Comparative Clinical Effects of Early Pharyngostomy Alimentation and Intravenous Fluid Infusion following Oesophageal Transection and Anastomosis in Nigerian Breeds of Dogs

Twelve adult Nigerian breeds of dogs were used to compare the clinical responses of dogs alimented through pharyngostomy tubes (PGTs) with those maintained on intravenous infusion (50:50 mixture of Ringers lactate and 5% dextrose saline) during the first 14 days following oesophageal transection and anastomosis (OTA). The dogs were assigned to two groups (n=6), the pharyngostomy tube (PGT) group and the intravenous fluid infusion (IVF) group (n=6). Dogs in both groups underwent routine OTA. The PGT group was fed blanched processed dog food at 70g/kg body weight for 14 days through PGTs, while the IVF group was maintained on intravenous fluids at a dose of 70 mL/kg body weight daily also for 14 days post operatively. The postoperative complications observed in both groups showed that the mortality rate in the IVF group (83.3%) was significantly (P < 0.05) higher than in the PGT group (16.7%). Vomiting and leakages at the site of oesophageal anastomosis did not differ significantly between the groups. Cervical swelling was observed in two dogs (33.3%) in the IVF group, while tenesmus and displacement of the tubes were recorded in 66.6% and 100% respectively of the dogs in the PGT group. It is concluded that feeding dogs which had undergone OTA through PGTs during the immediate postoperative period reduces their morbidity and mortality; and shortens the recovery period when compared with similar dogs maintained solely on intravenous fluids. Keywords: Oesophageal, Transection, Anastomosis, Pharyngostomy, Complications, Morbidity, Mortality.

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Effects of Intravenous Fluid Restriction on Postoperative Complications

50 Studies Every Anesthesiologist Should Know ◽

10.1093/med/9780190237691.003.0023 ◽

2018 ◽

pp. 119-124

Keyword(s):

Body Weight ◽

Postoperative Complications ◽

Colorectal Surgery ◽

Intravenous Fluid ◽

Standard Group ◽

Fluid Restriction ◽

Standard Regimen ◽

Elective Colorectal Surgery ◽

Thoracic Epidural ◽

Fluid Regimen

This case focuses on the effects of limiting intravenous fluids on postoperative complications by asking the question: What are the effects of a restricted intravenous fluid regimen targeting an unchanged body weight vs. a standard regimen on complications after elective colorectal surgery? Patients receiving combined thoracic epidural and general anesthesia were randomized to two groups: the restricted fluid regimen and the standard fluid regimen. A total of 141 patients completed the trial: 69 in the restricted group and 72 in the standard group. This randomized, observer-blinded clinical trial demonstrated that a restricted intravenous fluid regimen aimed at unchanged body weight reduced complications after elective colorectal surgery.

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Intravenous fluid and electrolyte administration in elective gastrointestinal surgery: mechanisms of excessive therapy

Annals of The Royal College of Surgeons of England ◽

10.1308/rcsann.2017.0077 ◽

2017 ◽

Vol 99 (6) ◽

pp. 497-503 ◽

Cited By ~ 4

Author(s):

RG Simpson ◽

J Quayle ◽

N Stylianides ◽

G Carlson ◽

M Soop

Keyword(s):

