scholarly journals WAYS OF PREVENTION SYNDROME OF INTRA-ABDOMINAL HYPERTENSION IN BARIATRIC SURGERY

2019 ◽  
Vol 178 (5) ◽  
pp. 16-21
Author(s):  
M. I. Neimark ◽  
A. Yu. Elizariev ◽  
R. V. Kiselev
Keyword(s):  
Bariatric Surgery ◽  
Continuous Infusion ◽  
Postoperative Period ◽  
Fast Track ◽  
Perioperative Period ◽  
Abdominal Pressure ◽  
Fast Track Surgery ◽  
Beach Chair Position ◽  
Abdominal Hypertension ◽  
Combined Anesthesia

Patients with obesity who have undergone intra-abdominal endoscopic intervention belong to the category of patients with an increased risk of developing the syndrome of intra-abdominal hypertension (SIAH), which dictates the need to develop interventions aimed at its prevention.The OBJECTIVE was to evaluate the effectiveness of complex integrated methods of SIAH prevention in patients with morbid obesity with endoscopic bariatric surgery.MATERIAL AND METHODS. A randomized trial of 69 patients with a body mass index >35 kg/m INTENSIVE 2 was conducted; patients were divided into two groups depending on the type of anesthesia. In the 1st group (n=34), the operation was performed under combined anesthesia based on low-flow inhalation with desflurane in combination with prolonged epidural analgesia (PEA) with ropivacaine. Maintaining a deep level of myorelaxation under the control of acceleromyography in the post-tetanic counts (PTC) mode was achieved by continuous infusion of rocuronium. In the perioperative period, the infusion patients were in the «beach chair» position, and their research was carried out according to the principles of fast track surgery. In the 2nd group (n=35), the operation was performed under combined anesthesia based on lowflow inhalation with desflurane, neuromuscular blockade was performed by bolus injection of rocuronium under the control of acceleromyography in train of four (TOF) mode. Analgesia was provided by systemic administration of opioids. In both groups, markers of kidney injury were investigated, intra-abdominal pressure was monitored, the effectiveness of recovery after surgery and the quality of postoperative analgesia were assessed.RESULTS. A significantly lower level диурез of intra-abdominal pressure (IAP), связь higher compliance evaluation of the anterior crit abdominal внутрибрюшной wall, and a significantly стаканов lower level управляемой of markers of renal study injury in the отмечено postoperative period bariatric were revealed raga in the first дозе group compared to the second group during темпу the perioperative study period. keulenaerСONCLUSION. The effectiveness of using the position of deep muscle relaxation in the continuous infusion mode, adequate analgesia in the perioperative period using neuraxial techniques, using the «beach chair» position on the operating table and in the postoperative period, managing patients using fast track surgery for preventing the development of SIAG was identified.The authors declare no conflict of interest.The authors confirm that they respect the rights of the people participated in the study, including obtaining informed consent when it is necessary, and the rules of treatment of animals when they are used in the study. Author Guidelines contains the detailed information.

scholarly journals Fast-Track Surgery Could Improve Postoperative Recovery in Patients with Laparoscopy D2 Gastrectomy

2017 ◽  
Vol 102 (3-4) ◽  
pp. 151-156 ◽  
Author(s):  
Jiayan Wu ◽  
Hongcun Sha ◽  
Xiaoting Ren ◽  
Xiaoming Hong
Keyword(s):  
Fast Track ◽  
Perioperative Period ◽  
Bowel Function ◽  
Medical Intervention ◽  
Postoperative Recovery ◽  
Conventional Care ◽  
Fast Track Surgery ◽  
D2 Gastrectomy ◽  
Care Groups ◽  
Postoperative Stress

