pathological post-obstructive diuresis. Careful and timely monitoring with exact fluid replacement, correction of electrolyte imbalances and multidisciplinary care ensured complete recovery of the patient. Conclusions Despite obstructive uropathy being uncommon in obstetric practice, clinicians need to have a high index of suspicion to monitor and promptly manage the potentially life-threatening condition of post-obstructive diuresis in pregnant and puerperal women undergoing urinary tract decompression. Due to unreliability of laboratory cutoff values in pregnancy and puerperium, a more vigilant and multidisciplinary approach with lower threshold for intervention is more prudent in the management of these patients.
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Affiliation(s)
- Mohamed Rishard
- Department of obstetrics and gynecology, Faculty of Medicine, University of Colombo, Colombo, Sri Lanka.
| | | | | | - Susantha De Silva
- Department of Urology, National Hospital of Sri Lanka, Colombo, Sri Lanka
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Wattchow D, Heitmann P, Smolilo D, Spencer NJ, Parker D, Hibberd T, Brookes SSJ, Dinning PG, Costa M. Postoperative ileus-An ongoing conundrum. Neurogastroenterol Motil 2021; 33:e14046. [PMID: 33252179 DOI: 10.1111/nmo.14046] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2020] [Revised: 11/02/2020] [Accepted: 11/05/2020] [Indexed: 02/08/2023]
Abstract
BACKGROUND Postoperative ileus is common and is a major clinical problem. It has been widely studied in patients and in experimental models in laboratory animals. A wide variety of treatments have been tested to prevent or modify the course of this disorder. PURPOSE This review draws together information on animal studies of ileus with studies on human patients. It summarizes some of the conceptual advances made in understanding the mechanisms that underlie paralytic ileus. The treatments that have been tested in human subjects (both pharmacological and non-pharmacological) and their efficacy are summarized and graded consistent with current clinical guidelines. The review is not intended to provide a comprehensive overview of ileus, but rather a general understanding of the major clinical problems associated with it, how animal models have been useful to elucidate key mechanisms and, finally, some perspectives from both scientists and clinicians as to how we may move forward with this debilitating yet common condition.
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Affiliation(s)
- David Wattchow
- Department of Surgery, College of Medicine and Public Health, The Flinders University and Flinders Medical Centre, Bedford Park, SA, Australia
| | - Paul Heitmann
- Department of Surgery, College of Medicine and Public Health, The Flinders University and Flinders Medical Centre, Bedford Park, SA, Australia
| | - David Smolilo
- Department of Human Physiology, College of Medicine and Public Health, The Flinders University and Flinders Medical Centre, Bedford Park, SA, Australia
| | - Nick J Spencer
- Department of Human Physiology, College of Medicine and Public Health, The Flinders University and Flinders Medical Centre, Bedford Park, SA, Australia
| | - Dominic Parker
- Department of Surgery, College of Medicine and Public Health, The Flinders University and Flinders Medical Centre, Bedford Park, SA, Australia.,Department of Human Physiology, College of Medicine and Public Health, The Flinders University and Flinders Medical Centre, Bedford Park, SA, Australia
| | - Timothy Hibberd
- Department of Human Physiology, College of Medicine and Public Health, The Flinders University and Flinders Medical Centre, Bedford Park, SA, Australia
| | - Simon S J Brookes
- Department of Human Physiology, College of Medicine and Public Health, The Flinders University and Flinders Medical Centre, Bedford Park, SA, Australia
| | - Phil G Dinning
- Department of Surgery, College of Medicine and Public Health, The Flinders University and Flinders Medical Centre, Bedford Park, SA, Australia.,Department of Human Physiology, College of Medicine and Public Health, The Flinders University and Flinders Medical Centre, Bedford Park, SA, Australia
| | - Marcello Costa
- Department of Human Physiology, College of Medicine and Public Health, The Flinders University and Flinders Medical Centre, Bedford Park, SA, Australia
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Park SC, Chang SY, Mok S, Kim H, Chang BS, Lee CK. Risk factors for postoperative ileus after oblique lateral interbody fusion: a multivariate analysis. Spine J 2021; 21:438-445. [PMID: 33031922 DOI: 10.1016/j.spinee.2020.10.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Revised: 09/01/2020] [Accepted: 10/01/2020] [Indexed: 02/09/2023]
Abstract
BACKGROUND CONTEXT Oblique lateral interbody fusion (OLIF)-has become a widely used, efficient surgical tool for various degenerative lumbar conditions. Postoperative ileus (POI) is a relatively common complication after anterior lumbar interbody fusion due to the manipulation of the intestine during the surgical approach. However, to our knowledge, little is known about POI following OLIF even though it also involves bowel manipulation during a surgical procedure. PURPOSE To assess the incidence of POI and identify independent risk factors for POI development after OLIF. STUDY DESIGN/SETTING Retrospective cohort study. PATIENT SAMPLE All consecutive patients who underwent OLIF and percutaneous pedicle screw instrumentation from August 2012 until October 2019 at a single institution OUTCOME MEASURES: Patient demographics (sex, age, body weight, height, and body mass index), comorbidities (diabetes mellitus, gastroesophageal reflux disease, antithrombotic medication, previous abdominal surgery, and previous lumbar surgery), and perioperative details (preoperative diagnosis, number of levels fused, inadvertent endplate fracture during cage insertion, type of interbody graft, intraoperative estimated blood loss, duration of surgery and anesthesia, the amount of intraoperative remifentanil and propofol used as anesthetic agents, the total postoperative retroperitoneal closed-suction drainage output, and the cumulative opioid dosage administered in the first 72 hours postoperatively). METHODS POI was defined as 2 or more of the following at 72 hours postoperatively: (1) ongoing nausea or vomiting postoperatively, (2) the absence of flatus over last 24-hour period, (3) inability to tolerate an oral diet over last 24-hour period, (4) ongoing abdominal distention postoperatively, and (5) radiological confirmation. The subjects were divided into 2 groups: patients with POI and those without POI. Binary logistic regression analyses were performed on demographics, comorbidities, and perioperative factors to identify independent risk factors for POI. RESULTS Eighteen (3.9%) of 460 patients experienced POI after OLIF and percutaneous pedicle screw instrumentation. Patients with POI had a significantly longer postoperative length of hospital stay than those without POI (8.61 ± 2.66 vs 6.48 ± 2.64, p = .001). Multivariate logistic regression analysis identified inadvertent endplate fracture (adjusted odds ratio = 6.017, p = .001) and the amount of intraoperative remifentanil (adjusted odds ratio = 1.057, p = .024) as independent risk factors for the occurrence of POI following OLIF. CONCLUSION This study identified inadvertent endplate fracture and the amount of intraoperative remifentanil as independent risk factors for the development of POI after OLIF.
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Affiliation(s)
- Sung Cheol Park
- Department of Orthopedic Surgery, Seoul National University Hospital, 101 Daehangno, Jongno-gu, Seoul, Republic of Korea
| | - Sam Yeol Chang
- Department of Orthopedic Surgery, Seoul National University Hospital, 101 Daehangno, Jongno-gu, Seoul, Republic of Korea.
| | - Sujung Mok
- Department of Orthopedic Surgery, Seoul National University Hospital, 101 Daehangno, Jongno-gu, Seoul, Republic of Korea
| | - Hyoungmin Kim
- Department of Orthopedic Surgery, Seoul National University Hospital, 101 Daehangno, Jongno-gu, Seoul, Republic of Korea
| | - Bong-Soon Chang
- Department of Orthopedic Surgery, Seoul National University Hospital, 101 Daehangno, Jongno-gu, Seoul, Republic of Korea
| | - Choon-Ki Lee
- Department of Orthopedic Surgery, Seoul National University Hospital, 101 Daehangno, Jongno-gu, Seoul, Republic of Korea
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14
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Renner J, Moikow L, Lorenzen U. [Enhanced recovery after surgery (ERAS): less is more : What must be considered from an anesthesiological perspective?]. Chirurg 2021; 92:421-427. [PMID: 33570691 DOI: 10.1007/s00104-021-01360-6] [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] [Accepted: 01/14/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND Enhanced recovery after surgery (ERAS) is a multidisciplinary treatment model with the aim of guaranteeing a reduction of postoperative complications by the maintenance or early restoration of the patient-specific homoeostasis. From the anesthesiologist's perspective in all three areas of the perioperative phases there are important aspects that need to be addressed in the sense of a holistic treatment concept in order to achieve the highest possible benefit for the patient. OBJECTIVE In the perioperative period there is a bundle of anesthesiological measures, which make the ERAS concept into what it is now. At this point the focus is on the preoperative preparation and optimization of the patient and on the intraoperative and postoperative fluid management. MATERIAL AND METHODS A selective literature search was carried out in the Medline and Cochrane Library databases including consideration of national and international guidelines. RESULTS From an anesthesiological perspective there are relevant aspects in all three pillars of the perioperative phase, the adherence of which will improve the outcome of the patient: a comprehensive risk evaluation in the preoperative period and the avoidance of any sedative drugs; intraoperative individualized fluid management in the sense of a target-oriented optimization; early postoperative enteral nutrition and the avoidance of intravenous fluid administration, whenever justifiable. CONCLUSION Implementing the ERAS concept in the daily clinical routine in combination with maintaining a high compliance with the protocols is a demanding interdisciplinary challenge that urgently needs to be continued.
