Quality of recovery after surgery in patients with frailty

Based on the application of the conditional mean rule, a sampling-recovery algorithm is studied for a Gaussian two-dimensional process. The components of such a process are the input and output processes of an arbitrary linear system, which are characterized by their statistical relationships. Realizations are sampled in both processes, and the number and location of samples in the general case are arbitrary for each component. As a result, general expressions are found that determine the optimal structure of the recovery devices, as well as evaluate the quality of recovery of each component of the two-dimensional process. The main feature of the obtained algorithm is that the realizations of both components or one of them is recovered based on two sets of samples related to the input and output processes. This means that the recovery involves not only its own samples of the restored realization, but also the samples of the realization of another component, statistically related to the first one. This type of general algorithm is characterized by a significantly improved recovery quality, as evidenced by the results of six non-trivial examples with different versions of the algorithms. The research method used and the proposed general algorithm for the reconstruction of multidimensional Gaussian processes have not been discussed in the literature.

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The impact of multimodal analgesia based enhanced recovery protocol on quality of recovery after laparoscopic gynecological surgery: a randomized controlled trial

BMC Anesthesiology ◽

10.1186/s12871-021-01399-2 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Zhiyu Geng ◽

Hui Bi ◽

Dai Zhang ◽

Changji Xiao ◽

Han Song ◽

...

Keyword(s):

Enhanced Recovery ◽

Controlled Trial ◽

Bowel Function ◽

Multimodal Analgesia ◽

Study Group ◽

Gynecological Surgery ◽

Quality Of Recovery ◽

Enhanced Recovery Protocol ◽

The Impact

Abstract Background Our objective was to evaluate the impact of multimodal analgesia based enhanced recovery protocol on quality of recovery after laparoscopic gynecological surgery. Methods One hundred forty female patients scheduled for laparoscopic gynecological surgery were enrolled in this prospective, randomized controlled trial. Participants were randomized to receive either multimodal analgesia (Study group) or conventional opioid-based analgesia (Control group). The multimodal analgesic protocol consists of pre-operative acetaminophen and gabapentin, intra-operative flurbiprofen and ropivacaine, and post-operative acetaminophen and celecoxib. Both groups received an on-demand mode patient-controlled analgesia pump containing morphine for rescue analgesia. The primary outcome was Quality of Recovery-40 score at postoperative day (POD) 2. Secondary outcomes included numeric pain scores (NRS), opioid consumption, clinical recovery, C-reactive protein, and adverse events. Results One hundred thirty-eight patients completed the study. The global QoR-40 scores at POD 2 were not significantly different between groups, although scores in the pain dimension were higher in Study group (32.1 ± 3.0 vs. 31.0 ± 3.2, P = 0.033). In the Study group, NRS pain scores, morphine consumption, and rescue analgesics in PACU (5.8% vs. 27.5%; P = 0.0006) were lower, time to ambulation [5.0 (3.3–7.0) h vs. 6.5 (5.0–14.8) h; P = 0.003] and time to bowel function recovery [14.5 (9.5–19.5) h vs.17 (13–23.5) h; P = 0.008] were shorter, C-reactive protein values at POD 2 was lower [4(3–6) ng/ml vs. 5 (3–10.5) ng/ml; P = 0.022] and patient satisfaction was higher (9.8 ± 0.5 vs. 8.8 ± 1.2, P = 0.000). Conclusion For minimally invasive laparoscopic gynecological surgery, multimodal analgesia based enhanced recovery protocol offered better pain relief, lower opioid use, earlier ambulation, faster bowel function recovery and higher patient satisfaction, while no improvement in QoR-40 score was found. Trial registration ChiCTR1900026194; Date registered: Sep 26,2019.

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