131 PRACTICES IN PERIOPERATIVE NUTRITION PRECEDING OR FOLLOWING OESOPHAGECTOMY: RESULTS OF A EUROPEAN SURVEY

2021 ◽  
Vol 34 (Supplement_1) ◽  
Author(s):  
Hans Van Veer ◽  
Misha Luyer ◽  
Lieven Depypere ◽  
Philippe Nafteux ◽  
Willy Coosemans
Keyword(s):  
Nutritional Support ◽  
Nutritional Assessment ◽  
Enhanced Recovery ◽  
Oral Intake ◽  
Daily Practice ◽  
The Third ◽  
Preoperative Nutrition ◽  
Perioperative Nutrition ◽  
Feeding Regimen ◽  
Surgical Pathway

Abstract   The route and type of peri-operative feeding after oesophagectomy varies widely across centres, usually based on local experiences and standing orders. The aim of this survey on perioperative nutrition after oesophagectomy (PONOS) was to create a snapshot the way perioperative nutrition preceding or following oesophagectomy is established across reference centres in Europe, and what the reasons are for preferring one method over another. Methods A survey consisting of four parts was distributed to the membership of 3 European, mainly surgical oriented scientific societies between October 2019 and January 2020. The first part contained some general questions regarding demographics of the participants and type of performed surgery. In the second section, centres were asked about practices in preoperative nutrition. The third section questioned participants about their practices in postoperative nutrition; in the last part the daily practice was reflected against the current available ESPEN guidelines. Results Fifty-one surgeons from 49 centres in 16 countries participated. The majority had a structured nutrition team in their institution. An Enhanced Recovery Pathway was implemented in 2/3 of centres. ESPEN guidelines were followed in 50% of centers. Routine preoperative nutritional assessment was performed in 84%. Preoperative nutritional support consisted mainly of enteral and oral support; immediate postoperatively mostly a combination of oral and enteral or enteral only; at discharge mostly a combination of oral and enteral or only oral nutritional supplementation were used. Timing, definition and means of postoperative oral intake also seemed to differ widely across centres. Conclusion The PONOS survey confirmed our assumption that perioperative feeding after oesophagectomy exists in a wide variety across European centres performing oesophageal resections for cancer. Survey based feedback to the surgical community draws attention to this often underexposed part of the surgical pathway of a patient. As such, this might further enhance the exchange of experiences in order to try to harmonise peri-operative feeding regimen.

scholarly journals Integrated nutrition

2005 ◽  
Vol 64 (3) ◽  
pp. 319-323 ◽  
Author(s):  
S. P. Allison
Keyword(s):  
Nutritional Support ◽  
Enhanced Recovery ◽  
Mode Of Delivery ◽  
Oral Intake ◽  
Later Life ◽  
Scientific Discipline ◽  
Clinical Nutrition ◽  
Electrolyte Balance ◽  
Fully Integrated ◽  
Beneficial Effects

There is no branch of medicine in which nutritional considerations do not play some part. Overnutrition, undernutrition or unbalanced nutrition are the major causes of ill health in the world. Conversely, illness causes important nutritional and metabolic problems. The spectrum from lack to excess of nutrients is seamless as a clinical and scientific discipline, the two extremes being linked by the Barker effect by which intrauterine malnutrition and low birth weight predispose to obesity, diabetes and CVD in later life. However, the teaching of nutrition in medical and nursing schools remains sparse. Nutritional care cannot be practised satisfactorily in isolation from other aspects of management, since factors such as drugs, surgery and fluid and electrolyte balance affect nutritional status. Nutritional treatment may also have adverse or beneficial effects according to the composition, amount and mode of delivery of the diet and the clinical context in which it is given. Any benefits of nutritional support may also be negated by shortcomings in other aspects of treatment and must therefore be fully integrated into overall care. One example of this approach is the enhanced recovery after a surgery protocol incorporating immediate pre-operative carbohydrate and early post-operative oral intake with strict attention to zero fluid balance, epidural analgesia and early mobilisation. Other examples include the deleterious effect on surgical outcome of salt and water overload or hyperglycaemia, either of which may negate the benefits of nutritional support. There is a need, therefore, to integrate clinical nutrition more closely, not just into medical and surgical practice, but also into the organisation of health services in the hospital and the community, and into the training of doctors and nurses. Societies originally devoted to parenteral and enteral nutrition need to widen their scope to embrace wider aspects of clinical nutrition.