Body Weight ◽

Epidural Analgesia ◽

Postoperative Morbidity ◽

Independent Predictor ◽

Gastrointestinal Surgery ◽

Intravenous Fluid ◽

Intravenous Fluids ◽

Intravenous Fluid Administration ◽

Cumulative Fluid Balance ◽

Upper Gastrointestinal

INTRODUCTION While clinical guidelines stress the importance of the judicious perioperative intravenous fluid administration, data show that adherence to these protocols is poor. The reasons have not been identified. We therefore audited the magnitude and indications of fluid and electrolyte administration in a teaching hospital. We hypothesised that epidural analgesia is associated with excessive fluid therapy. MATERIALS AND METHODS Intravenous fluid and electrolyte administration during the day of surgery and the subsequent 2 days in consecutive patients undergoing elective gastrointestinal surgery between November 2013 and May 2014 were retrospectively audited. Timing, volumes and indications were recorded. RESULTS One hundred patients undergoing elective gastrointestinal resection were studied. Patients received 9030 ml ± 2860 ml (mean ± standard deviation) intravenous fluids containing a total of 1180 ml ± 420 mmol sodium and resulting in a cumulative fluid balance of +5120 ml ± 2510 ml; 44% ± 14% of total volumes were given in theatre. Nearly all fluid was given for maintenance, 100% (96–100%, interquartile range), with 17 patients only receiving replacement or resuscitation. Independent predictors of increased volumes included open surgery, upper gastrointestinal surgery, increased duration and epidural analgesia but not body weight. Postoperative fluid volume was the only independent predictor of postoperative complication grade (P = 0.0044). CONCLUSIONS Despite published guidelines, perioperative fluid and electrolyte administration were excessive and were associated with postoperative morbidity. Substantial volumes were administered in theatre. Nearly all administration was for maintenance, yet patients received approximately five times the amount of sodium required. Epidural analgesia was an independent predictor of fluid volumes but body weight was not.

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A Toxicological Evaluation of Methylliberine (Dynamine®)

Journal of Toxicology ◽

10.1155/2019/4981420 ◽

2019 ◽

Vol 2019 ◽

pp. 1-25

Author(s):

Timothy S. Murbach ◽

Róbert Glávits ◽

John R. Endres ◽

Amy E. Clewell ◽

Gábor Hirka ◽

...

Keyword(s):

Body Weight ◽

Micronucleus Test ◽

Recovery Period ◽

High Dose ◽

Clinical Effects ◽

Oral Toxicity ◽

Food Ingredient ◽

Toxicological Evaluation ◽

Potential Health

Methylliberine (CAS 51168-26-4), a methoxiuric acid, is a caffeine metabolite present at low levels in various Coffea plants; however, very little has been published regarding this compound and we could find no toxicological data in the public domain. Therefore, we undertook the toxicological investigation of a pure, synthetic form of methylliberine in order to evaluate its potential health hazards as a food ingredient. A (1) bacterial reverse mutation test, (2) in vitro mammalian chromosomal aberration test, (3) in vivo mammalian micronucleus test, and (4) 90-day repeated-dose oral toxicity study in rats with a 28-day recovery period were conducted. No in vitro mutagenic or clastogenic activity was observed in the presence or absence of metabolic activation up to the maximum OECD recommended test concentrations. No genotoxicity was observed in the mammalian micronucleus study up to the highest dose tested of 700 mg/kg bw. In the 90-day study, methylliberine was administered to Han:WIST rats at doses of 0, 75, 112, 150, 187, and 225 mg/kg bw/day. No mortality or morbidity was observed and no toxicologically relevant clinical effects or effects on clinical pathology parameters were observed. In male animals, test item-related effects on body weight and sexual organs, which were not reversible after a 28-day recovery period without treatment, were observed in the high-dose group. Body weight development was also slightly and reversibly depressed in the 187 mg/kg bw/day male group. No toxicological effects were observed in females. The NOAEL for females was determined to be 225 mg/kg bw/day, the highest dose tested, while the NOAEL for males was determined to be 150 mg/kg bw/day. Future studies are encouraged to corroborate the safety, and assess efficacy, of methylliberine in humans.

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Intravenous Infusion in Dogs and Primates

Journal of the American College of Toxicology ◽

10.3109/10915819409140654 ◽

1994 ◽

Vol 13 (1) ◽

pp. 40-47 ◽

Cited By ~ 5

Author(s):

C.J. Perkin ◽

R. Stejskal

Keyword(s):