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Affiliation(s)
- Jochen Renner
- Klinik für Anästhesiologie und Operative Intensivmedizin, Städtisches Krankenhaus Kiel, Chemnitzstr. 33, 24116, Kiel, Deutschland.
| | - Lutz Moikow
- Klinik für Anästhesiologie, Helios Kliniken Schwerin, Schwerin, Deutschland
| | - Ulf Lorenzen
- Klinik für Anästhesiologie und Operative Intensivmedizin, UKSH, Campus Kiel, Kiel, Deutschland
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15
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Clinical indicators for the incidence of postoperative ileus after elective surgery for colorectal cancer. BMC Surg 2021; 21:80. [PMID: 33573636 PMCID: PMC7879517 DOI: 10.1186/s12893-021-01093-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2021] [Accepted: 01/31/2021] [Indexed: 01/15/2023] Open
Abstract
Background The occurrence of postoperative ileus leads to increased patient morbidity, longer hospitalization, and higher healthcare costs. No clear policy on postoperative ileus prevention exists. Therefore, we aim to evaluate the clinical factors involved in the development of postoperative ileus after elective surgery for colorectal cancer. Methods We retrospectively analyzed patients who underwent elective surgery involving bowel resection with or without re-anastomosis for colon cancer between April 2015 and March 2020. The primary readout was the presence or absence of postoperative ileus. Univariate and multivariate analyses were used to identify pre- and intraoperative risk factors, and the incidence of postoperative ileus was assessed using independent factors. Results Postoperative ileus occurred in 48 out of 356 patients (13.5%). In multivariate analysis, male sex poor performance status, and intraoperative in–out balance per body weight were independently associated with postoperative ileus development. The incidence of postoperative ileus was 2.5% in the cases with no independent factors; however, it increased to 36.1% when two factors were observed and 75.0% when three factors were matched. Conclusions We discovered that male gender, poor performance status, and intraoperative in–out balance per body weight were associated with the development of postoperative ileus. Of these, intraoperative in–out balance per body weight is a controllable factor. Hence it is important to control the intraoperative in–out balance to lower the risk for postoperative ileus.
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16
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Abstract
Postoperative nausea and vomiting (PONV), postoperative vomiting (POV), post-discharge nausea and vomiting (PDNV), and opioid-induced nausea and vomiting (OINV) continue to be causes of pediatric morbidity, delay in discharge, and unplanned hospital admission. Research on the pathophysiology, risk assessment, and therapy for PDNV, OINV and pain therapy options in children has received increased attention. Multimodal pain management with the use of perioperative regional and opioid-sparing analgesia has helped decrease nausea and vomiting. Two common emetogenic surgical procedures in children are adenotonsillectomy and strabismus repair. Although PONV risk factors differ between adults and children, the approach to decrease baseline risk is similar. As PONV and POV are frequent in children, antiemetic prophylaxis should be considered for those at risk. A multimodal approach for antiemetic and pain therapy involves preoperative risk evaluation and stratification, antiemetic prophylaxis, and pain management with opioid-sparing medications and regional anesthesia. Useful antiemetics include dexamethasone and serotonin 5-hydroxytryptamine-3 (5-HT3) receptor antagonists such as ondansetron. Multimodal combination prophylactic therapy using two or three antiemetics from different drug classes and propofol total intravenous anesthesia should be considered for children at high PONV risk. "Enhanced recovery after surgery" protocols include a multimodal approach with preoperative preparation, adequate intravenous fluid hydration, opioid-sparing analgesia, and prophylactic antiemetics. PONV guidelines and management algorithms help provide effective postoperative care for pediatric patients.
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Affiliation(s)
- Anthony L Kovac
- Department of Anesthesiology, University of Kansas Medical Center, 3901 Rainbow Boulevard, Mail Stop 1034, Kansas City, KS, 66160, USA.
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17
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Pan W, Cai S, Latour JM, Zhong M, Lv M, Li J, Zhang X, Zhang Y. External use of Mirabilite combined with Lactulose improves postoperative gastrointestinal mobility among older patients undergoing abdominal surgery. J Adv Nurs 2020; 77:755-762. [PMID: 33230937 DOI: 10.1111/jan.14640] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2020] [Revised: 08/21/2020] [Accepted: 10/21/2020] [Indexed: 12/15/2022]
Abstract
AIMS To evaluate the feasibility and efficacy of Mirabilite combined with Lactulose in older patients after abdominal surgery. DESIGN It is a retrospective observational cohort study with a pre and post intervention group. METHODS Medical records were retrospectively reviewed of postoperative Intensive Care patients with postoperative gastrointestinal tract dysfunction (aged >60 years) in the Surgical Intensive Care Unit from January 2017-December 2018. RESULTS One hundred and sixty-seven post-surgical Intensive Care patients with postoperative gastrointestinal tract dysfunction were analysed; 74 patients received Mirabilite + Lactulose treatment and 93 patients received Lactulose treatment. The recovery rate of bowel sounds was better in the Mirabilite + Lactulose group (62.16%) compared with the Lactulose group (37.63%) after 3-day treatment (p = 0.002) and the relative risk (RR) was 1.65 (95% CI, 1.20, 2.27). Moreover 70.27% patients in the Mirabilite + Lactulose group finally had flatus or defecation compared with 46.24% patients in Lactulose group (p = 0.003) and the RR was 1.52 (1.17, 1.98). The abdominal girth and Inter Abdominal Pressure in Mirabilite + Lactulose group showed significantly greater decrease over a 3-day period compared with Lactulose group (4.86 vs. 3.46 cm, p = 0.027; 4.80 vs. 3.11 mmHg, p = 0.002 respectively). The pain score had greater decrease from the baseline in Mirabilite + Lactulose group than in Lactulose group (2.40 vs. 1.11; p < 0.01). Patients in the Mirabilite + Lactulose group had shorter hospital stay than the Lactulose group 12.5 (SD 3.51) versus 13.9 (SD 5.14), p = 0.05. CONCLUSIONS This study demonstrated that external use of Mirabilite combined with Lactulose can be considered as an easy intervention to improve postoperative gastrointestinal mobility in older intensive care patients who suffer from postoperative gastrointestinal tract dysfunction after surgery. IMPACT Our results provide a great option to alleviate the sufferings of postoperative patients. The externally use Mirabilite is a painless and safe interventions that is easy to implement by ICU nurses.