The objective of this study is to evaluate the safety and efficacy of fast track surgery (FTS) management in gastric cancer (GC) with laparoscopy D2 gastrectomy. FTS is the integration of different medical intervention activities during the perioperative period to accelerate the recovery of patients undergoing surgery. It has been used for colorectal cancer. The present study focuses on evaluating FTS in GC with laparoscopy D2 gastrectomy. Seventy-five patients diagnosed with GC between June 2014 and December 2016 were enrolled in this study and were divided into FTS and conventional care groups. All patients received elective standard D2 gastrectomy. The clinical parameters and serum indicators were compared. FTS was associated with shorter postoperative hospital stay (17.17 ± 9.27 versus 14.06 ± 5.05 days; P = 0.046), shorter time to bowel function return (4.56 ± 1.16 versus 3.12 ± 0.88 days; P < 0.01), less stress response on postoperative day 1 (108.13 ± 40.55 versus 79.01 ± 37.10; P < 0.01), and accelerated decrease in serum albumin (30.76 ± 4.10 versus 32.56 ± 3.20 g/L; P = 0.04) and lymphocyte count (0.78 ± 0.34 versus 0.78 ± 0.34 g/L; P = 0.016). The postoperative complications, including ileus, anastomotic leakage, and infection, were similar (all P > 0.05). FTS combined with laparoscopy D2 gastrectomy can promote faster postoperative recovery, improve early postoperative nutritional status, and more effectively reduce postoperative stress reaction and is safe and effective for GC patients.

scholarly journals Effect of L-arginine on the resolution rate of postoperative ileus in patients with urgent abdominal pathology

2018 ◽  
Vol 1 (1) ◽  
pp. 34-40
Author(s):  
L. V. Novitskaya-Usenko ◽  
O. N. Kligunenko ◽  
S. G. Dyomin ◽  
O. V. Zaharchuk ◽  
A. I. Lavrova
Keyword(s):  
Intensive Care ◽  
Gastrointestinal Tract ◽  
Postoperative Period ◽  
Intestinal Motility ◽  
Postoperative Ileus ◽  
Abdominal Pressure ◽  
Surgical Interventions ◽  
Number Of Patients ◽  
Abdominal Hypertension ◽  
Pharmacological Correction

Background. Postoperative ileus is widespread in the postoperative period and occurs not only after extended operations on the abdominal cavity, retroperitoneal cavity, but also after minor surgical interventions, including laparoscopic operations [1, 2]. The aim of this study is to increase the effectiveness of intensive care after urgent abdominal surgeries by developing a drug correction for bowel motility disorders based on studying of the motor and evacuator function of the gastrointestinal tract, inflammatory markers, hemodynamic parameters and electrolyte blood composition. Materials and methods. 51 patients were examined, who underwent urgent surgical interventions with laparotomy access for infringed hernias, acute intestinal obstruction, perforation of duodenal ulcers. Depending on the variant of drug correction of postoperative intestinal motility disorder, patients were divided into 2 groups. The first (control) group (n = 27). In the postoperative period, the pharmacological correction of the motor-evacuator function of the gastrointestinal tract was performed by combining a solution of 0,5% metoclopramide and neostigmine bromide. The second (main) group (n = 24). In the postoperative period, the pharmacological correction of the motor-evacuator function of the gastrointestinal tract was performed by combining 0.5% metoclopramide solution and L-arginine (Tivortin, Yuriya-Farm, Ukraine). Motorevacuation disorders of the gastrointestinal tract (the frequency of development of bloating, nausea, vomiting, delay in the escape of gases, an independent moving of gases, measurement of intra-abdominal pressure), parameters of hemodynamics, the level of systolic, diastolic, mean arterial pressure, cardiac index, stroke volume, total peripheral vascular resistance, heart rate, minute volume of blood circulation and left ventricular power, markers of inflammation (leukocyte count, fibrinogen, IL-lα, TNFα, IL-10, calculation of leukocyte intoxication index, the study of electrolytes of blood serum (Na+, K+, Ca2+, Cl- ) were studied before and after 1st, 3rd and 7th days after the operation. Results. The use of L-arginine leads to a decrease in the phenomena of peripheral vasospasm, which, improving the microcirculation of the intestinal wall leads to a faster recovery of the motor-evacuation function of the gastrointestinal tract. With standard prokinetic therapy (combination of metoclopramide with neostigmine bromide), the number of patients with elevated intra-abdominal pressure increases in 92,1%, оn the second day after surgery, the number of patients with elevated intra-abdominal pressure exceeds the norm in 100%. The resumption of intestinal motility 3 days after the operation is accompanied by the normalization of intra-abdominal pressure in 55% of patients. Against the backdrop of the use of L-arginine with metoclopramide on day 1 after the operation, the number of patients with an increase in intra-abdominal pressure does not exceed 50%. 37,5% of them have elevated intra-abdominal pressure, 8,3% have abdominal hypertension of the 1st degree. On the second day of the observation, intraabdominal pressure in 41,7% patients normalized, abdominal hypertension of 1 degree was noted in 16,7%. of them. On the 3rd day after surgery, intra-abdominal pressure corresponded to the norm in 79,2% of patients, abdominal hypertension of 1st degree was registered in 8,3% of patients. Сonclusions. The use of a combination of metoclopramide with L-arginine reduces the stress on the myocardium, activates - anti-inflammatory link of the cytokine system, accelerates the normalization of intra-abdominal pressure, increases the rate of self-evacuation, independent defecation, and reduces the patients’ stay in the intensive care, which makes it possible to recommend it as the most optimal remedy for resuming motor activity intestines after urgent operations in abdominal surgery.