Body Weight ◽

Intravenous Infusion ◽

Body Weight Gain ◽

Femoral Vein ◽

Blood Pressure Measurement ◽

Recovery Period ◽

Vena Cava ◽

Test Material ◽

Catheter Tip ◽

Inflammatory Changes

Continuous intravenous infusion allows the intended clinical dosing regime to be better evaluated during preclinical studies. Depending on the test material and vehicle, infusion for up to 6 months in primates and 12 months in beagle dogs is possible, but 28 days is the most frequent duration. Under general anesthesia, medical grade catheters are placed in the vena cava via the femoral vein, passed subcutaneously, and exteriorized between the scapulae. A jacket and tether system are used to connect the catheter to an external pump for dosing and the animals are allowed to move freely within the cages. Dosing usually commences after a 1-week recovery period. Body weight gain, food intake, and general observations indicate that the procedure does not adversely affect the normal laboratory behavior of the animals. Test article infusion periods from a few minutes up to 24 h a day, 7 days a week are used; a low infusion rate ofsaline is used for the balance of the 24-h period. Dosage volumes up to 120 ml/kg/day can be infused for 28 days and larger volumes for shorter periods. Up to three separate catheters can be inserted to allow coadministration of compounds for assessment of potential interactions. Body weight, ophthalmoscopy, blood sampling, electrocardiography, and indirect blood pressure measurement can be performed during infusion. Histopathologic common changes in all species include thrombosis, proliferation of vascular intima, and various local inflammatory changes at the infusion site in the vicinity of the catheter tip. These generally are considered to be due to physical irritation by the catheter. Secondary changes include pulmonary microemboli or thrombosis and histiocytosis in hepatic sinusoids often with erythrophago-cytosis. The main findings associated with infusion of very large volumes are reticulocytosis and increased hematopoiesis. These spontaneous findings must be distinguished from those possibly related to administration of the test material and/or vehicle.

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Pain therapy to reduce perioperative complications

Innovative Surgical Sciences ◽

10.1515/iss-2019-0008 ◽

2019 ◽

Vol 4 (4) ◽

pp. 158-166

Author(s):

Stephan M. Freys ◽

Esther Pogatzki-Zahn

Keyword(s):

Postoperative Pain ◽

Postoperative Complications ◽

Adverse Events ◽

Acute Pain ◽

Surgical Procedure ◽

Pain Therapy ◽

Recovery Period ◽

Acute Pain Therapy

AbstractThe incidence rates of adverse events secondary to any operation are a well-known problem in any surgical field. One outstanding example of such adverse events is postoperative pain. Thus, the incidence of acute postoperative pain following any surgical procedure and its treatment are central issues for every surgeon. In the times of Enhanced Recovery After Surgery (ERAS) programs, acute pain therapy became an increasingly well investigated and accepted aspect in almost all surgical subspecialties. However, if it comes to the reduction of postoperative complications, in the actual context of postoperative pain, surgeons tend to focus on the operative process rather than on the perioperative procedures. Undoubtedly, postoperative pain became an important factor with regard to the quality of surgical care: both, the extent and the quality of the surgical procedure and the extent and the quality of the analgesic technique are decisive issues for a successful pain management. There is growing evidence that supports the role of acute pain therapy in reducing postoperative morbidity, and it has been demonstrated that high pain scores postoperatively may contribute to a complicated postoperative course. This overview comprises the current knowledge on the role of acute pain therapy with regard to the occurrence of postoperative complications. Most of the knowledge is derived from studies that primarily focus on the type and quality of postoperative pain therapy in relation to specific surgical procedures and only secondary on complications. As far as existent, data that report on the recovery period after surgery, on the rehabilitation status, on perioperative morbidity, on the development of chronic pain after surgery, and on possible solutions of the latter problem with the institution of transitional pain services will be presented.

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129 Compliance with The ERAS Protocol Amongst Colorectal Surgery Junior Doctors at Gloucester Royal Hospital

British Journal of Surgery ◽

10.1093/bjs/znab259.008 ◽

2021 ◽

Vol 108 (Supplement_6) ◽

Author(s):

L Brennan

Keyword(s):