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Affiliation(s)
- Wenyan Pan
- Department of Nursing, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Shining Cai
- Department of Nursing, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Jos M Latour
- Faculty of Health, School of Nursing and Midwifery, University of Plymouth, Plymouth, UK
| | - Ming Zhong
- Department of Critical Care Medicine, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Minzhi Lv
- Department of Biostatistics, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Jingjing Li
- Department of Nursing, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Xiaomin Zhang
- Faculty of Nursing, Fudan University, Shanghai, China
| | - Yuxia Zhang
- Department of Nursing, Zhongshan Hospital, Fudan University, Shanghai, China.,Faculty of Nursing, Fudan University, Shanghai, China
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18
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Consideration of Migraines Among Risk Factors for Postoperative Nausea and Vomiting. J Clin Med 2020; 9:jcm9103154. [PMID: 33003496 PMCID: PMC7600372 DOI: 10.3390/jcm9103154] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Revised: 09/22/2020] [Accepted: 09/28/2020] [Indexed: 02/06/2023] Open
Abstract
The impact of migraine on postoperative nausea and vomiting (PONV) is controversial, and few studies have focused on their relationship. Thus, we investigated the impact of migraine, among other risk factors, on PONV in a large retrospective study. We analyzed 10 years of clinical data from the Smart Clinical Data Warehouse of Hallym University Medical Center. PONV was defined as nausea or vomiting within the first 24 h after surgery. Patients diagnosed by a neurologist and with a history of triptan use before surgery were enrolled into the migraine group. We enrolled 208,029 patients aged > 18 years who underwent general anesthesia (GA), among whom 19,786 developed PONV within 24 h after GA and 1982 had migraine. Before propensity score matching, the unadjusted and fully adjusted odds ratios (ORs) for PONV in subjects with versus without migraine were 1.52 (95% confidence interval (CI), 1.34–1.72; p < 0.001) and 1.37 (95% CI, 1.21–1.56; p < 0.001), respectively. The OR for PONV in patients with migraine was also high (OR, 1.37; 95% CI, 1.13–1.66; p = 0.001) after matching. Our findings suggest that migraine is a significant risk factor for PONV.
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19
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Greer D, Karunaratne YG, Karpelowsky J, Adams S. Early enteral feeding after pediatric abdominal surgery: A systematic review of the literature. J Pediatr Surg 2020; 55:1180-1187. [PMID: 31676081 DOI: 10.1016/j.jpedsurg.2019.08.055] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2019] [Revised: 08/07/2019] [Accepted: 08/25/2019] [Indexed: 02/03/2023]
Abstract
INTRODUCTION Traditionally enteral nutrition has been delayed following abdominal surgery in children, to prevent complications. However, recent evidence in the adult literature refutes the supposed benefits of fasting and suggests decreased complications with early enteral nutrition (EEN). This review aimed to compile the evidence for EEN in children in this setting. METHODS Databases Pubmed, EmBase, Medline and reference lists were searched for articles containing relevant search terms according to PRISMA guidelines. First and second authors reviewed abstracts. Studies containing patients less than 18 years undergoing abdominal surgery, with feeding initiated earlier than standard practice, were included. Studies including pyloromyotomy were excluded. Primary outcome was length of stay (LOS). Secondary outcomes included time to full enteral nutrition, time to stool and postoperative complications. RESULTS Fourteen articles met inclusion criteria - five on neonatal abdominal surgery, three on gastrostomy formation and six on intestinal anastomoses. There were three randomized control trials (RCTs), five cohort studies, four historical control trials, one nonrandomized trial and one case series. Nine studies showed a decreased LOS with EEN. Most studies which reported time to full enteral nutrition showed improvement with EEN; however, time to stool was similar in most studies. Postoperative complications were either decreased or not statistically different in EEN groups in all studies. CONCLUSION Studies to date in a limited number of procedures suggest EEN appears safe and effective in children undergoing abdominal surgery. Although robust evidence is lacking, there are clear benefits in LOS and time to full feeds, and no increase in complications. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Douglas Greer
- Department of Pediatric Surgery, Sydney Children's Hospital, Randwick, NSW, Australia.
| | - Yasiru G Karunaratne
- Department of Pediatric Surgery, Sydney Children's Hospital, Randwick, NSW, Australia
| | - Jonathan Karpelowsky
- Discipline of Child & Adolescent Health, Sydney Medical School, University of Sydney, NSW, Australia; Department of Pediatric Surgery, Children's Hospital at Westmead, Sydney, NSW, Australia
| | - Susan Adams
- Department of Pediatric Surgery, Sydney Children's Hospital, Randwick, NSW, Australia; University of New South Wales, Randwick, NSW, Australia
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Kwon YS, Choi JW, Lee HS, Kim JH, Kim Y, Lee JJ. Effect of a Preoperative Proton Pump Inhibitor and Gastroesophageal Reflux Disease on Postoperative Nausea and Vomiting. J Clin Med 2020; 9:E825. [PMID: 32197451 PMCID: PMC7141242 DOI: 10.3390/jcm9030825] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Revised: 03/13/2020] [Accepted: 03/14/2020] [Indexed: 01/09/2023] Open
Abstract
Postoperative nausea and vomiting (PONV) are common complications after anesthesia, but no study has considered the effects of a proton pump inhibitor (PPI) and gastroesophageal reflux disease (GERD) on PONV at the same time. Thus, we investigated the effects of a PPI and GERD on PONV. Patients aged ≥18 years who underwent general anesthesia between 2010 and 2019 were enrolled. In total, 202,439 patients were included and 21,361 In a multivariate analysis, the OR for PONV was higher in subjects with GERD (OR, 1.157; 95% CI, 1.032-1.298; p = 0.012). The OR was lower for subjects with taking a PPI (OR, 0.890; 95% CI, 0.832-0.953; p < 0.0001). In patients without GERD, the incidence of PONV was lower when lansoprazole (OR, 0.801; 95% CI, 0.718-0.894; p < 0.0001), pantoprazole (OR, 0.856; 95% CI, 0.748-0.980; p = 0.025) and ilaprazole (OR, 0.391; 95% CI, 0.158-0.966; p = 0.042) were taken. However, in GERD patients, all PPIs did not show reducing the incidence of PONV. Taken together, the results show that a lansoprazole, pantoprazole, and ilaprazole reduced PONV in patients without GERD, and PPI could not reduce PONV in patients with GERD.
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Affiliation(s)
- Young Suk Kwon
- Department of Anesthesiology and Pain Medicine, Chuncheon Sacred Heart Hospital, College of Medicine, Hallym University, Chuncheon 24253, Korea; (Y.S.K.); (H.S.L.); (J.H.K.)
- Institute of New Frontier Research Team, Hallym University, Chuncheon 24253, Korea;
| | - Jun Woo Choi
- Department of Anesthesiology and Pain Medicine, Chuncheon Sacred Heart Hospital, College of Medicine, Hallym University, Chuncheon 24253, Korea; (Y.S.K.); (H.S.L.); (J.H.K.)
| | - Ho Seok Lee
- Department of Anesthesiology and Pain Medicine, Chuncheon Sacred Heart Hospital, College of Medicine, Hallym University, Chuncheon 24253, Korea; (Y.S.K.); (H.S.L.); (J.H.K.)
- Institute of New Frontier Research Team, Hallym University, Chuncheon 24253, Korea;
| | - Jong Ho Kim
- Department of Anesthesiology and Pain Medicine, Chuncheon Sacred Heart Hospital, College of Medicine, Hallym University, Chuncheon 24253, Korea; (Y.S.K.); (H.S.L.); (J.H.K.)
- Institute of New Frontier Research Team, Hallym University, Chuncheon 24253, Korea;
| | - Youngmi Kim
- Institute of New Frontier Research Team, Hallym University, Chuncheon 24253, Korea;
| | - Jae Jun Lee
- Department of Anesthesiology and Pain Medicine, Chuncheon Sacred Heart Hospital, College of Medicine, Hallym University, Chuncheon 24253, Korea; (Y.S.K.); (H.S.L.); (J.H.K.)
- Institute of New Frontier Research Team, Hallym University, Chuncheon 24253, Korea;
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21
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Gannam‐Somri L, Matter I, Hadjittofi C, Vaida S, Khalaily H, Hossein J, Somri M. Combined epidural-general anaesthesia vs general anaesthesia in neonatal gastrointestinal surgery: A randomized controlled trial. Acta Anaesthesiol Scand 2020; 64:34-40. [PMID: 31506919 DOI: 10.1111/aas.13469] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2019] [Revised: 08/26/2019] [Accepted: 09/01/2019] [Indexed: 10/26/2022]
Abstract
BACKGROUND Post-operative ileus is a frequent complication of gastrointestinal surgery under general anaesthesia. The aim of this study was to investigate whether combined epidural-general anaesthesia is associated with expedited gastrointestinal function recovery in neonates undergoing elective gastrointestinal surgery. METHODS A randomized controlled trial including 60 neonates who underwent gastrointestinal surgery at a university hospital was performed. Thirty neonates received combined epidural-general anaesthesia (CEGA), and 30 neonates received general anaesthesia (GA) alone. The primary outcome was the post-operative time to tolerance of full enteral nutrition. The secondary outcomes were the post-operative time defaecation, the duration of nasogastric drainage, and infections. RESULTS After excluding two neonates from the CEGA group, where repeated attempts at epidural catheterization were unsuccessful, a total of 58 patients completed the study (CEGA: 28; GA: 30). Full enteral nutrition was tolerated earlier in CEGA vs the GA group (4.0 vs 8.0 days; P = .0001). Time to defaecation was shorter in the CEGA group (3.5 vs 5.0 days; P = .0001). Duration of nasogastric drainage was similar between groups (7.0 vs 7.0 days; P = .9502). Fewer patients in the CEGA group experienced post-operative infection (35.7% vs 60.0%; P = .038). CONCLUSION Combined epidural-general anaesthesia is associated with expedited gastrointestinal function recovery and a lower infection risk after gastrointestinal surgery in neonates.
