scholarly journals Does Goal-directed Fluid Therapy Affect Postoperative Orthostatic Intolerance?

2013 ◽  
Vol 119 (4) ◽  
pp. 813-823 ◽  
Author(s):  
Morten Bundgaard-Nielsen ◽  
Øivind Jans ◽  
Rasmus G. Müller ◽  
André Korshin ◽  
Birgitte Ruhnau ◽  
...  
Keyword(s):  
Stroke Volume ◽  
Fluid Therapy ◽  
Orthostatic Intolerance ◽  
Length Of Hospital Stay ◽  
Early Mobilization ◽  
Postoperative Recovery ◽  
Major Surgery ◽  
Control Group ◽  
Open Radical Prostatectomy ◽  
Double Blinded

Abstract Background: Early mobilization is important for postoperative recovery but is limited by orthostatic intolerance (OI) with a prevalence of 50% 6 h after major surgery. The pathophysiology of postoperative OI is assumed to include hypovolemia besides dysregulation of vasomotor tone. Stroke volume–guided fluid therapy, so-called goal-directed therapy (GDT), corrects functional hypovolemia, and the authors hypothesized that GDT reduces the prevalence of OI after major surgery and assessed this in a prospective, double-blinded trial. Methods: Forty-two patients scheduled for open radical prostatectomy were randomized into standard fluid therapy (control group) or GDT groups. Both groups received a fixed-volume crystalloid regimen supplemented with 1:1 replacement of blood loss with colloid, and in addition, the GDT group received colloid to obtain a maximal stroke volume (esophageal Doppler). The primary outcome was the prevalence of OI assessed with a standardized mobilization protocol before and 6 h after surgery. Hemodynamic and hormonal orthostatic responses were evaluated. Results: Twelve (57%) versus 15 (71%) patients in the control and GDT groups (P = 0.33), respectively, demonstrated OI after surgery, group difference 14% (CI, −18 to 45%). Patients in the GDT group received more colloid during surgery (1,758 vs. 1,057 ml; P = 0.001) and reached a higher stroke volume (102 vs. 89 ml; P = 0.04). OI patients had an increased length of hospital stay (3 vs. 2 days; P = 0.02) and impaired hemodynamic and norepinephrine responses on mobilization. Conclusion: GDT did not reduce the prevalence of OI, and patients with OI demonstrated impaired cardiovascular and hormonal responses to mobilization.

Goal-directed Intraoperative Fluid Administration Reduces Length of Hospital Stay after Major Surgery

2002 ◽  
Vol 97 (4) ◽  
pp. 820-826 ◽  
Author(s):  
Tong J. Gan ◽  
Andrew Soppitt ◽  
Mohamed Maroof ◽  
Habib El-Moalem ◽  
Kerri M. Robertson ◽  
...  
Keyword(s):  
Stroke Volume ◽  
Hospital Stay ◽  
Elective Surgery ◽  
Length Of Hospital Stay ◽  
Postoperative Hospital Stay ◽  
Fluid Administration ◽  
Major Surgery ◽  
Control Group ◽  
Surgical Morbidity ◽  
Protocol Group

Background Intraoperative hypovolemia is common and is a potential cause of organ dysfunction, increased postoperative morbidity, length of hospital stay, and death. The objective of this prospective, randomized study was to assess the effect of goal-directed intraoperative fluid administration on length of postoperative hospital stay. Methods One hundred patients who were to undergo major elective surgery with an anticipated blood loss greater than 500 ml were randomly assigned to a control group (n = 50) that received standard intraoperative care or to a protocol group (n = 50) that, in addition, received intraoperative plasma volume expansion guided by the esophageal Doppler monitor to maintain maximal stroke volume. Length of postoperative hospital stay and postoperative surgical morbidity were assessed. Results Groups were similar with respect to demographics, surgical procedures, and baseline hemodynamic variables. The protocol group had a significantly higher stroke volume and cardiac output at the end of surgery compared with the control group. Patients in the protocol group had a shorter duration of hospital stay compared with the control group: 5 +/- 3 versus 7 +/- 3 days (mean +/- SD), with a median of 6 versus 7 days, respectively ( = 0.03). These patients also tolerated oral intake of solid food earlier than the control group: 3 +/- 0.5 versus 4.7 +/- 0.5 days (mean +/- SD), with a median of 3 versus 5 days, respectively ( = 0.01). Conclusions Goal-directed intraoperative fluid administration results in earlier return to bowel function, lower incidence of postoperative nausea and vomiting, and decrease in length of postoperative hospital stay.

