scholarly journals Intrathecal Analgesia and Restrictive Perioperative Fluid Management within Enhanced Recovery Pathway: Hemodynamic Implications

2013 ◽  
Vol 216 (6) ◽  
pp. 1124-1134 ◽  
Author(s):  
Martin Hübner ◽  
Jenna K. Lovely ◽  
Marianne Huebner ◽  
Seth W. Slettedahl ◽  
Adam K. Jacob ◽  
...  
Keyword(s):  
Enhanced Recovery ◽  
Fluid Management ◽  
Enhanced Recovery Pathway ◽  
Perioperative Fluid Management ◽  
Intrathecal Analgesia

scholarly journals Perioperative fluid management: Consensus statement from the enhanced recovery partnership

2012 ◽  
Vol 1 (1) ◽  
Author(s):  
Monty G Mythen ◽  
Michael Swart ◽  
Nigel Acheson ◽  
Robin Crawford ◽  
Kerri Jones ◽  
...  
Keyword(s):  
Consensus Statement ◽  
Enhanced Recovery ◽  
Fluid Management ◽  
Perioperative Fluid Management

scholarly journals Efficacy and Outcomes of Intrathecal Analgesia as Part of an Enhanced Recovery Pathway in Colon and Rectal Surgical Patients

2018 ◽  
Vol 2018 ◽  
pp. 1-5 ◽  
Author(s):  
Amit Merchea ◽  
Jenna K. Lovely ◽  
Adam K. Jacob ◽  
Dorin T. Colibaseanu ◽  
Scott R. Kelley ◽  
...  
Keyword(s):  
Colorectal Surgery ◽  
Enhanced Recovery ◽  
Single Injection ◽  
Anesthetic Management ◽  
Multimodal Analgesia ◽  
Surgical Patients ◽  
Enhanced Recovery Pathway ◽  
Pain Scores ◽  
Blood Patch ◽  
Intrathecal Analgesia

Purpose. Multimodal analgesia is an essential component of an enhanced recovery pathway (ERP). An ERP that includes the use of single-injection intrathecal analgesia (IA) has been shown to decrease morbidity and cost and shorten length of stay (LOS). Limited data exist on safety, feasibility, and the optimal IA regimen. Our objective was to characterize the efficacy, safety, and feasibility of IA within an ERP in a cohort of colorectal surgical patients. Methods. We performed a retrospective review of all consecutive patients aged ≥ 18 years who underwent open or minimally invasive colorectal surgery from October 2012 to December 2013. All patients were enrolled in an institutional ERP that included the use of single-injection IA. Demographics, anesthetic management, efficacy (pain scores and opiate consumption), postoperative ileus (POI), adverse effects, and LOS are reported. Results. 601 patients were identified. The majority received opioid-only IA (91%) rather than a multimodal regimen. Median LOS was 3 days. Overall rate of ileus was 16%. Median pain scores at 4, 8, 16, 24, and 48 hours were 3, 2, 3, 4, and 3, respectively. There was no difference in postoperative pain scores, LOS, or POI based on intrathecal medication or dose received. Overall, development of respiratory depression (0.2%) or pruritus (1.2%) was rare. One patient required blood patch for postdural headache. Conclusion. Intrathecal analgesia is safe, feasible, and efficacious in the setting of ERP for colorectal surgery. All regimens and doses achieved a short LOS, low pain scores, and a low incidence of POI. This trial is registered with Clinicaltrails.gov NCT03411109.

scholarly journals Perioperative liberal versus restrictive fluid strategies and postoperative outcomes: a systematic review and metanalysis on randomised-controlled trials in major abdominal elective surgery

Critical Care ◽  
2021 ◽  
Vol 25 (1) ◽  
Author(s):  
Antonio Messina ◽  
Chiara Robba ◽  
Lorenzo Calabrò ◽  
Daniel Zambelli ◽  
Francesca Iannuzzi ◽  
...  
Keyword(s):  
Systematic Review ◽  
Postoperative Complications ◽  
Randomised Controlled Trials ◽  
Elective Surgery ◽  
Fluid Management ◽  
Risk Difference ◽  
Controlled Trials ◽  
Perioperative Fluid Management ◽  
Liberal Approach ◽  
Randomised Controlled

Abstract Background Postoperative complications impact on early and long-term patients’ outcome. Appropriate perioperative fluid management is pivotal in this context; however, the most effective perioperative fluid management is still unclear. The enhanced recovery after surgery pathways recommend a perioperative zero-balance, whereas recent findings suggest a more liberal approach could be beneficial. We conducted this trial to address the impact of restrictive vs. liberal fluid approaches on overall postoperative complications and mortality. Methods Systematic review and meta-analysis, including randomised controlled trials (RCTs). We performed a systematic literature search using MEDLINE (via Ovid), EMBASE (via Ovid) and the Cochrane Controlled Clinical trials register databases, published from 1 January 2000 to 31 December 2019. We included RCTs enrolling adult patients undergoing elective abdominal surgery and comparing the use of restrictive/liberal approaches enrolling at least 15 patients in each subgroup. Studies involving cardiac, non-elective surgery, paediatric or obstetric surgeries were excluded. Results After full-text examination, the metanalysis finally included 18 studies and 5567 patients randomised to restrictive (2786 patients; 50.0%) or liberal approaches (2780 patients; 50.0%). We found no difference in the occurrence of severe postoperative complications between restrictive and liberal subgroups [risk difference (95% CI) = 0.009 (− 0.02; 0.04); p value = 0.62; I2 (95% CI) = 38.6% (0–66.9%)]. This result was confirmed also in the subgroup of five studies having a low overall risk of bias. The liberal approach was associated with lower overall renal major events, as compared to the restrictive [risk difference (95% CI) = 0.06 (0.02–0.09); p value  = 0.001]. We found no difference in either early (p value  = 0.33) or late (p value  = 0.22) postoperative mortality between restrictive and liberal subgroups Conclusions In major abdominal elective surgery perioperative, the choice between liberal or restrictive approach did not affect overall major postoperative complications or mortality. In a subgroup analysis, a liberal as compared to a restrictive perioperative fluid policy was associated with lower overall complication renal major events, as compared to the restrictive. Trial Registration CRD42020218059; Registration: February 2020, https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=218059.

Clinical update: perioperative fluid management

The Lancet ◽  
2007 ◽  
Vol 369 (9578) ◽  
pp. 1984-1986 ◽  
Author(s):  
Matthias Jacob ◽  
Daniel Chappell ◽  
Markus Rehm
Keyword(s):  
Fluid Management ◽  
Perioperative Fluid Management
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