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Affiliation(s)
- Lina Gannam‐Somri
- The Ruth and Bruce Rappaport Faculty of Medicine Technion—Israel Institute of Technology Haifa Israel
| | - Ibrahim Matter
- The Ruth and Bruce Rappaport Faculty of Medicine Technion—Israel Institute of Technology Haifa Israel
- Department of Surgery Bnei Zion Medical Center Haifa Israel
| | | | - Sonia Vaida
- Obstetric Anesthesia Department of Anesthesiology Penn State College of Medicine Penn State Milton S. Hershey Medical Center Hershey USA
| | - Husein Khalaily
- Department of Anaesthesia Bnei Zion Medical Center Haifa Israel
| | - Jalaa Hossein
- Department of Anaesthesia Bnei Zion Medical Center Haifa Israel
| | - Mostafa Somri
- The Ruth and Bruce Rappaport Faculty of Medicine Technion—Israel Institute of Technology Haifa Israel
- Department of Anaesthesia Bnei Zion Medical Center Haifa Israel
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22
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Mc Loughlin S, Terrasa S, Ljungqvist O, Sanchez G, Garcia Fornari G, Alvarez A. Nausea and vomiting in a colorectal ERAS program: Impact on nutritional recovery and the length of hospital stay. Clin Nutr ESPEN 2019; 34:73-80. [DOI: 10.1016/j.clnesp.2019.08.010] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2019] [Revised: 07/22/2019] [Accepted: 08/26/2019] [Indexed: 02/06/2023]
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Hill TL. Gastrointestinal Tract Dysfunction With Critical Illness: Clinical Assessment and Management. Top Companion Anim Med 2019; 35:47-52. [PMID: 31122688 DOI: 10.1053/j.tcam.2019.04.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2018] [Revised: 04/08/2019] [Accepted: 04/09/2019] [Indexed: 12/29/2022]
Abstract
The gut is the site of digestion and absorption as well as serving as an endocrine and immune organ. All of these functions may be affected by critical illness. This review will discuss secondary effects of critical illness on the gut in terms of gastrointestinal function that is clinically observable and discuss consequences of gut dysfunction with critical illness to patient outcome. Because there is little evidence-based medicine in the veterinary field, much of our understanding of gut dysfunction with critical illness comes from animal models or from the human medical field. We can extrapolate some of these conclusions and recommendations to companion animals, particularly in dogs, who have similar gastrointestinal physiology to people. Additionally, the evidence regarding gut dysfunction in veterinary patients will be explored. By recognizing signs of dysfunction early and taking preventative measures, we may be able to increase success with treatment of critical illnesses.
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Affiliation(s)
- Tracy L Hill
- Department of Small Animal Medicine and Surgery, College of Veterinary Medicine, The University of Georgia, Athens, GA, USA.
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24
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Radkey DI, Writt VE, Snyder LBC, Jones BG, Johnson RA. Gastrointestinal effects following acupuncture at Pericardium-6 and Stomach-36 in healthy dogs: a pilot study. J Small Anim Pract 2018; 60:38-43. [PMID: 30281151 DOI: 10.1111/jsap.12935] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2018] [Revised: 08/27/2018] [Accepted: 08/30/2018] [Indexed: 12/28/2022]
Abstract
OBJECTIVES To quantify changes in gastric and intestinal emptying times in the conscious dog following gastrointestinal acupoint stimulation. MATERIALS AND METHODS In a randomised, blinded crossover study, six dogs were fed 30×1.5 mm barium-impregnated polyethylene spheres and underwent: (1) no acupuncture (Control); (2) stimulation of target points PC6 and ST36 (Target) and (3) stimulation of non-target points LU7 and BL55 (Sham). Abdominal radiographs were assessed immediately after feeding the spheres and every hour for 12 hours and their number in the stomach and large intestines was counted. RESULTS The number of barium-impregnated polyethylene spheres found distal to the stomach was less in the Target group compared to the Control and Sham groups between hours 2 and 4, but no differences between groups were seen for the remainder of the treatment period. The number of spheres found within the colon/rectum was less in the Target group compared to the Control and Sham groups between hours 4 and 6, and compared to the Sham group only at hour 7 but no differences between groups were seen after hour 8. CLINICAL SIGNIFICANCE Acupuncture targeted at the gastrointestinal tract of dogs was associated briefly with slowed gastric emptying and gastrointestinal transit time. This foundational study lays the groundwork for additional studies of acupuncture effects associated with altered physiologic states.
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Affiliation(s)
- D I Radkey
- Department of Surgical Sciences, School of Veterinary Medicine, University of Wisconsin, Madison, Wisconsin, 53706, USA
| | - V E Writt
- Department of Surgical Sciences, School of Veterinary Medicine, University of Wisconsin, Madison, Wisconsin, 53706, USA
| | - L B C Snyder
- Department of Surgical Sciences, School of Veterinary Medicine, University of Wisconsin, Madison, Wisconsin, 53706, USA
| | - B G Jones
- Anetech Imaging Services, Fountain Valley, California, 92708, USA
| | - R A Johnson
- Department of Surgical Sciences, School of Veterinary Medicine, University of Wisconsin, Madison, Wisconsin, 53706, USA
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Shi J, Li S, Wang Y, Zheng L. Retrospective study on recovery of 521 gastrointestinal tumor patients after laparoscopic surgery. Oncol Lett 2018; 16:3531-3536. [PMID: 30127958 PMCID: PMC6096134 DOI: 10.3892/ol.2018.9064] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2017] [Accepted: 06/20/2018] [Indexed: 11/17/2022] Open
Abstract
Influencing factors for recovery of patients with gastrointestinal tumor after laparoscopic surgery were explored to promote recovery of patients. Clinical data from 521 gastrointestinal tumor patients who underwent laparoscopic surgery in Dalian Central Hospital were collected. The recovery of gastrointestinal function was recorded, and the factors that affected the recovery of gastrointestinal function were analyzed. All data were processed using Statistical Product and Service Solutions (SPSS) 21.0 software. t-test and F-test were used for univariate analysis, and multivariate linear regression was adopted for multivariate analysis. Results of univariate analysis displayed that age, starting time of postoperative activity, peritoneal drainage tube indwelling time, blood potassium level, sleep disorder, fasting and fluid deprivation time, duration of the first postoperative defecation/exhaustion, abdominal distention and pain reaction and social support level had significant influences on recovery of patients after operation (P<0.05). Results of multivariate analysis indicated that peritoneal drainage tube indwelling time, blood potassium level, fasting and fluid deprivation time and starting time of postoperative activity were independent factors affecting the recovery of patients after operation (P<0.05). Some methods are conducive to the recovery of gastrointestinal function in patients with gastrointestinal tumor, including the removal of peritoneal drainage tube, timely potassium supplementation, and diet recovery after laparoscopic surgery as soon as possible.