Perioperative dialogue on postoperative recovery measured by the use of pain medication, psychopharmaceutical agents and length of hospital stay

2018 ◽  
Vol 38 (4) ◽  
pp. 212-219
Author(s):  
Christine Leo Swenne ◽  
Louise Hjelte ◽  
Emma Härdne ◽  
Carin Friberg ◽  
Erebouni Arakelian
Keyword(s):  
Hospital Stay ◽  
Hyperthermic Intraperitoneal Chemotherapy ◽  
Length Of Hospital Stay ◽  
Pain Medication ◽  
Postoperative Recovery ◽  
Major Surgery ◽  
Control Group ◽  
Medication Consumption ◽  
Experienced Pain ◽  
Before And After

The effects of perioperative dialogue have been studied using qualitative methods, describing patient satisfaction with their care. However, they have not been studied in patients with peritoneal carcinomatosis who undergo major surgery, nor with quantitative variables. The aim was to study the use of pain medication and length of hospital stay following cytoreductive surgery and hyperthermic intraperitoneal chemotherapy in patients who received, versus those who did not receive, perioperative dialogue. The study had a quantitative, retrospective and comparative design including 89 audits. Of these, 37 patients received perioperative dialogues, and 52 patients did not (the control group). The result showed that by postoperative day six, patients who received a perioperative dialogue experienced pain less frequently than patients in the control group. However, no differences between the groups were noted with regard to pain medication consumption and length of hospital stay. To ease their worries, all patients in both groups used benzodiazepines. The perioperative dialogue may be studied quantitatively, but it must involve the patient, who is an equal partner in the dialogue. Structured validated self-reporting measures may be used systematically before and after surgery in order to evaluate the perioperative dialogue using quantitative measures.

ERAS Improves Postoperative Recovery in Children

2021 ◽  
Author(s):  
Tingmei Wu ◽  
Haiwen Li ◽  
Huixia Zhou ◽  
Xuemei Hao ◽  
Xiaojun Wang ◽  
...  
Keyword(s):  
Inflammatory Cytokine ◽  
Enhanced Recovery ◽  
Length Of Hospital Stay ◽  
Final Analysis ◽  
Postoperative Recovery ◽  
Controlled Study ◽  
Control Group ◽  
Robot Assisted ◽  
Cytokine Levels ◽  
Eras Protocol

Abstract Objective: Enhanced recovery after surgery (ERAS) protocols are established in adults but not fully evaluated in children. This study investigated whether an ERAS protocol improved recovery and influenced postoperative inflammatory cytokine levels in children undergoing surgery for hydronephrosis. Methods: This randomized controlled study included patients who underwent robot-assisted laparoscopic surgery for hydronephrosis at Bayi Children's Hospital (Beijing, China) between October 2018 and September 2019. Patients were randomized to an ERAS group (perioperative ERAS protocol) or control group (standard perioperative management). Outcomes related to postoperative recovery and inflammatory cytokine levels were evaluated. Results: The final analysis included 18 patients in each group. Five patients (27.78%) in each group experienced postoperative complications (abdominal pain, nausea and vomiting, subcutaneous emphysema or fever). The ERAS group had a shorter time to first postoperative flatus than the control group (25 vs. 49 hours; P =0.009), although the time for abdominal drainage flow to reach ≤20 mL/day, time to urinary catheter removal and length of hospital stay did not differ significantly between groups. Preoperative plasma cytokine levels were comparable between groups. Compared with the control group, the ERAS group had a higher IL-6 level on postoperative day 2 ( P <0.05) and a lower concentration of IL-1β on postoperative days 1 and 2 ( P <0.05). Postoperative levels of CRP, TNFα and IL-10 did not differ significantly between groups. Conclusions: ERAS may accelerate postoperative recovery and modulate the postoperative inflammatory response in pediatric patients undergoing robot-assisted laparoscopic pyeloplasty for hydronephrosis.