P-OGC05 The introduction of an Upper Gastrointestinal (UGI) specific menu can reduce the need for routine jejunostomy (JEJ) placement following UGI Cancer resection

2021 ◽  
Vol 108 (Supplement_9) ◽  
Author(s):  
Vida Dossou
Keyword(s):  
Patient Satisfaction ◽  
Staff Training ◽  
Nutritional Support ◽  
Enhanced Recovery ◽  
Oral Intake ◽  
Oral Feeding ◽  
Ward Staff ◽  
Cancer Resection ◽  
Early Oral Feeding ◽  
Satisfaction Surveys

Abstract Background Despite the fact that early oral feeding (EOF) after the surgical resection of oesophageal and gastric tumours is safe, and is associated with favourable early in-hospital outcomes, sooner return to physiological GI function and hospital discharge, there can still be some reluctance in establishing EOF. Concerns remain around risk of anastomotic leak, pneumonia, Naso-gastric tube (NGT) reinsertion, re-operation, readmissions and mortality. However, when utilising EOF, a reduction in length of stay, earlier removal of NGT and earlier initiation of soft diet can be observed. JEJ placement is beneficial however  complications can arise and the optimal nutritional pathway remains debatable.  Methods Patient satisfaction surveys were conducted amongst UGI Cancer patients following Cancer resection and analysed pre and post UGI menu development and staff training. Expert UGI Patient volunteers assisted in the UGI menu development through food tastings producing a new menu in collaboration with the catering department. The new menu was launched and an UGI snack box provided to the UGI Enhanced Recovery Unit (ERAS).  Oral intake of Diet and Oral Nutritional Support was analysed for calorie and protein content post menu change, ward staff training and specialist UGI dietetic counselling. This was then compared with calculated minimum estimated nutritional requirements.  Results Of the ten patients audited pre discharge: Remaining 1 patient achieved 51% of protein requirements, below the aim of 60%. No patient audited required supplementary Enteral feeding via JEJ or Naso-jejunal tube Patient satisfaction surveys were completed prior to catering staff training and menu revision, after the new menu was implemented. The results show a significant improvement in patient satisfaction following UGI menu implementation. Conclusions Specialist UGI RD support, UGI specific menu and Oral Nutritional Support can reduce the need for routine JEJ placement in favour of on an individual patient basis.  Collaborative working between UGI Dietitians, Ward staff, Catering staff and Expert patients is required for UGI specific menu development to be effectual.  This audit is limited to small numbers due to adapted operational procedures during the pandemic. This audit will be repeated on a larger scale to yield more meaningful data.   Future audit will capture data on how many UGI patients went on to require enteral nutritional support with three months of discharge.

Auricular field nerve stimulation using the NSS-2 BRIDGE® device as an alternative to opioids following kidney donor surgery

2021 ◽  
Vol 0 (0) ◽  
Author(s):  
Jacques E. Chelly ◽  
Amy L. Monroe ◽  
Raymond M. Planinsic ◽  
Amit Tevar ◽  
Brittany E. Norton
Keyword(s):  
Enhanced Recovery ◽  
Randomized Study ◽  
Cranial Nerves ◽  
Oral Morphine ◽  
Oral Intake ◽  
Control Group ◽  
Hospital Data ◽  
Kidney Donor ◽  
Post Surgery ◽  
Post Operative Nausea

Abstract Objectives The purpose of this study was to investigate the role that the NSS-2 BRIDGE® device, an auricular field nerve stimulator, may play in reducing opioid requirement and pain in kidney donor surgery. It was not a randomized study. Electrophysiologic studies have demonstrated that the stimulation of the cranial nerves produced by the NSS-2 BRIDGE® device modulates the ascending/descending spinal pain pathways, especially at the level of the limbic system. Methods The design compared the effects of the NSS-2 BRIDGE® device (NSS 2-BRIDGE® device group; n=10) to a control group (n=10). In both groups, the surgery was performed using the same standard enhanced recovery after surgery protocol based on the use of a multimodal analgesic approach. For the active treatment group, the NSS-2 BRIDGE® device was placed in the post anesthesia care unit. The primary endpoint was opioid requirement (oral morphine equivalent, OME in mg) at 24 h post-surgery. Secondary endpoints included pain (0–10), at 24 and 48 h, time to discharge from the recovery room, incidence of post-operative nausea and vomiting at 24 h, time to oral intake, time to ambulation, and time to discharge from the hospital. Data was analyzed using unpaired t-test and presented as mean ± standard deviation. Results Compared to control, the use of the NSS-2 BRIDGE® was associated with a 75.4% reduction in OME (33.6 vs. 8.3 mg; p=0.03) and 41.5% reduction in pain (5 vs. 3.28; p=0.06) at 24 h and a 73.3% difference in pain at 48 h (1.6 ± 1.6 vs. 6.0 ± 2.8; p=0.0004). There was no difference in non-opioid analgesics administration between groups. Conclusions The tolerability of NSS-2 BRIDGE® device was reported by most to be excellent. This study suggests that the NSS-2 BRIDGE® device may represent a complementary approach for controlling postoperative opioid consumption and pain in patients undergoing kidney donation.

