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1.
ERAS protocol in gynecologic oncology.
Bajsová, S, Klát, J
Ceska gynekologie. 2019;(5):376-385
Abstract
OBJECTIVE To summarize current knowledge of the ERAS protocol in gynecologic oncology surgery. DESIGN Review article. SETTINGS Department of Obstetrics and Gynecology, University Hospital Ostrava, Ostrava, Department of Obstetrics and Gynecology, University of Ostrava, Ostrava. METHODS Literature review, PubMed and Medline databases were used to search relevant literature from 1995 to 2019. CONCLUSION ERAS (Enhanced Recovery after Surgery) is a perioperative treatment program based on evidence-based medicine. Guidelines consist of pre-operative, perioperative and post-operative care items. Implementation of the ERAS protocol leads to a decrease in complications up to 40% and a reduction in hospitalization by up to 30%, thereby reducing overall costs without increasing the number of rehospitalizations. Multidisciplinary cooperation not only with anesthesiologists and consultant surgeons, but also with nutritional specialists and nurses is crucial.
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2.
Critical Care Management of Living Donor Liver Transplants.
Lemon, K, Al-Khafaji, A, Humar, A
Critical care clinics. 2019;(1):107-116
Abstract
This article represents a review of the postoperative management of donors and recipients after living donor liver transplant, including monitoring, liberation from mechanical ventilation, nutritional support, and pain control. Vascular complications, such as biliary and sepsis, and bleeding are also discussed. Finally, commonly used immunosuppression and antimicrobial prophylaxes are reviewed.
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3.
External suction versus simple water-seal on chest drainage following pulmonary surgery: an updated meta-analysis.
Zhou, J, Chen, N, Hai, Y, Lyu, M, Wang, Z, Gao, Y, Pang, L, Liao, H, Liu, L
Interactive cardiovascular and thoracic surgery. 2019;(1):29-36
Abstract
OBJECTIVES The decision to apply simple water-seal drainage or the addition of an external suction to the simple water-seal drainage following pulmonary surgery is made based on the surgeon's experience or preference and has remained controversial. This meta-analysis aimed to assess the effects of the addition of suction to simple water-seal on the postoperative outcomes. METHODS PubMed, EMBASE and Web of Science were searched from their inception to 30 August 2017. The risk ratio and the weight mean difference were calculated for dichotomous and continuous outcomes, respectively, each with 95% confidence intervals (CIs). The heterogeneity and risk of bias were also assessed. RESULTS A total of 10 randomized controlled trials enrolling 1601 patients were included. Overall, compared with simple water-seal, the addition of external suction reduced the occurrence of postoperative pneumothorax (risk ratio 0.35, 95% CI 0.13-0.93; P = 0.04) and other cardiopulmonary complications (risk ratio 0.65, 95% CI 0.48-0.89; P = 0.008), and increased the duration of chest tube drainage (weight mean difference 0.92 days, 95% CI 0.04-1.81, P = 0.04). However, the effect difference between the 2 groups was not significant regarding air leak duration, length of hospital stay and the occurrence of prolonged air leak. The stability of these studies was strong. No evidence of publication bias was detected. CONCLUSIONS The addition of suction to simple water-seal made no difference to air leak duration, hospital stay or the occurrence of prolonged air leak following pulmonary surgery. In patients where there is concern about a residual or increasing pneumothorax, the addition of suction may be applied selectively.
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4.
Fluid Management With Peritoneal Dialysis After Pediatric Cardiac Surgery.
Barhight, MF, Soranno, D, Faubel, S, Gist, KM
World journal for pediatric & congenital heart surgery. 2018;(6):696-704
Abstract
Children who undergo cardiac surgery with cardiopulmonary bypass are a unique population at high risk for postoperative acute kidney injury (AKI) and fluid overload. Fluid management is important in the postoperative care of these children as fluid overload is associated with increased morbidity and mortality. Peritoneal dialysis catheters are an important tool in the armamentarium of a cardiac intensivist and are used for passive drainage for fluid removal or dialysis for electrolyte and uremia control in AKI. Prophylactic placement of a peritoneal catheter is a safe method of fluid removal that is associated with few major complications. Early initiation of peritoneal dialysis has been associated with improved clinical markers and outcomes such as early achievement of a negative fluid balance, lower vasoactive medication needs, shorter duration of mechanical ventilation, and decreased mortality. In this review, we discuss the safety and potential benefits of peritoneal catheters for dialysis or passive drainage in children following cardiopulmonary bypass.