scholarly journals AVALIAÇÃO DE UM PROTOCOLO DE MOBILIZAÇÃO PRECOCE EM UMA UNIDADE DE TERAPIA INTENSIVA

2019 ◽  
Vol 3 ◽  
pp. 92
Author(s):  
Cassia Cinara Costa ◽  
Briane Da Silva Leite ◽  
Claudia Kist Fortino ◽  
Vinicius Gonçalves Bastos
Keyword(s):  
Intensive Care ◽  
Intervention Group ◽  
Length Of Hospital Stay ◽  
Early Mobilization ◽  
Pulmonary Complications ◽  
Control Group ◽  
Strength Gain ◽  
Early Ambulation ◽  
Peripheral Muscle ◽  
Terapia Intensiva

RESUMOAvaliar se o protocolo de mobilização precoce contribui para a redução do tempo de internação na Unidade de Terapia Intensiva (UTI) em pacientes submetidos a ventilação mecânica invasiva (VMI), analisar o tempo de assistência à VMI e os efeitos da mobilização precoce na força da musculatura periférica, através de um estudo de coorte concorrente com amostra consecutiva, realizado em 14 pacientes que estiveram internados em uma UTI de um hospital do Vale dos Sinos/RS. Os pacientes foram divididos em Grupo Controle, que realizou a fisioterapia do setor, e Grupo Intervenção, que recebeu o protocolo de mobilização precoce proposto por Morris et al. (2008). Os pacientes do Grupo Intervenção permaneceram um tempo menor no VMI e de internação na UTI, além de terem um ganho de força muscular periférica quando comparado ao Grupo Controle. O protocolo de mobilização precoce pode reduzir a incidência de complicações pulmonares, acelerar a recuperação, diminuir o tempo da VMI e o tempo de internação da UTI.Palavras-chave: Deambulação precoce. Fisioterapia. Reabilitação. Unidades de Terapia Intensiva.ABSTRACTTo evaluate whether the early mobilization protocol contributes to the reduction of the length of hospital stay in the Intensive Care Unit (ICU) in patients undergoing mechanical ventilation (NIV), to analyze the time of NIV care and the effects of early mobilization on the strength of the peripheral musculature. Through a concurrent cohort study with a consecutive sample, performed in 14 patients who were hospitalized in an ICU of a Vale dos Sinos / RS hospital. The patients were divided into a Control Group that performed the physiotherapy of the sector, and Intervention Group that received the protocol of early mobilization proposed by Morris et al. (2008). The Intervention Group patients remained shorter in the NIV and in the ICU, in addition to having a peripheral muscle strength gain when compared to the Control Group. The early mobilization protocol can reduce the incidence of pulmonary complications, accelerate recovery, decrease NIV time and ICU length of stay.Keywords: Early Ambulation. Intensive Care Units. Physical Therapy Specialty. Rehabilitation.

Abstract P192: Orthostatic Tolerance Before And After 60 Days Of Strict Head Down Tilt Bedrest With And Without Daily Artificial Gravity Training

Hypertension ◽  
2021 ◽  
Vol 78 (Suppl_1) ◽  
Author(s):  
Jan Hoenemann ◽  
Fabian Hoffmann ◽  
Stefan Moestl ◽  
Karten Heusser ◽  
Edwin Mulder ◽  
...  
Keyword(s):  
Stroke Volume ◽  
Plasma Volume ◽  
Orthostatic Intolerance ◽  
Lower Body Negative Pressure ◽  
Cardiovascular Responses ◽  
Pooled Analysis ◽  
Artificial Gravity ◽  
Control Group ◽  
Orthostatic Tolerance ◽  
Before And After