Colorectal Surgery ◽

Enhanced Recovery ◽

Length Of Hospital Stay ◽

Intravenous Fluid ◽

Junior Doctors ◽

Intravenous Fluids ◽

Elective Colorectal Surgery ◽

Royal Hospital ◽

Elective Surgical Procedures ◽

Eras Protocol

Abstract Background Enhanced recovery after surgery (ERAS) is an evidence-based protocol aiming to expedite recovery following elective surgical procedures. ERAS has shown to reduce the length of hospital stay, complications, readmissions, and costs. The junior doctor’s role in ERAS centres around admission, preoperative nutritional care, and ERAS compliance. This audit aimed to review prescribing of perioperative nutritional drinks (NutriciaPreop© and Fortisips) and intravenous fluids for patients undergoing elective colorectal surgery at Gloucester Royal Hospital. Method An 80% standard was set for this audit. A full audit cycle was completed. Drug and intravenous fluid charts were analysed for correct prescribing of NutriciaPreop© and intravenous fluids pre-operatively, and peri operative Fortisips. Improvement measures included ward posters and education to incoming junior doctors. Results Initial data collection showed that 70% of patients received a correct intravenous fluid prescription pre-operatively. 24% of patients were prescribed NutriciaPreop© and 18% were prescribed Fortisips. During re-auditing intravenous fluids were correctly prescribed in 80% of patients, NutriciaPreop© in 67% of patients and Fortisips in 60%. Conclusions This audit emphasises the importance of good quality inductions for junior doctors and how simple measures improve prescribing of essential peri-operative nutrition. Additionally, the value of multidisciplinary team involvement in junior doctor training has been highlighted.

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ANALISIS FAKTOR KEJADIAN PHLEBITIS DENGAN SIMULASI MODEL FISIS ALAT TERAPI INTRAVENA

Jurnal SainHealth ◽

10.51804/jsh.v3i1.336.21-29 ◽

2019 ◽

Vol 3 (1) ◽

pp. 21

Author(s):

Menik Dwi Kurniatie

Keyword(s):

Diastolic Pressure ◽

Maximum Height ◽

Intravenous Fluids ◽

Intravenous Therapy ◽

Fluid Infusion ◽

History Of ◽

Fluid Drop ◽

Mechanical Factors ◽

Physical Phenomena ◽

Drop Rate

Intravenous therapy through long-term infusion is at risk for complications such as phlebitis. The influence of medical factors with a history of hypertension and mechanical factors based on the location of the position of infusion is the main study of the causes of phlebitis.One of the causes of phlebitis is the flow of intravenous fluids which is not proportional to the volume of infusion fluid. Intravenous Therapy Devices with the aim of assessing the physical phenomena modeling experiments intravenous therapy with the theory of fluid mechanics and prove the existence of linkage patient's blood pressure and height of intravenous fluid drop rate. The research method is experimental with the physical modeling of intravenous therapeutic devices. Physical model of intravenous therapy devices using a manometer to measure the pressure tube as diastolic pressure and variation on fluid infusion used was NaCl 0.9% and Glucose 5%. The results of this research was obtained diastolic pressure below 80 mmHg produced a drop rate of fluid infusion is almost constant with a maximum height of a standard intravena pole 1meter, while at an altitude above the altitude variation of normal use by 90 mmHg diastolic pressure with height variations of 1.1 to 1.3 meters yield drop rate a linear of infusion liquid to height variations. So to prevent turbulence of intravenous fluids (the cause of phlebitis) by increasing the location standard for infusion

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How glucagon-like peptide 1 receptor agonists work

Endocrine Connections ◽

10.1530/ec-21-0130 ◽

2021 ◽

Author(s):

Christine Rode Andreasen ◽

Andreas Andersen ◽

Filip Krag Knop ◽

Tina Vilsbøll

Keyword(s):

Body Weight ◽

Therapeutic Potential ◽

Clinical Effects ◽

Glucose Lowering ◽

Receptor Agonists ◽

Reduce Body Weight ◽

Glucagon Like Peptide ◽

Glucagon Like Peptide 1 ◽

Clinical Utilisation

Recent years, glucagon-like peptide 1 receptor agonists (GLP-1RAs) have become central in the treatment of type 2 diabetes (T2D). In addition to their glucose-lowering properties with low risk of hypoglycaemia, GLP-1RAs reduce body weight and show promising results in reducing cardiovascular risk and renal complications in high-risk individuals with T2D. These findings have changed guidelines on T2D management over the last years, and GLP-1RAs are now widely used in overweight patients with T2D as well as in patients with T2D and cardiovascular disease regardless of glycaemic control. The currently available GLP-1RAs have different pharmacokinetic profiles and differ in their ability to improve glycaemia, reduce body weight and in their cardio- and renal protective potentials. Understanding how these agents work, including insights into their pleiotropic effects on T2D pathophysiology, may improve their clinical utilisation and be useful for exploring other indications such as non-alcoholic steatohepatitis and neurodegenerative disorders. In this review, we provide an overview of approved GLP-1RAs, their clinical effects and mode of actions, and we offer insights into the potential of GLP-1RAs for other indications than T2D. Finally, we will discuss the emerging data and therapeutic potential of using GLP-1RAs in combinations with other receptor agonists.