scholarly journals PENATALAKSANAAN IMPAKSI GIGI MOLAR TIGA BAWAH (WISDOM TEETH) DENGAN KOMPLIKASINYA PADA PASIEN DEWASA MUDA

2013 ◽  
Vol 3 (3) ◽  
Author(s):  
Krista Veronica Siagian
Keyword(s):  
Young Adult ◽  
Young Women ◽  
Daily Practice ◽  
Impacted Teeth ◽  
The Third ◽  
Wisdom Teeth ◽  
Mandibular Teeth ◽  
General Dentist

Abstract: In daily practice, we often found the third mandibular impacted teeth that  popular called the wisdom teeth, with the complication, such as dentoalveolar abses, sub cutans abses n caries at distal second mandibular teeth .  The frequencies is  about 88,8% and mostly found in the young adult ages between 18 to 30 years old.  A general dentist is needed to know about the symptom and management of the simple third mandibular impacted teeth that found in the young adult ages.  This paper reported a case in the young women with ages 24 years old with the third mandibular impacted teeth with abses dentoalveolar and caries at distal second mandibular teeth. Keywords: Wisdom teeth, impacted.     Abstrak: Dalam praktek dokter gigi sehari-hari, sering kali ditemukan pasien  dewasa muda yang  memiliki gigi molar tiga bawah yang impaksi ataupun  malposisi, yang sering disebut `Wisdom Teeth`.   Frekuensi terjadinya gigi gigi molar tiga bawah yang impaksi ataupun  malposisi yaitu 88.8 %, dan paling banyak ditemukan pada umur dewasa muda, 18-30 tahun.  Seorang dokter gigi harus memiliki pengetahuan mengenai gejala dan penatalaksanaan pengambilan bedah sederhana dari gigi molar tiga bawah yang impaksi ataupun  malposisi . Tulisan ini dilaporkan seorang wanita dewasa muda berumur 24 tahun dengan kasus gigi molar tiga bawah kanan yang impaksi dengan komplikasinya, abses dentoalveolar dan karies di bagian distal gigi molar dua mandibula. Kata kunci: wisdom teeth, impaksi.

Intravenous cannula used for continuous intraoral mandibular nerve block in trigeminal neuralgia

2021 ◽  
Vol 14 (3) ◽  
pp. e240368
Author(s):  
Harriet Katharine Stringer ◽  
Farzad Borumandi
Keyword(s):  
Chronic Pain ◽  
Pain Relief ◽  
Trigeminal Neuralgia ◽  
Trigeminal Nerve ◽  
Inferior Alveolar Nerve ◽  
Oral Intake ◽  
Nerve Blocks ◽  
Chronic Pain Condition ◽  
Intravenous Cannula ◽  
The Third

Trigeminal neuralgia is a chronic pain condition affecting one or more distributions of the trigeminal nerve. Patients with this condition experience short, sharp, shooting pain attacks, which can progress to longer, more frequent durations. The pain is often difficult to control. We report of a man who was admitted with severe neuralgia of the third division of the trigeminal nerve. Talking and any oral intake triggered a severe agonising pain. The latter made the regular oral intake of analgesia challenging. The pain was temporarily controlled with frequent local anaesthesia (LA). Dental core trainees were performing regular inferior alveolar nerve blocks which significantly improved patients’ condition allowing him to communicate and have oral intake. Subsequently, a catheter was placed allowing for a continuous anaesthesia. The connecting tube of the cannula was then used by nursing staff to administer LA providing pain relief without the need of repeated intraoral injections.

Nutrition and the Use of Metabolic Assessment in the Ventilator-dependent Patient

1991 ◽  
Vol 2 (3) ◽  
pp. 453-461
Author(s):  
Robert E. ST. John ◽  
Patti Eisenberg
Keyword(s):  
Carbon Dioxide ◽  
Mechanical Ventilation ◽  
Dead Space ◽  
Indirect Calorimetry ◽  
Nutritional Support ◽  
Nutritional Assessment ◽  
Caloric Intake ◽  
Elevated Carbon Dioxide ◽  
Carbon Dioxide Production ◽  
Dependent Patient

Nutritional support is an important aspect of care in hospitalized patients, especially those receiving mechanical ventilation. While nutritional assessments can help guide the clinician in determining appropriate caloric intake requirements and refeeding schedules, few tools exist to evaluate the consequences of over- or underfeeding. Metabolic assessment using indirect calorimetry is a new method of nutritional assessment for use at the bedside of the weaning patient. The data obtained from a metabolic assessment can be used to adjust formulas and total caloric intake as well as differentiate between dead space and elevated carbon dioxide production as reasons for persistent hypercarbia