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Affiliation(s)
- Jiakun Shi
- Department of Gastrointestinal Surgery, Dalian Central Hospital, Dalian, Liaoning 116033, P.R. China
| | - Shengjie Li
- Department of Gastrointestinal Surgery, Dalian Central Hospital, Dalian, Liaoning 116033, P.R. China
| | - Yujie Wang
- Department of Gastrointestinal Surgery, Dalian Central Hospital, Dalian, Liaoning 116033, P.R. China
| | - Lei Zheng
- Department of Gastrointestinal Surgery, Dalian Central Hospital, Dalian, Liaoning 116033, P.R. China
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Khadem E, Shirazi M, Janani L, Rahimi R, Amiri P, Ghorat F. Effect of Topical Chamomile Oil on Postoperative Bowel Activity after Cesarean Section: A Randomized Controlled Trial. J Res Pharm Pract 2018; 7:128-135. [PMID: 30211237 PMCID: PMC6121760 DOI: 10.4103/jrpp.jrpp_17_103] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE Postoperative ileus (POI) is a common complication after surgery that requires a multifactorial therapeutic approach. This study aims to assess the effect of topical chamomile oil on postoperative bowel activity after cesarian section. METHODS This randomized controlled trial was carried out in 2015 at Chamran Hospital in Iran. A block randomization list was generated for 142 parturient divided into three groups. In the intervention group (arm A) (n = 47), chamomile oil was applied topically on abdominal region after the stability of the patient. Placebo group (arm B) (n = 47) received placebo oil and control group (arm C) (n = 48) had no intervention. A recovery program was used after surgery for all participants. The primary outcome was time to first flatus. Secondary outcomes were time to bowel sounds, defecation, return of appetite, hospital stay, and rate of nausea and vomiting, abdominal pain. FINDINGS Times to first flatus were significantly shorter in Group A (arm A vs. B, P < 0.001 and arm A vs. C, P < 0.001). In addition, time to first bowel sounds (arm A vs. B, P < 0.001 and arm A vs. C, P < 0.001) and return of appetite (arm A vs. B, P < 0.001 and arm A vs. C, P < 0.001) were significantly shorter in arm A. The times from surgery to first defecation were shorter in Group A versus B and C. However, there were no statistically significant differences between three groups. CONCLUSION These results suggest that topical chamomile oil has a potential therapeutic effect on gastrointestinal motility and can reduce the duration of POI.
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Affiliation(s)
- Ebrahim Khadem
- Department of Persian Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Mahboobeh Shirazi
- Maternal, Fetal and Neonatal Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Leila Janani
- Preventive Medicine and Public Health Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Roja Rahimi
- Department of Traditional Pharmacy, Tehran University of Medical Sciences, Tehran, Iran
| | - Parastoo Amiri
- Department of Community Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Fereshteh Ghorat
- Traditional and Complementary Medicine Research Center, Sabzevar University of Medical Sciences, Sabzevar, Iran
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Abubaker AK, Al-Qudah MA. The Role of Endoscopic Sphenopalatine Ganglion Block on Nausea and Vomiting After Sinus Surgery. Am J Rhinol Allergy 2018; 32:369-373. [PMID: 29947243 DOI: 10.1177/1945892418782235] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background Postoperative nausea and vomiting (PONV) are among the most common unpleasant and distressing adverse events following surgery under general anesthesia. Functional endoscopic sinus surgery (FESS) is a common otolaryngology procedure. Prevention of PONV and early recovery are cost-effective. Objective The aim of this study was to evaluate the prophylactic effect of bilateral endoscopic injection of lidocaine with epinephrine in the sphenopalatine ganglion (SPG) on PONV in patients undergoing FESS. Methods One hundred patients with chronic rhinosinusitis undergoing general anesthesia for FESS were enrolled in this double-blind, placebo-controlled study. Patients were randomized to receive injection of 2 mL of 2% lidocaine with epinephrine or 2 mL of saline at the end of surgery. Postoperatively, patients were observed for 24 h. PONV was evaluated immediately, 6 h, and 24 h after surgery. Results The 2 groups were comparable in characteristic and intraoperative features. In general, the incidence of PONV after FESS was 36%. The average time that patients can tolerate oral feeding was 3.4 h after surgery. Endoscopic SPG injection with lidocaine significantly reduced the incidence of vomiting and PONV. In addition, SPG injection with lidocaine reduced the incidence of severe vomiting and decreased the number of vomiting episodes. No complications were encountered in either group. Conclusion SPG injection with lidocaine at the end of surgery is a safe, noninvasive, and an effective technique in reducing early PONV in endoscopic sinus surgery patients.
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Affiliation(s)
- Ahmad K Abubaker
- 1 Department of Anesthesia and Recovery, Jordan University of Science and Technology, Irbid, Jordan
| | - Mohannad A Al-Qudah
- 2 Department of Special Surgery, Division of ORL-HNS, Jordan University of Science and Technology, Irbid, Jordan
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Hedrick TL, McEvoy MD, Mythen M(MG, Bergamaschi R, Gupta R, Holubar SD, Senagore AJ, Gan TJ, Shaw AD, Thacker JKM, Miller TE, Wischmeyer PE, Carli F, Evans DC, Guilbert S, Kozar R, Pryor A, Thiele RH, Everett S, Grocott M, Abola RE, Bennett-Guerrero E, Kent ML, Feldman LS, Fiore JF. American Society for Enhanced Recovery and Perioperative Quality Initiative Joint Consensus Statement on Postoperative Gastrointestinal Dysfunction Within an Enhanced Recovery Pathway for Elective Colorectal Surgery. Anesth Analg 2018; 126:1896-1907. [DOI: 10.1213/ane.0000000000002742] [Citation(s) in RCA: 54] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
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Ghodraty MR, Rokhtabnak F, Dehghan HR, Pournajafian A, Baghaee Vaji M, Koleini ZS, Porhomayon J, Nader ND. Crystalloid versus colloid fluids for reduction of postoperative ileus after abdominal operation under combined general and epidural anesthesia. Surgery 2017; 162:1055-1062. [DOI: 10.1016/j.surg.2017.06.014] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2017] [Revised: 06/01/2017] [Accepted: 06/19/2017] [Indexed: 12/29/2022]
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Kingma BF, Steenhagen E, Ruurda JP, van Hillegersberg R. Nutritional aspects of enhanced recovery after esophagectomy with gastric conduit reconstruction. J Surg Oncol 2017; 116:623-629. [PMID: 28968919 DOI: 10.1002/jso.24827] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2017] [Accepted: 08/09/2017] [Indexed: 12/18/2022]
Abstract
Enhanced Recovery After Surgery (ERAS) aims to accelerate recovery by a set of multimodality management strategies. For esophagectomy, several nutritional elements of ERAS can be safely introduced and are advised in routine practice, including preadmission counseling to screen and treat for potential malnutrition, shortened preoperative fasting, and carbohydrate loading. However, the timing of oral intake and the use of routine nasogastric decompression remain matter of debate after esophagectomy. Furthermore, more research is needed on future developments such as perioperative immunonutrition.
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Affiliation(s)
- B Feike Kingma
- Department of Surgery, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Elles Steenhagen
- Department of Dietetics, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Jelle P Ruurda
- Department of Surgery, University Medical Center Utrecht, Utrecht, The Netherlands
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Abstract
Postoperative pain control is a highly studied topic because of its significant effect on costs, hospital course, and, most importantly, patient satisfaction. Opioid use has been the "status quo" of postoperative pain management but prolongs hospital stays and increases complications. Optimizing acute pain management in patients with orthopedic trauma is important and can translate into significant positive physiologic and financial outcomes. Although multiple viable examples of optimizing acute pain management in the literature demonstrate outcome improvements, implementation has not been widespread. Significant outcome success will depend more on systemwide implementation than a specific regimen for postoperative pain control.
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Abstract
Objectives: To determine whether perioperative fluid restrictive administration can reduce specific postoperative complications in adults undergoing major abdominal surgery. Methods: We searched the MEDLINE, EMBASE, and Cochrane Central Register of Controlled Trials, Google scholar, and article reference lists (up to December 2015) for studies that assessed fluid therapy and morbidity or mortality in patients undergoing major abdominal surgeries. The quality of the trials was assessed using the Jadad scoring system, and a meta-analysis of the included randomized, controlled trials was conducted using Review Manager software, version 5.2. Results: Ten studies with a total of 1160 patients undergoing major abdominal surgeries were included. We found that perioperative restrictive fluid therapy could reduce the risk of postoperative infectious complications (odds ratio [OR]=0.54, 95% confidence interval [CI]:0.39-0.74, p=0.0001, I2=37%), pulmonary complications (OR=0.49, 95% CI: 0.26-0.93, p=0.03, I2=50%), and cardiac complications (OR=0.45, 95% CI: 0.29-0.69, p=0.0003, I2=48%), but had no effect on the risk of gastrointestinal complications (OR=0.87, 95% CI: 0.51-1.46, p=0.59, I2=0%), renal complications (OR=0.76, 95% CI: 0.43-1.34, p=0.35, I2=0%), and postoperative mortality (OR=0.62, 95% CI: 0.25-1.50, p=0.29, I2=0%). Conclusion: Perioperative restrictive fluid administration was superior to liberal fluid administration in reducing the infectious, pulmonary and cardiac complications after major abdominal surgeries.