scholarly journals Optimization of perioperative management of patients with small intestinal urinary diversion after radical cystectomy

2017 ◽  
Vol 98 (6) ◽  
pp. 900-906
Author(s):  
T N Musayev ◽  
Z Sh Vezirova
Keyword(s):  
Radical Cystectomy ◽  
Postoperative Period ◽  
Perioperative Period ◽  
Early Postoperative Period ◽  
Urologic Oncology ◽  
Patient Preparation ◽  
Combined Anesthesia ◽  
Small Intestinal ◽  
The Republic ◽  
Criteria For Evaluation

Aim. To evaluate the incidence of complications of the developed scheme of management of patients in the perioperative period after radical cystectomy with small intestinal urinary derivation. Methods. The study included 105 (100%) patients treated at the department of urologic oncology of the National center of oncology of the Ministry of Health of the Republic of Azerbaijan during the period from 2008 to 2015. Modified Hautman Ileocystoplasty was performed in 87 (82.9%) patients, urine derivation by Bricker’s method - in 18 (17.1%) patients. Tactics for patient management corresponded to the proposed scheme of patient preparation and algorithm for the management. The main criteria for evaluation of the efficacy of the proposed scheme were the incidence and nature of the most common complications in the early postoperative period (30 days) according to the Clavien-Dindo classification. Results. 131 complications occurred in 71 (67.6%) patients within 30 days after the operation, out of them one complication in 32 (30.5%) patients, two in 23 (22%), three complications in 11 (10.5%), four and more - in 5 (4.8%) patients. The most common complication in the early postoperative period was gastrointestinal atony - 33.4% (n=35). Conclusion. Combined anesthesia and extraperitoneal bladder removal provide significant reduction of the incidence of postoperative gastrointestinal atony; for conclusive evaluation of the effectiveness of the proposed complex controlled studies are necessary.

scholarly journals Effect of fast-track surgery in gynecological laparoscopy: a randomized controlled trial

2020 ◽  
Vol 7 (3) ◽  
pp. 235-238
Author(s):  
Xue-Ping Zhu ◽  
Sha-Sha Zhao ◽  
Jie-Dan Qin
Keyword(s):  
Fast Track ◽  
Controlled Trial ◽  
Postoperative Nausea And Vomiting ◽  
Perioperative Period ◽  
Bowel Function ◽  
Control Group ◽  
Fast Track Surgery ◽  
Randomized Controlled ◽  
Gynecological Laparoscopy ◽  
Function Recovery