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5.
[Not Available].
Laurenius, A, Näslund, I, Sandvik, J, Videhult, P, Wirén, M
Lakartidningen. 2018
Abstract
Each year 6,800 bariatric operations are performed in Sweden. Bariatric surgery involves both a reduced intake and a reduced absorption of vitamins and minerals. There has been debate about whose responsibility long-term follow-up is, particularly regarding monitoring vitamin and mineral status. The Swedish Society for Bariatric Surgery and the Norwegian Association for Bariatric Surgery, who oversee their respective national quality registers, have appointed an expert group to develop guidelines for postoperative supplementation and nutritional monitoring of vitamins and minerals, along with a schedule for routine follow-up. Several existing international guidelines have served as the basis for the development of this guidance. The Finnish Association for Metabolic Surgery and The Danish Association for the Study of Obesity have also decided to adopt the recommendations. The care of the patient group with severe obesity is a common responsibility of primary care and hospitals, as patients are heavily affected by obesity-related morbidity, which, even without surgery, requires major health care efforts, not least from primary care. After surgery, a large proportion of these efforts can be reduced, but focus changes.
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6.
Diabetes management before, during, and after bariatric and metabolic surgery.
Kheniser, KG, Kashyap, SR
Journal of diabetes and its complications. 2018;(9):870-875
Abstract
Metabolic surgery is unrivaled by other therapeutic modalities due to its ability to foster diabetes remission. Metabolic surgery is an integral therapeutic modality in obese and morbidly obese populations because pharmacological and behavioral therapy often fail to effectively manage type II diabetes. However, given the invasiveness of the metabolic surgery relative to behavioral therapy and the need to conform to preparatory and discharge guidelines, patients must adhere to strict nutritional and diabetes management protocols. Also, the pharmacological regimen that is instituted upon discharge is distinct from the preoperative regimen. Oftentimes, the dose for insulin and oral medications are significantly decreased or withdrawn. As time elapses and depending on several factors (e.g., exercise adherence), diabetes control becomes tenuous in a small portion of the patients because there is weight regain and on-going beta cell failure. At this time interval, intensification of diabetes therapy becomes prudent. Indeed, pharmacotherapy from the preoperative to the postoperative phase is labile and may be complex. Therefore, by discussing pharmacology options during the preoperative, perioperative, and postoperative period, the goal is to guide clinician-driven care.
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7.
Perioperative management of adult diabetic patients. Postoperative period.
Cheisson, G, Jacqueminet, S, Cosson, E, Ichai, C, Leguerrier, AM, Nicolescu-Catargi, B, Ouattara, A, Tauveron, I, Valensi, P, Benhamou, D, et al
Anaesthesia, critical care & pain medicine. 2018;:S27-S30
Abstract
Follow on from continuous intravenous administration of insulin with an electronic syringe (IVES) is an important element in the postoperative management of a diabetic patient. The basal-bolus scheme is the most suitable taking into account the nutritional supply and variable needs for insulin, reproducing the physiology of a normal pancreas: (i) slow (long-acting) insulin (=basal) which should immediately take over from IVES insulin simulating basal secretion; (ii) ultra-rapid insulin to simulate prandial secretion (=bolus for the meal); and (iii) correction of possible hyperglycaemia with an additional ultra-rapid insulin bolus dose. A number of schemes are proposed to help calculate the dosages for the change from IV insulin to subcutaneous insulin and for the basal-bolus scheme. Postoperative resumption of an insulin pump requires the patient to be autonomous. If this is not the case, then it is mandatory to establish a basal-bolus scheme immediately after stopping IV insulin. Monitoring of blood sugar levels should be continued postoperatively. Hypoglycaemia and severe hyperglycaemia should be investigated. Faced with hypoglycaemia <3.3mmol/L (0.6g/L), glucose should be administered immediately. Faced with hyperglycaemia >16.5mmol/L (3g/L) in a T1D or T2D patient treated with insulin, investigations for ketosis should be undertaken systematically. In T2D patients, unequivocal hyperglycaemia should also call to mind the possibility of diabetic hyperosmolarity (hyperosmolar coma). Finally, the modalities of recommencing previous treatments are described according to the type of hyperglycaemia, renal function and diabetic control preoperatively and during hospitalisation.