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Affiliation(s)
- Qianyun Pang
- Department of Anesthesia, Chongqing Cancer Institute/ Hospital/Cancer Center, Chongqing, China. E-mail.
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33
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Torrente C, Vigueras I, Manzanilla EG, Villaverde C, Fresno L, Carvajal B, Fiñana M, Costa-Farré C. Prevalence of and risk factors for intraoperative gastroesophageal reflux and postanesthetic vomiting and diarrhea in dogs undergoing general anesthesia. J Vet Emerg Crit Care (San Antonio) 2017; 27:397-408. [PMID: 28544250 DOI: 10.1111/vec.12613] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2015] [Revised: 08/25/2015] [Accepted: 09/12/2015] [Indexed: 01/04/2023]
Abstract
OBJECTIVE To determine the prevalence of intraoperative gastroesophageal reflux (GER) and postanesthetic vomiting and diarrhea, and to evaluate risk factors associated with these gastrointestinal disorders (GID) in dogs undergoing general anesthesia. DESIGN Prospective observational study. SETTING University teaching hospital. ANIMALS Two hundred thirty-seven client-owned dogs undergoing general inhalant anesthesia for diagnostic or surgical purposes. INTERVENTIONS None MEASUREMENTS AND MAIN RESULTS: Patient, surgical, and anesthetic variables, and postanesthetic treatments administered in the immediate postanesthesia period were evaluated in relation to GID using univariate and multivariate logistic regression analysis (P < 0.05). Seventy-nine of the 237 (33.4%) dogs developed GID during the perianesthetic period. The prevalences of GER, vomiting, and diarrhea were 17.3%, 5.5%, and 10.5%, respectively. Intraabdominal surgery (P = 0.016; odds ratio [OR] 2.82, 95% confidence interval [CI]: 1.21-6.62), changes in body position (P = 0.003; OR 3.17, 95% CI: 1.47-6.85), and length of anesthesia (P = 0.052; OR 1.006, 95% CI: 1.000-1.013) were associated with GER. Changes in the ventilation mode during surgery (P = 0.011; OR 6.54, 95% CI: 1.8-23.8), length of anesthesia (P = 0.024; OR 1.001, 95% CI: 1.001-1.020), and rescue synthetic colloid support due to hypotension (P = 0.005; OR 6.9, 95% CI: 1.82-26.3) were positively associated with postanesthetic vomiting. On the contrary, dogs that received acepromazine as premedication were significantly less likely (P < 0.019; OR 12.3, 95% CI: 1.52-100) to vomit. Finally, length of anesthesia, changes in body position, changes in ventilation mode, or hypoxemia during the procedure tended to increase the risk (univariate model) of diarrhea during the recovery phase. CONCLUSIONS GID are common in dogs undergoing general anesthesia. Duration and characteristics of the procedure, anesthetic management, and changes in certain patient variables are significant risk factors for the presence of GID in the perioperative period.
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Affiliation(s)
- Carlos Torrente
- Servei d'Emergències i Cures Intensives, Fundació Hospital Clínic Veterinari and Departament de Medicina i Cirurgia Animals
| | - Isabel Vigueras
- Servei d'Emergències i Cures Intensives, Fundació Hospital Clínic Veterinari and Departament de Medicina i Cirurgia Animals
| | - Edgar G Manzanilla
- Facultat de Veterinària, Universitat Autònoma de Barcelona Barcelona 08193, Spain; and, the Teagasc Research Centre, Oak Park, Carlow, Ireland
| | | | - Laura Fresno
- Servei d'Anestèsia i Cirurgia, Fundació Hospital Clínic Veterinari and Departament de Medicina i Cirurgia Animals
| | | | | | - Cristina Costa-Farré
- Servei d'Anestèsia i Cirurgia, Fundació Hospital Clínic Veterinari and Departament de Medicina i Cirurgia Animals
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Uña Orejón R, Del Huercio Martinez I, Casinello Ogea C, Del Prado Ureta Tolsada M, Uña Orejon S. Intraoperatorive hydroxyethyl starch: A safe therapy or a poison? REVISTA ESPANOLA DE ANESTESIOLOGIA Y REANIMACION 2016; 63:588-593. [PMID: 27129792 DOI: 10.1016/j.redar.2016.03.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/29/2015] [Revised: 02/22/2016] [Accepted: 03/02/2016] [Indexed: 06/05/2023]
Affiliation(s)
- R Uña Orejón
- Jefe de Sección Bloque Quirúrgico, Servicio de Anestesiología, Hospital "La Paz", Madrid, Spain.
| | | | - C Casinello Ogea
- FEA Servicio de Anestesiología, Hospital "Miguel Servet", Zaragoza, Spain
| | | | - S Uña Orejon
- FEA Servicio de Anestesiología, Hospital General de Albacete, Spain
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Olsen U, Brox JI, Bjørk IT. Preoperative bowel preparation versus no preparation before spinal surgery: A randomised clinical trial. Int J Orthop Trauma Nurs 2016; 23:3-13. [DOI: 10.1016/j.ijotn.2016.02.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2015] [Revised: 10/23/2015] [Accepted: 02/04/2016] [Indexed: 01/24/2023]
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Ahn JH, Ahn HJ. Effect of thoracic epidural analgesia on recovery of bowel function after major upper abdominal surgery. J Clin Anesth 2016; 34:247-52. [PMID: 27687384 DOI: 10.1016/j.jclinane.2016.04.042] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2015] [Revised: 04/20/2016] [Accepted: 04/24/2016] [Indexed: 12/20/2022]
Abstract
STUDY OBJECTIVE We investigated whether thoracic epidural analgesia (TEA) shortens the first gas-out time compared to intravenous patient-controlled analgesia (iv-PCA) and promotes earlier discharge after major upper abdominal surgery. DESIGN Prospective observational study. SETTING A tertiary care university hospital. PATIENTS Fifty-six patients undergoing major upper abdominal surgery. INTERVENTIONS TEA (n=28) was performed using a paramedian approach at T6-7 or T7-8. Hydromorphone (8 μg/mL) was added to 0.15% ropivacaine (bolus/lockout time/basal: 3 mL/15 minutes/5 mL). The iv-PCA regimen (n=28) included 20 μg/mL fentanyl (bolus/lockout time/basal: 0.5 mL/15 minutes/0.5 mL). The 2 analgesic methods were maintained for 3 days. MEASUREMENT The primary end point was first gas-out time, and the secondary end points were hospital discharge, pain scores, and first voiding time. MAIN RESULTS No differences in first gas-out time (TEA, 4.1±1.2 days; iv-PCA, 3.4±1.9 days; P=.15) or hospital stay (TEA, 9.8±2.2 days; iv-PCA, 11.4±5.2 days; P=.19) were observed between the 2 groups. A visual analog pain scale scores during rest and coughing were lower in the TEA than those for iv-PCA even with 40% to 46% less rescue analgesic. However, TEA delayed first voiding time (3.6±0.9 vs 2.8±1.6 days; P=.02) and required more frequent bladder catheterization (46% vs 11%; P=.008) than those of iv-PCA. CONCLUSION TEA with a regimen of hydromorphone (8 μg/mL) added to 0.15% ropivacaine did not provide earlier gas-out compared to that of iv-PCA in patients who underwent major upper abdominal surgery.