AbstractObjectiveTo evaluate the value of fast-track surgery (FTS) in gynecological laparoscopy during the perioperative period.MethodsThe clinical data of 234 patients who underwent gynecological laparoscopy from January to December in 2018 were collected. Of note, 117 patients received a routine nursing method (control group), and 117 patients received the FTS nursing method (observation group).ResultsCompared with the control group, FTS group had a quicker postoperative bowel function recovery, earlier to get out of bed, and a lower anxiety level (P < 0.05); The incidence of postoperative nausea and vomiting of two groups had no statistical difference.ConclusionsThe application of FTS in gynecological laparoscopy is safe, effective, and worth promoting.

scholarly journals Fast-track surgery and enhanced recovery after surgery concepts after their application in hernia repair

2021 ◽  
Vol 68 (1) ◽  
pp. 10-16
Author(s):  
V.V. Boiko ◽  
◽  
K.Y. Parkhomenko ◽  
O.E. Feskov ◽  
A.Y. Gavrikov ◽  
...  
Keyword(s):  
Hernia Repair ◽  
Postoperative Period ◽  
Efficient Solution ◽  
Fast Track ◽  
Enhanced Recovery ◽  
Enhanced Recovery After Surgery ◽  
Preoperative Preparation ◽  
Fast Track Surgery ◽  
Postoperative Rehabilitation ◽  
Surgical Interventions

The growing number of surgical interventions that occur worldwide, along with the increasing prevalence of general somatic pathology, keeps current the problem of preventing complications during surgery and in the postoperative period. An efficient solution to this problem is to determine the risk of surgery, directed preoperative preparation, taking into account the comorbidity, optimization of surgery and postoperative rehabilitation. Fast-track surgery and enhanced recovery after surgery programs have significant potential for improving outcomes of surgery. These programs are widely used in various fields of surgery, but their effectiveness in herniology, especially in the performing simultaneous surgeries, there are very few reports, and the results of individual studies are contradictory. The review provides an analysis of holistic strategies of fast-track surgery and enhanced recovery and individual measures to assess the effectiveness of their impact on the immediate results of surgical interventions.

scholarly journals Effectiveness of the concept of fast-trak surgery for simultaneous laparoscopic hernioplastics and cholecistectomy

2021 ◽  
Keyword(s):  
Postoperative Period ◽  
Inpatient Treatment ◽  
Fast Track ◽  
Early Postoperative Period ◽  
Wound Complications ◽  
Fast Track Surgery ◽  
Surgical Interventions ◽  
Group I ◽  
Laparoscopic Hernioplasty ◽  
Group Ii

The aim of the research was to study the feasibility and effectiveness of simultaneous laparoscopic hernioplasty and cholecystectomy in patients with combined abdominal pathology. Material and methods. Simultaneous laparoscopic hernioplasty and cholecystectomy during 2015–2019 performed on 70 patients, including 49 (70 %) women, mean age 57.3 ± 6.5 g. In 37 patients the principles of Fast-track surgery were applied (group I), including thorough examination for diagnostics of combined abdominal pathology and clinically significant general somatic pathology; if necessary a course of therapy for full compensation of general somatic pathology was prescribed; during the operation of epidural prolonged anesthesia; choice in favor of laparoscopic technology; at the end of the operation – irrigation of the subdiaphragmatic space with local anesthetic; postoperatively: early drainage removal; withdrawal from opioids by prescribing parenteral paracetomol; activation of the patient 6-8 hours after surgery; on the day of surgery – use of chewing gum and fluid intake. In 33 patients the standard complex of perioperative management (group II) is applied. The immediate results of surgical interventions have been studied. Results. There were no significant complications during the operation and in the early postoperative period. In the first group, seroma (after open alloplasty) was detected in 2 (5 %) cases, and in the second group, small wound complications were detected in 4 (12 %) cases (p > 0.05 according to the χ2 criterion). The duration of inpatient treatment in patients of group I is 4.4 ± 1.2 months, in group II – 7.0 ± 1.3 days (р < 0.001 by Student’s test). Conclusion. Application of the principles of Fast-track surgery and accelerated recovery at all stages of simultaneous laparoscopic hernioplasty and cholecystectomy (preparation for surgery, during the operation and in the postoperative period) does not increase the number of postoperative complications and decreased duration of inpatient treatment from 7,0 ± 1,3 in patients with traditional postoperative management to 4,4 ± 1,2 days.