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Tolvaptan in reversing worsening acute heart failure: A systematic review and meta-analysis

Journal of International Medical Research ◽

10.1177/0300060519882221 ◽

2019 ◽

Vol 47 (11) ◽

pp. 5414-5425

Author(s):

Lili Wang ◽

Qianhui Zhang ◽

Meixia Liu ◽

Shuxia Chen ◽

Shuang Han ◽

...

Keyword(s):

Heart Failure ◽

Body Weight ◽

Clinical Outcomes ◽

Acute Heart Failure ◽

Serum Sodium ◽

Meta Analysis ◽

Credible Interval ◽

Current Evidence ◽

Clinical Effects ◽

Body Weight Reduction

Objective In this meta-analysis, we aimed to compare efficacy and clinical outcomes of tolvaptan in treating acute heart failure (AHF). Methods Using MEDLINE, we searched relevant clinical studies using tolvaptan that investigated clinical effects in treating AHF. We performed meta-analysis for potentially extractable clinical outcomes such as body weight reduction, change in serum sodium levels, and clinical or safety events including worsening heart failure, worsening renal function (WRF), all-cause mortality, rehospitalization, and dyspnea improvement. Results The results showed that tolvaptan significantly reduced body weight (mean change: −1.28 kg, 95% credible interval (CI): −1.58–0.98), increased serum sodium levels (mean change: 3.48 mmol/L; 95% Cl: 3.22–3.74), and improved dyspnea function (odds ratio (OR): 1.43; 95% CI: 1.26–1.62) versus conventional therapy. The event risk of WRF was also significantly reduced (OR: 0.35; 95% CI: 0.15–0.80). Low, intermediate, and high tolvaptan doses did not reduce mortality and rehospitalization risks. No significant publication bias was observed regarding effects on mortality and rehospitalization. Conclusion Current evidence indicates that using tolvaptan as add-on therapy can decrease body weight, increase sodium levels, improve dyspnea function, and reverse WRF, which may circumvent loop diuretics overdose and improve outcomes in patients with AHF.

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Factors Affecting Length of Stay Following 3-Column Spinal Osteotomies in Pediatric Patients

Global Spine Journal ◽

10.1177/2192568219895225 ◽

2019 ◽

pp. 219256821989522

Author(s):

So Kato ◽

Taylor Dear ◽

Stephen J. Lewis

Keyword(s):

Body Weight ◽

Postoperative Complications ◽

Length Of Stay ◽

Pediatric Patients ◽

Perioperative Complications ◽

Intraoperative Complications ◽

Operation Time ◽

Fluid Administration ◽

Prolonged Stay ◽

Factors Affecting

Study Design: A retrospective analysis. Objectives: Length of stay (LOS) is one of the important indicators for the quality of patient care. Although perioperative complications are known to be associated with longer LOS in general, little has been understood regarding LOS after 3-column spinal osteotomy for the rigid spinal deformity in pediatric population. The main objective of the article is to identify factors affecting the LOS in pediatric patients undergoing 3-column posterior spinal osteotomies. Methods: Following research ethics approval, a retrospective review was performed of 35 consecutive posterior 3-column spinal osteotomies performed on pediatric patients in a single academic institution. Patients’ demographic data, preoperative comorbidities, details of operative procedures, intraoperative complications, and postoperative complications were investigated, and LOS was compared among the groups. Results: The mean LOS was 9.0 days, and the median LOS was 7 days (range = 4-23 days). Low body weight and syndromic deformity were associated with longer LOS. Operation time ≥6 hours and total perioperative fluid administration greater than or equal to twice the estimated blood volume were associated with longer LOS. Among postoperative complications, those with respiratory complication had prolonged stay. Conclusions: Preoperative low body weight and syndromic scoliosis had longer LOS after 3-column osteotomies. Excessive fluid administration and respiratory complications were associated with longer LOS.

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