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8.
The use of telemedicine for delivering healthcare to bariatric surgery patients: A literature review.
Coldebella, B, Armfield, NR, Bambling, M, Hansen, J, Edirippulige, S
Journal of telemedicine and telecare. 2018;(10):651-660
Abstract
Introduction Bariatric weight loss surgery is one of the most effective treatments for severe obesity. Research shows that the availability of healthcare services pre and post bariatric surgery improves behavioural change and weight loss outcomes. The aim of this systematic review is to assess the evidence relating to the use of telemedicine for providing health services to bariatric surgery patients. Methods A search was conducted using PubMed, EMBASE, CINAHL, PsycNET and SCOPUS. Original research relating to telemedicine for bariatric surgery patients published in peer-reviewed journals were included. Results Database search returned 258 references and a total of 10 studies were included in the review. Six studies assessed use, feasibility and acceptance of telemedicine by patients/practitioners. Studies also examined the use of telemedicine for weight loss, changes in physical activity, diet/eating or other behavioural changes. Two studies were randomised controlled trials; one showed a significant difference in outcomes between intervention and control group. Discussion This review suggests that telemedicine may be a potential method for providing healthcare services to bariatric surgery patients. However, the current evidence base does not allow for definitive conclusions.
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9.
Nutritional interventions to improve recovery from postoperative ileus.
Smeets, BJJ, Luyer, MDP
Current opinion in clinical nutrition and metabolic care. 2018;(5):394-398
Abstract
PURPOSE OF REVIEW Postoperative ileus (POI) is an important contributor to postoperative morbidity. However, postoperative outcomes have improved by enhanced recovery after surgery (ERAS) programs. Enteral nutrition is an essential part of ERAS and many studies suggest a therapeutic effect of nutrition on POI. RECENT FINDINGS Early postoperative enteral nutrition has been shown to reduce various complications, including POI, although studies are heterogeneous. Experimental studies suggest that composition and timing of the enteral feed is important for the potential beneficial effects: lipid-enriched nutrition given just before, during, and directly after surgery was most effective in reducing POI in an experimental setting. In a clinical study in patients undergoing advanced rectal cancer surgery, direct start of enteral tube feeding reduced POI. Conversely, perioperative lipid-enriched enteral nutrition did not reduce POI in patients undergoing colorectal surgery with an ERAS protocol. SUMMARY POI is common and remains an important determinant of postoperative recovery following colorectal surgery. Nutrition is a potential therapeutic means to reduce POI. Timing and composition of the enteral feed have been shown to be essential for the beneficial effects of enteral nutrition in an experimental setup. However perioperative lipid-enriched nutrition does not reduce POI in patients undergoing colorectal surgery with an ERAS protocol.
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10.
[Nutrient Assessment and Perioperative Management in Esophageal Cancer Patients Undergoing Esophagectomy].
Sohda, M, Kuwano, H
Kyobu geka. The Japanese journal of thoracic surgery. 2017;(8):708-711
Abstract
Esophagectomy is a most invasive operation, as compared with other operations of the gastrointestinal tract. Obstructions of the food passageway and the overgrowth of tissue postoperatively may lead to malnutrition. Therefore, significant assessment and management of nutrients is very important for esophageal cancer patients. The body mass index, albumin, the prognostic nutritional index, controlling nutritional status, and the Glasgow Prognostic Score are reported as useful assessment tools for esophageal cancer. The patient's general condition, including his or her nutritional status, influences the performance of esophagectomy. Therefore, improving the nutritional status enables an adaptation of therapy and leads to preventive benefits for decreasing postoperative complications. The previously cited nutritional tools are very useful indices because the measurement of each factor is convenient and fast. Also, early recovery from operative stress is the most important target of postoperative management after esophagectomy. Accurate and adequate perioperative management allows early recovery from operative stress in esophageal cancer patients. Preoperative steroid injection, oral care, respiratory training and rehabilitation, smoking cessation, and so on are very important for esophageal cancer patients. The efforts of a team that includes doctors, nurses, and healthcare providers are necessary for sufficient postoperative management after esophagectomy.