Clinical benefits of a swallowing intervention for esophageal cancer patients after esophagectomy

2020 ◽  
Author(s):  
Jun Takatsu ◽  
Eiji Higaki ◽  
Takahiro Hosoi ◽  
Masahiro Yoshida ◽  
Masahiko Yamamoto ◽  
...  
Keyword(s):  
Esophageal Cancer ◽  
Cancer Patients ◽  
Enhanced Recovery ◽  
Intervention Group ◽  
Oral Intake ◽  
Control Group ◽  
Recurrent Laryngeal Nerve Paralysis ◽  
Swallowing Function ◽  
Nerve Paralysis ◽  
Postoperative Stay

Summary Dysphagia after esophagectomy is the main cause of a prolonged postoperative stay. The present study investigated the effects of a swallowing intervention led by a speech–language–hearing therapist (SLHT) on postoperative dysphagia. We enrolled 276 consecutive esophageal cancer patients who underwent esophagectomy and cervical esophagogastric anastomosis between July 2015 and December 2018; 109 received standard care (control group) and 167 were treated by a swallowing intervention (intervention group). In the intervention group, swallowing function screening and rehabilitation based on each patient’s dysfunction were led by SLHT. The start of oral intake, length of oral intake rehabilitation, and length of the postoperative stay were compared in the two groups. The patient’s subgroups in the 276 patients were examined to clarify the more effectiveness of the intervention. The start of oral intake was significantly earlier in the intervention group (POD: 11 vs. 8 days; P = 0.009). In the subgroup analysis, the length of the postoperative stay was also significantly shortened by the swallowing intervention in patients without complications (POD: 18 vs. 14 days; P = 0.001) and with recurrent laryngeal nerve paralysis (RLNP) (POD: 30 vs. 21.5 days; P = 0.003). A multivariate regression analysis identified the swallowing intervention as a significant independent factor for the earlier start of oral intake and a shorter postoperative stay in patients without complications and with RLNP. Our proposed swallowing intervention is beneficial for the earlier start of oral intake and discharge after esophagectomy, particularly in patients without complications and with RLNP. This program may contribute to enhanced recovery after surgery.

Enteral nutritional support in patients undergoing chemoradiotherapy for esophageal carcinoma

2020 ◽  
Vol 16 (35) ◽  
pp. 2949-2957
Author(s):  
Bei Wang ◽  
Xiaowen Jiang ◽  
Dalong Tian ◽  
Wei Geng
Keyword(s):  
Esophageal Cancer ◽  
High Risk ◽  
Enteral Nutrition ◽  
Nutritional Status ◽  
Cancer Patients ◽  
Nutritional Support ◽  
Nutritional Assessment ◽  
Assessment Tools ◽  
Tumor Patients ◽  
Selection Of

Esophageal cancer patients are at a high risk of malnutrition. Both the disease itself and chemoradiotherapy will lead to the deterioration of nutritional status. The development of nutritional oncology promotes the application of enteral nutrition in tumor patients. Through nutritional support, prognosis is improved and the incidence of adverse chemoradiotherapy reactions is reduced, especially in those with head and neck or esophageal cancer. This review summarizes enteral nutritional support in esophageal cancer patients undergoing chemoradiotherapy in recent years, including a selection of nutritional assessment tools, the causes and consequences of malnutrition in esophageal cancer patients, types of access and effects of enteral nutrition. More patients with esophageal cancer will benefit from the development of enteral nutrition technology in the future.

The Use, Efficacy and Monitoring of Artificial Nutritional Support in a Teaching Hospital

1995 ◽  
Vol 40 (6) ◽  
pp. 179-183 ◽  
Author(s):  
J P. McWhirter ◽  
K. Hill ◽  
J. Richards ◽  
CR Pennington
Keyword(s):  
Patient Outcomes ◽  
Teaching Hospital ◽  
Nutritional Support ◽  
Nutritional Assessment ◽  
Nutrient Supply ◽  
Energy Requirements ◽  
Feeding Time

The implementation of circulated guidelines has been audited, by assessing the extent to which nutritional goals were set and achieved and recording the levels of morbidity as a result of complications. Adults receiving artificial nutritional support were studied over a six month period. Nutritional assessment was used to determine adequacy of prescription and efficacy of the support. Energy requirements were retrospectively calculated and compared with prescriptions and actual intakes. Complications and interruptions to the regimens which resulted in lost feeding time were recorded, as were patient outcomes. Nutrient prescriptions were inadequate, delivery of prescriptions was incomplete and thus nutrient supply inadequate.

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