scholarly journals Evolution of approaches in treatment of acute pain syndrome (review)

2020 ◽  
Vol 4 (39) ◽  
pp. 28-34
Author(s):  
M. S. Vetsheva ◽  
O. L. Podkorytova ◽  
V. O. Churakov ◽  
A. D. Dushkin ◽  
M. P. Golovashchenko
Keyword(s):  
Acute Pain ◽  
Fast Track ◽  
Pain Syndrome ◽  
Perioperative Period ◽  
Point Of View ◽  
The Body ◽  
New Drugs ◽  
Patient Controlled Analgesia ◽  
Fast Track Surgery ◽  
Independent Direction

In recent years, the treatment of acute pain syndrome has been considered as an independent direction in anesthesiology and intensive care. New schemes of postoperative analgesia and new drugs developed by pharmacologists are actively being introduced. One of the newer regimens for pain relief is patient-controlled analgesia (CPA) or on-demand analgesia. The development of the concept of fast track surgery, one of the most widely discussed areas for the development of innovative technologies in modern surgery, from the point of view of the anesthesiologist of the resuscitation specialist, minimizes the stress response of the body to surgical aggression at all stages of the perioperative period. Increasingly, the method of preemptive analgesia is used more widely, based on the use of analgesics before the start of the operation, which helps to prevent the occurrence of peripheral and central sensitization.

scholarly journals Effect of operation technic on development of postoperative complications after appendectomy

2018 ◽  
Vol 9 (4) ◽  
pp. 63-66
Author(s):  
P. M. Lavreshin ◽  
V. K. Gobedgishvili ◽  
V. V. Gobedgishvili ◽  
E. V. Kochkarov ◽  
O. V. Vladimirova
Keyword(s):  
Postoperative Complications ◽  
Acute Appendicitis ◽  
Postoperative Period ◽  
Fast Track ◽  
Test System ◽  
Abdominal Adhesions ◽  
Fast Track Surgery ◽  
Results Of Treatment ◽  
Connective Tissue Dysplasia ◽  
Instrumental Methods

Objective: to improve the results of treatment of patients with acute appendicitis. Te results of surgical treatment of 360 patients with acute appendicitis were presented.Materials and methods: in predicting of development of intra-abdominal adhesions in patients afer appendectomy and of effectiveness of anti-adhesion therapy in postoperative period was used clinical, laboratorial (phenotype signs of connective tissue dysplasia syndrome, activity of the enzyme N-acetyltransferase, a test system based on sorbents with magnetic properties with immobilized granular antigen from adhesive tissue), instrumental methods of research. Te frst group included 120 (50%) patients who underwent standard appendectomy. In 120 patients with acute appendicitis (the second group) the elements of “Fast-Track” surgery was used in performing classical laparotomy appendectomy. Te third group consisted of 120 patients who underwent laparoscopic appendectomy.Results: all patients with diagnosed adhesive process in the early stages of its development in postoperative period were provided with anti-adhesion therapy. Te least number of postoperative complications was observed in cases of multimodal approach to treatment of acute appendicitis.Conclusions: application of “Fast-Track” surgery principles allowed to reduce development of intra-abdominal adhesion afer surgery compared with traditional appendectomy on 6.6 %, and with laparoscopic — on 2.8 %.

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