Background: Orthostatic intolerance occurs after space flight, immobilization and in patients with autonomic diseases, so there is a need for more effective countermeasures. We hypothesized that daily artificial gravity elicited through short-arm centrifugation attenuates plasma volume loss and orthostatic intolerance following 60 days of HDTBR, which models cardiovascular responses to weightlessness. Methods: We studied 24 healthy persons (8 women, 33.4±9.3 yr, 24.3±2.1 kg/m2) exposed to 60d HDTBR. Subjects were assigned to 30 min/d continuous short arm centrifugation (cAG), 6x5 min short arm centrifugation (iAG), or a control group (ctr, no countermeasures). Head-up tilt testing (15 min of 80°) followed by incremental lower body negative pressure (-10 mmHg every 3 min) until presyncope was performed before and at the end of HDTBR. Plasma volume was measured (CO rebreathing) 12-2 days before and after 56d of HDTBR. Stroke volume was measured by cMRI. Norepinephrine, epinephrine, aldosterone, and renine plasma levels were measured before and after HDTBR. Results: Time to presyncope decreased in all groups following bedrest (ctr: 22:56 min pre and 9:35 min post, cAG 15:34 min pre and 10:11 min post; iAG 14:56 min pre and 10:00 min post, p<0.001). The significant interaction (p=0.025) between bedrest and intervention was explained by greater baseline orthostatic tolerance time in the ctr. AG Data was pooled analysis. The reduction in stroke volume (ctr, pre: 93±19 ml, HDTBR: 69±13 ml, AG, pre: 88±20 ml, HDTBR: 67±17 ml) and plasma volume was similar (ctr, pre: 4155±1085 ml, HDTBR: 3855±1087 ml, AG, pre: 4114±1250 ml, HDTBR: 3674± 1313 ml). Catechols and aldosterone did not change significantly during bedrest. The increase in renine was similar between groups (ctr pre: 18±12 mE/L, HDTBR: 21±8 mE/L, AG pre: 21±10 mE/L, HDTBR: 31±12 mE/L). Conclusions: 30 min daily AG didn’t prevent a reduction in orthostatic tolerance following 60d HDTBR. Whether numerically smaller reductions in orthostatic tolerance in the AG groups indicate efficacy or result from baseline differences can’t be ascertained. A stronger AG stimulus or combination with other countermeasures might be required to maintain orthostatic tolerance and to attenuate the volume reduction.

scholarly journals The effect of opioid-free anesthesia protocol on the early quality of recovery after major surgery (SOFA trial): study protocol for a prospective, monocentric, randomized, single-blinded trial

Trials ◽  
2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Maxime Léger ◽  
Solène Pessiot-Royer ◽  
Tristan Perrault ◽  
Elsa Parot-Schinkel ◽  
Fabienne Costerousse ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Chronic Pain ◽  
Daily Practice ◽  
Postoperative Recovery ◽  
Major Surgery ◽  
Control Group ◽  
Opioid Use ◽  
Wide Range

Abstract Background Since the 2000s, opioid-free anesthesia (OFA) protocols have been spreading worldwide in anesthesia daily practice. These protocols avoid using opioid drugs during anesthesia to prevent short- and long-term opioid side effects while ensuring adequate analgesic control and optimizing postoperative recovery. Proofs of the effect of OFA protocol on optimizing postoperative recovery are still scarce. The study aims to compare the effects of an OFA protocol versus standard anesthesia protocol on the early quality of postoperative recovery (QoR) from major surgeries. Methods The SOFA trial is a prospective, randomized, parallel, single-blind, monocentric study. Patients (n = 140) scheduled for major plastic, visceral, urologic, gynecologic, or ear, nose, and throat (ENT) surgeries will be allocated to one of the two groups. The study group (OFA group) will receive a combination of clonidine, magnesium sulfate, ketamine, and lidocaine. The control group will receive a standard anesthesia protocol based on opioid use. Both groups will receive others standard practices for general anesthesia and perioperative care. The primary outcome measure is the QoR-15 value assessed at 24 h after surgery. Postoperative data such as pain intensity, the incidence of postoperative complication, and opioid consumption will be recorded. We will also collect adverse events that may be related to the anesthetic protocol. Three months after surgery, the incidence of chronic pain and the quality of life will be evaluated by phone interview. Discussion This will be the first study powered to evaluate the effect of OFA versus a standard anesthesia protocol using opioids on global postoperative recovery after a wide range of major surgeries. The SOFA trial will also provide findings concerning the OFA impact on chronic pain incidence and long-term patient quality of life. Trial registration ClinicalTrials.gov NCT04797312. Registered on 15 March 2021

Oral Midodrine Hydrochloride for Prevention of Orthostatic Hypotension during Early Mobilization after Hip Arthroplasty