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Affiliation(s)
- Jin Hee Ahn
- Department of Anesthesiology and Pain Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Hyun Joo Ahn
- Department of Anesthesiology and Pain Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
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Evaluation of the efficacy of daikenchuto (TJ -100) for the prevention of paralytic ileus after pancreaticoduodenectomy: A multicenter, double-blind, randomized, placebo-controlled trial. Surgery 2016; 159:1333-41. [DOI: 10.1016/j.surg.2015.11.019] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2015] [Revised: 11/18/2015] [Accepted: 11/27/2015] [Indexed: 01/04/2023]
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Levy N, Mills P, Mythen M. Is the pursuit of DREAMing (drinking, eating and mobilising) the ultimate goal of anaesthesia? Anaesthesia 2016; 71:1008-12. [PMID: 27079158 DOI: 10.1111/anae.13495] [Citation(s) in RCA: 49] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Affiliation(s)
- N. Levy
- Department of Anaesthesia; West Suffolk Hospital; Bury St Edmunds Suffolk UK
| | - P. Mills
- Department of Anaesthesia; West Suffolk Hospital; Bury St Edmunds Suffolk UK
| | - M. Mythen
- University College London Hospitals; NIHR Biomedical Research Centre; London UK
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Dugdale AHA, Taylor PM. Equine anaesthesia-associated mortality: where are we now? Vet Anaesth Analg 2016; 43:242-55. [PMID: 26970940 DOI: 10.1111/vaa.12372] [Citation(s) in RCA: 70] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2015] [Accepted: 01/12/2016] [Indexed: 11/28/2022]
Abstract
OBJECTIVES To review the literature concerning mortality associated with general anaesthesia in horses and to assess whether there is evidence for a reduction in mortality over the 20 years since the Confidential Enquiry into Perioperative Equine Fatalities (CEPEF). DATABASES USED PubMed, Scopus, Google Scholar. Search terms used: horse; pony; equine; anaesthesia; anesthesia; recovery; morbidity, and mortality. CONCLUSIONS The most recent studies, in which isoflurane and sevoflurane have been more commonly used for anaesthesia maintenance, report fewer intraoperative cardiac arrests than older studies in which halothane was favoured. Catastrophic fractures, however, have become the greatest cause of recovery-associated mortality.
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Affiliation(s)
- Alexandra H A Dugdale
- Faculty of Health and Life Sciences, Institute of Veterinary Science, University of Liverpool, Neston, UK
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Palágyi P, Barna S, Csábi P, Lorencz P, László I, Molnár Z. Recent Advances of Mucosal Capnometry and the Perspectives of Gastrointestinal Monitoring in the Critically Ill. A Pilot Study. J Crit Care Med (Targu Mures) 2016; 2:30-37. [PMID: 29967834 DOI: 10.1515/jccm-2016-0002] [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: 09/21/2015] [Accepted: 12/05/2015] [Indexed: 11/15/2022] Open
Abstract
Mucosal capnometry involves the monitoring of partial pressure of carbon dioxide (PCO2) in mucous membranes. Different techniques have been developed and applied for this purpose, including sublingual or buccal sensors, or special gastrointestinal tonometric devices. The primary use of these procedures is to detect compensated shock in critically ill patients or patients undergoing major surgery. Compensatory mechanisms, in the early phases of shock, lead to the redistribution of blood flow towards the vital organs, within ostensibly typical macro-haemodynamic parameters. Unfortunately, this may result in microcirculatory disturbances, which can play a pivotal role in the development of organ failure. In such circumstances mucosal capnometry monitoring, at different gastrointestinal sites, can provide a sensitive method for the early diagnosis of shock. The special PCO2 monitoring methods assess the severity of ischaemia and help to define the necessary therapeutic interventions and testing of these monitors have justified their prognostic value. Gastrointestinal mucosal capnometry monitoring also helps in determining the severity of ischaemia and is a useful adjunctive in the diagnosis of occlusive splanchnic arterial diseases. The supplementary functional information increases the diagnostic accuracy of radiological techniques, assists in creating individualized treatment plans, and helps in follow-up the results of interventions. The results of a pilot study focusing on the interrelation of splanchnic perfusion and gastrointestinal function are given and discussed concerning recent advances in mucosal capnometry.
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Affiliation(s)
- Péter Palágyi
- Department of Anaesthesiology and Intensive Therapy, University of Szeged, Szeged, Hungary
| | - Sándor Barna
- Department of Anaesthesiology and Intensive Therapy, Bács-Kiskun County Hospital, Teaching Hospital of the University of Szeged, Szeged, Hungary
| | - Péter Csábi
- Department of Anaesthesia and Intensive Care, Wexham Park Hospital, Wexham Park, United Kingdom
| | - Péter Lorencz
- Department of Anaesthesiology and Intensive Therapy, University of Szeged, Szeged, Hungary
| | - Ildikó László
- Department of Anaesthesiology and Intensive Therapy, University of Szeged, Szeged, Hungary
| | - Zsolt Molnár
- Department of Anaesthesiology and Intensive Therapy, University of Szeged, Szeged, Hungary
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Goal-directed fluid therapy in gastrointestinal surgery in older coronary heart disease patients: randomized trial. World J Surg 2015; 37:2820-9. [PMID: 24048581 DOI: 10.1007/s00268-013-2203-6] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
BACKGROUND Our aim was to determine whether substitution of goal-directed fluid therapy (GDT) (perioperative fluid administration) for traditional therapy to manage elderly patients with coronary heart disease scheduled for gastrointestinal (GI) surgery was advantageous. We determined if it would reduce cardiac complications and shorten time to recovery and discharge. METHODS Altogether, 60 of these elderly patients were randomized into GDT (n = 30) and control (n = 30) groups. In the GDT group, fluid management was carried out under guidance of hemodynamic status indicators. Types and quantities of fluids administered, blood loss, intraoperative urine output, time of extubation, intensive care unit (ICU) stay, hospital stay, postoperative adverse cardiac events, and GI complications were recorded. RESULTS Total fluids infused were 2,910 ± 645 ml (GDT group) and 3,640 ± 771 ml (control group) (p < 0.05). Numbers of adverse cardiac events in the two groups were not significantly different (p = 0.121). Return of GI function was significantly faster in the GDT group (p < 0.001). Median ICU stay was 32.5 h in the GDT group and 47.5 h in the control group (p < 0.001). Median hospital stay was 18 days in the GDT group and 22 days in the control group (p < 0.001). CONCLUSIONS GDT was associated with shorter ICU stay and time to discharge and faster return of GI function compared to traditional fluid therapy. The number of adverse cardiac events was similar in the two groups.
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Lacy AM, Tasende MM, Delgado S, Fernandez-Hevia M, Jimenez M, De Lacy B, Castells A, Bravo R, Wexner SD, Heald RJ. Transanal Total Mesorectal Excision for Rectal Cancer: Outcomes after 140 Patients. J Am Coll Surg 2015. [PMID: 26206640 DOI: 10.1016/j.jamcollsurg.2015.03.046] [Citation(s) in RCA: 229] [Impact Index Per Article: 25.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND The anatomic difficulties that we have to deal with in open surgery for rectal cancer have not been overcome with the laparoscopic approach. In the search for a solution, a change of concept arose: approaching the rectum from below. The main objectives of this study were to show the potential advantages of the hybrid transabdominal-transanal total mesorectal excision (taTME). This approach may improve quality of the mesorectal specimens. Second, proctectomy can be technically easier and more safely performed "down to up," which would result in shorter surgical times, lower conversion rates, and less morbidity. STUDY DESIGN A prospective series of hybrid taTME was conducted from October 2011 to November 2014. RESULTS During the study period, 140 procedures were performed. Mean operative time was 166 minutes. There were no conversions or intraoperative complications. Macroscopic quality assessment of the resected specimen was complete in 97.1% and nearly complete in 2.1%. Thirty-day morbidity was minor (Clavien-Dindo I + II) in 24.2% and major (Clavien-Dindo III + IV) in 10 %. No patient died within the first 30 days postsurgery (Clavien-Dindo V). The mean follow-up was 15 months, with a 2.3% local recurrence rate and a 7.6% rate of systemic recurrence. CONCLUSIONS Pathologic analysis showed a very good macroscopic quality of TME specimens, which is the most important prognostic factor in rectal cancer. Intraoperative outcomes regarding conversion, surgical times, and intraoperative complications are very satisfactory. Short-term morbidity and oncologic outcomes are as good as in other laparoscopic TME series.