2015 ◽  
Vol 123 (6) ◽  
pp. 1292-1300 ◽  
Author(s):  
Øivind Jans ◽  
Jesper Mehlsen ◽  
Per Kjærsgaard-Andersen ◽  
Henrik Husted ◽  
Søren Solgaard ◽  
...  
Keyword(s):  
Relative Risk ◽  
Total Hip Arthroplasty ◽  
Orthostatic Hypotension ◽  
Hip Arthroplasty ◽  
Primary Outcome ◽  
Orthostatic Intolerance ◽  
Early Mobilization ◽  
Major Surgery ◽  
Double Blind ◽  
Total Hip

Abstract Background Early postoperative mobilization is essential for rapid recovery but may be impaired by orthostatic intolerance (OI) and orthostatic hypotension (OH), which are highly prevalent after major surgery. Pathogenic mechanisms include an insufficient postoperative vasopressor response. The oral α-1 agonist midodrine hydrochloride increases vascular resistance, and the authors hypothesized that midodrine would reduce the prevalence of OH during mobilization 6 h after total hip arthroplasty relative to placebo. Methods This double-blind, randomized trial allocated 120 patients 18 yr or older and scheduled for total hip arthroplasty under spinal anesthesia to either 5 mg midodrine hydrochloride or placebo orally 1 h before mobilization at 6 and 24 h postoperatively. The primary outcome was the prevalence of OH (decrease in systolic or diastolic arterial pressures of &gt; 20 or 10 mmHg, respectively) during mobilization 6 h after surgery. Secondary outcomes were OI and hemodynamic responses to mobilization at 6 and 24 h. Results At 6 h, 14 (25%; 95% CI, 14 to 38%) versus 23 (39.7%; 95% CI, 27 to 53%) patients had OH in the midodrine and placebo group, respectively, relative risk 0.63 (0.36 to 1.10; P = 0.095), whereas OI was present in 15 (25.0%; 15 to 38%) versus 22 (37.3%; 25 to 51%) patients, relative risk 0.68 (0.39 to 1.18; P = 0.165). At 24 h, OI and OH prevalence did not differ between groups. Conclusions Preemptive use of oral 5 mg midodrine did not significantly reduce the prevalence of OH during early postoperative mobilization compared with placebo. However, further studies on dose and timing are warranted since midodrine is effective in chronic OH conditions.

scholarly journals ENHANCED RECOVERY (ERAS) AFTER LIVER SURGERY:COMPARATIVE STUDY IN A BRAZILIAN TERCIARY CENTER

2019 ◽  
Vol 32 (1) ◽  
Author(s):  
Uirá Fernandes TEIXEIRA ◽  
Marcos Bertozzi GOLDONI ◽  
Fábio Luiz WAECHTER ◽  
José Artur SAMPAIO ◽  
Florentino Fernandes MENDES ◽  
...  
Keyword(s):  
Enhanced Recovery ◽  
Surgical Stress ◽  
Length Of Hospital Stay ◽  
Early Mobilization ◽  
Oral Feeding ◽  
Control Group ◽  
Colonic Surgery ◽  
Early Oral Feeding ◽  
Tertiary Center ◽  
Eras Protocol

ABSTRACT Background: After the publication of the first recommendations of ERAS Society regarding colonic surgery, the proposal of surgical stress reduction, maintenance of physiological functions and optimized recovery was expanded to other surgical specialties, with minimal variations. Aim: To analyze the implementation of ERAS protocols for liver surgery in a tertiary center. Methods: Fifty patients that underwent elective hepatic surgery were retrospectively evaluated, using medical records data, from June 2014 to August 2016. After September 2016, 35 patients were prospectively evaluated and managed in accordance with ERAS protocol. Results: There was no difference in age, type of hepatectomy, laparoscopic surgery and postoperative complications between the groups. In ERAS group, it was observed a reduction in preoperative fasting and in the length of hospital stay by two days (p< 0.001). Carbohydrate loading, j-shaped incision, early oral feeding, postoperative prevention of nausea and vomiting and early mobilization were also significantly related to ERAS group. Oral bowel preparation, pre-anesthetic medication, sub-costal incision, prophylactic nasogastric intubation and abdominal drainage were more common in control group. Conclusion: Implementation of ERAS protocol is feasible and beneficial for health institutions and patients, without increasing morbidity and mortality.

Sign in / Sign up

Export Citation Format

Share Document