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Affiliation(s)
- Antonio M Lacy
- Department of Gastrointestinal Surgery, Institute of Digestive and Metabolic Diseases (ICMDM), Hospital Clinic, IDIBAPS, Biomedical Research Center (CIBERehd), Esther Koplowitz Center, University of Barcelona, Barcelona, Spain.
| | - Marta M Tasende
- Department of Gastrointestinal Surgery, Institute of Digestive and Metabolic Diseases (ICMDM), Hospital Clinic, IDIBAPS, Biomedical Research Center (CIBERehd), Esther Koplowitz Center, University of Barcelona, Barcelona, Spain
| | - Salvadora Delgado
- Department of Gastrointestinal Surgery, Institute of Digestive and Metabolic Diseases (ICMDM), Hospital Clinic, IDIBAPS, Biomedical Research Center (CIBERehd), Esther Koplowitz Center, University of Barcelona, Barcelona, Spain
| | - María Fernandez-Hevia
- Department of Gastrointestinal Surgery, Institute of Digestive and Metabolic Diseases (ICMDM), Hospital Clinic, IDIBAPS, Biomedical Research Center (CIBERehd), Esther Koplowitz Center, University of Barcelona, Barcelona, Spain
| | - Marta Jimenez
- Department of Gastrointestinal Surgery, Institute of Digestive and Metabolic Diseases (ICMDM), Hospital Clinic, IDIBAPS, Biomedical Research Center (CIBERehd), Esther Koplowitz Center, University of Barcelona, Barcelona, Spain
| | - Borja De Lacy
- Department of Gastrointestinal Surgery, Institute of Digestive and Metabolic Diseases (ICMDM), Hospital Clinic, IDIBAPS, Biomedical Research Center (CIBERehd), Esther Koplowitz Center, University of Barcelona, Barcelona, Spain
| | - Antoni Castells
- Department of Gastroenterology, Institute of Digestive and Metabolic Diseases (ICMDM), Hospital Clinic, IDIBAPS, Biomedical Research Center (CIBERehd), Esther Koplowitz Center, University of Barcelona, Barcelona, Spain
| | - Raquel Bravo
- Department of Gastrointestinal Surgery, Institute of Digestive and Metabolic Diseases (ICMDM), Hospital Clinic, IDIBAPS, Biomedical Research Center (CIBERehd), Esther Koplowitz Center, University of Barcelona, Barcelona, Spain
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Fluid management in the cardiothoracic intensive care unit: diuresis--diuretics and hemofiltration. Curr Opin Anaesthesiol 2014; 27:133-9. [PMID: 24514030 DOI: 10.1097/aco.0000000000000055] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
PURPOSE OF REVIEW The present review discusses the current concepts of fluid management in cardiothoracic surgery, and its clinical implications with special reference to organ-related complications and their prevention. RECENT FINDINGS Current strategies in fluid management for cardiothoracic patients, various fluid formulation, and the preventive strategies for minimizing fluid-related complications are described, with particular reference to new discoveries and controversies that have arisen from recent literature. SUMMARY The optimal fluid management in cardiothoracic patients has not been settled. Results of recent clinical published trials highlight the need for minimizing fluid administration and attempting to use diuretics to achieve a negative fluid, although hypovolemia and hypoperfusion should be carefully considered. An individualized optimization of fluid status, using goal-directed therapy, has emerged as a possible preferable approach. The old debate between crystalloid and colloid solutions has been partially solved, as some colloids have demonstrated deleterious effect on renal function and coagulation system. Various preventive strategies have also emerged for minimizing fluid-related complications.
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De Santis V, Frati G, Greco E, Tritapepe L. Ivabradine: a preliminary observation for a new terapeutic role in patients with multiple organ dysfunction syndrome. Clin Res Cardiol 2014; 103:831-4. [PMID: 24805930 PMCID: PMC4159564 DOI: 10.1007/s00392-014-0722-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2014] [Accepted: 04/24/2014] [Indexed: 12/13/2022]
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Aguilera-Martinez R, Ramis-Ortega E, Carratalá-Munuera. C, Fernández-Medina JM, Saiz-Vinuesa MD, Barrado-Narvión MJ. Effectiveness of continuous enteral nutrition versus intermittent enteral nutrition in intensive care patients: a systematic review. ACTA ACUST UNITED AC 2014. [DOI: 10.11124/jbisrir-2014-1129] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
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The Effect of the Gelatinous Lactulose for Postoperative Bowel Movement in the Patients Undergoing Cesarean Section. INTERNATIONAL SCHOLARLY RESEARCH NOTICES 2014; 2014:752862. [PMID: 27433530 PMCID: PMC4897242 DOI: 10.1155/2014/752862] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/13/2014] [Revised: 09/22/2014] [Accepted: 10/08/2014] [Indexed: 11/28/2022]
Abstract
Lactulose is a non-digestible disaccharide formed from fructose and galactose. The objective of this study was to assess the effect of lactulose on gastrointestinal function after cesarean section. One hundred patients who underwent cesarean section at the Japanese Red Cross Katsushika Maternity Hospital were enrolled in this study. They were divided into 2 groups by randomization: (1) an L group that was treated with gelatinous lactulose (N = 48) and (2) a control group (C group) that did not receive gelatinous lactulose (N = 52). The interval between cesarean section and first postoperative flatus, defecation, and walking; appearance of symptoms of ileus; use of other medicines for stimulating bowel movement; properties and state of feces; and duration of postoperative hospital stay were compared between the two groups. The two groups did not show a significant difference in postoperative outcomes, except for the incidence of loose or watery stools (50% in the L group and 26.9% in the C group, P = 0.03). This study could not demonstrate the apparent effectiveness of lactulose in improving bowel function after cesarean section. Therefore, a routine use of gelatinous lactulose after surgery may negatively impact the patients undergoing cesarean section.
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Reyad AR, Elkharboutly W, Wahba A, Elmorshedi M, Hasaneen NA. Effect of intraoperative dobutamine on splanchnic tissue perfusion and outcome after Whipple surgery. J Crit Care 2013; 28:531.e7-15. [DOI: 10.1016/j.jcrc.2013.02.017] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2011] [Revised: 12/26/2012] [Accepted: 02/24/2013] [Indexed: 01/05/2023]
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48
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Terzioglu F, Şimsek S, Karaca K, Sariince N, Altunsoy P, Salman MC. Multimodal interventions (chewing gum, early oral hydration and early mobilisation) on the intestinal motility following abdominal gynaecologic surgery. J Clin Nurs 2013; 22:1917-25. [DOI: 10.1111/jocn.12172] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/31/2012] [Indexed: 12/24/2022]
Affiliation(s)
| | - Sevgi Şimsek
- Gynecologic Unit; Hacettepe University Adult Hospital; Sihhiye Ankara Turkey
| | - Kubra Karaca
- Gynecologic Unit; Hacettepe University Adult Hospital; Sihhiye Ankara Turkey
| | - Nilay Sariince
- Gynecologic Unit; Hacettepe University Adult Hospital; Sihhiye Ankara Turkey
| | - Pinar Altunsoy
- Gynecologic Unit; Hacettepe University Adult Hospital; Sihhiye Ankara Turkey
| | - Mehmet Coskun Salman
- Obstetric and Gynecologic Department; Hacettepe University Hospital; Ankara Turkey
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De Santis V, Vitale D, Santoro A, Magliocca A, Porto AG, Nencini C, Tritapepe L. Ivabradine: potential clinical applications in critically ill patients. Clin Res Cardiol 2013; 102:171-8. [PMID: 23064879 DOI: 10.1007/s00392-012-0516-3] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2012] [Accepted: 10/04/2012] [Indexed: 12/17/2022]
Abstract
It has been extensively demonstrated that an elevated heart rate is a modifiable, independent risk factor for cardiovascular events. A high heart rate increases myocardial oxygen consumption and reduces diastolic perfusion time. It can also increase ventricular diastolic pressures and induce ventricular arrhythmias. Critical care patients are prone to develop a stress induced cardiac impairment and consequently an increase in sympathetic tone. This in turn increases heart rate. In this setting, however, heart rate lowering might be difficult because the effects of inotropic drugs could be hindered by heart rate reducing drugs like beta-blockers. Ivabradine is a new selective antagonist of funny channels. It lowers heart rate, reducing the diastolic depolarization slope. Moreover, ivabradine is not active on sympathetic pathways, thus avoiding any interference with inotropic amines. We reviewed the literature available regarding heart rate control in critical care patients, focusing our interest on the use of ivabradine to assess the potential benefits of the drug in this particular setting.
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Affiliation(s)
- Vincenzo De Santis
- Department of Anesthesiology and Intensive Care, Azienda USL di Ravenna, Viale Randi 5, 48121, Ravenna, Italy.
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Okada KI, Kawai M, Uesaka K, Kodera Y, Nagano H, Murakami Y, Morita S, Sakamoto J, Yamaue H. Effect of Daikenchuto (TJ-100) on Postoperative Bowel Motility and on Prevention of Paralytic Ileus after Pancreaticoduodenectomy: A Multicenter, Randomized, Placebo-controlled Phase II Trial (The JAPAN-PD Study). Jpn J Clin Oncol 2013; 43:436-8. [DOI: 10.1093/jjco/hyt005] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
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