The purpose of the reviewThe analysis of the components of enhanced recovery after surgery (ERAS) protocols in urologic surgery.Recent findingsERAS protocols has been studied for over 20 years in different surgical procedures, mostly in colorectal surgery. The concept of improving patient care and reducing postoperative complications was also applied to major urologic surgery and especially procedure of radical cystectomy. This procedure is technically challenging, due to a major surgical resection and high postoperative complication rate that may reach 65%. Several clinical pathways were introduced to improve perioperative course and reduce the length of hospital stay. These protocols differ from ERAS modalities in other surgeries. The reasons for this are longer operative time, increased risk of perioperative transfusion and infection, and urinary diversion achieved using transposed intestinal segments. Previous studies in this area analyzed the need for mechanical bowel preparation, postoperative nasogastric tube decompression, as well as the duration of urinary drainage. Furthermore, the attention has also been drawn to perioperative fluid optimization, pain management, and bowel function.SummaryNotwithstanding partial resemblance between the pathways in major urologic surgery and other pelvic surgeries, there are still scarce guidelines for ERAS protocols in urology, which is why further studies should assess the importance of preoperative medical optimization, implementation of thoracic epidural anesthesia and analgesia, and perioperative nutritional management.
Study aimed to investigate relationship between oxidative stress markers and postoperative recovery in woman after abdominal hysterectomy, as well as to test the hypothesis that diff erent analgesics diff erently infl uence redox status. e quality of recovery was evaluated with a QoR-40 questionnaire in fi fty-one patients who underwent abdominal hysterectomy, preoperatively and on the 1 st , 2 nd , 3 rd postoperative days (POD1,2,3). Blood samples were collected at baseline (T0), 3 (T1), 24 (T2), 48 (T3) and 72 (T4) hours after surgery. Oxidative stress markers concentrations (TBARS, NO 2 -, H 2 O 2 , O 2 -) as well as antioxidative enzymes (SOD, CAT, and GSH) were analyzed.QoR-40 total score signifi cantly declined on POD1 and POD2 and returned to baseline levels on POD3 (p<0.001). H 2 O 2 levels signifi cantly decreased from T0 to T3 and then, increased at T4 (p=0,011). Changes of TBARS and H 2 O 2 from T0 to T3 showed signifi cant and negative correlation (r=-0.303, p=0.046). ere was no signifi cant correlation between QoR-40 total score and any parameter of oxidative stress response (p>0.05). Changes in TBARS levels from T0 to T3 were statistically signifi cant between the study subgroups primarily due to increase of the concentrations in patients receiving paracetamol (p=0.031). Patients age, duration of surgery and cigarette smoking status showed signifi cant infl ucences on and association with some oxidative stress response markers (TBARS, О 2 -, CAT) (p<0.05). Women who underwent hysterectomy had signifi cant changes of H 2 O 2 and TBARS activity however, those changes were not associated with changes of QoR-40 total scores during recovery.
Background and Objectives: Coagulation disorders during COVID-19 infection are associated with poor prognosis and disease severity, because two processes that interfere each other are thrombosis and inflammation. Very important issue for clinicians is timely and adequate hemostasis and inflammation monitoring in order to prevent and treat potentially lethal consequences. Materials and Methods: The study was approved by the Ethics Committee of the Clinical center Nis, Serbia. One hundered fourty two patients presented with COVID-19 ARDS were admitted to the ICU in Clinic for anesthesiology Clinical Center Nis, from 14th April 2020 to 25 th May 2020. On admission blood was collected for biochemical and coagulation testing. The data obtained was analyzed using Statistical Package for Social Sciences (SPSS v. 25, Chicago, IL, USA). Results: Among all parameters assessed, mortality was associated with higher age (p&lt;0.05), higher factor I (p&lt;0.05), INR (p&lt;0.001), D-Dimer (p&lt;0.001), ADP (p&lt;0.001), ASPI (p&lt;0.001), TRAP (p&lt;0.001), PSEP (p&lt;0.001), A5 extest (p&lt;0.01), A10 ex test (p&lt;0.01), A5 fib (p&lt;0.001), A10fib (p&lt;0.001) and MCF fib (p&lt;0.001) values, but lower CT extest values (p&lt;0.05). Mortality was associated with extreme values of D-Dimer above 1000 (p&lt;0.001), ADP above 590 (p&lt;0.001), ASPI above 800 (p&lt;0.001), TRAP above 1500 (p&lt;0.001) and PSEP above 1000 (p&lt;0.05). Conclusions: The key to success in the treatment of COVID 19 infection is timely and adequate therapy and patient monitoring, which is impossible without early risk stratification and mortality prediction. Sophisticated hemostasis parameters can contribute to early risk assessment, which was initially performed only on the basis of the patient's clinical status.
Background and Objectives: Coagulation disorders during COVID-19 infection are associated with a poorer prognosis and higher disease severity because thrombosis and inflammation are two processes that interfere with each other. A very important issue for clinicians is timely and adequate hemostasis and inflammation monitoring to prevent and treat potentially lethal consequences. The aim of this study was to identify specific hemostatic parameters that are associated with a higher risk of intrahospital mortality. Materials and Methods: This study was approved by the Ethics Committee of the Clinical Center Nis in Serbia. One hundred and forty-two patients presented with COVID-19 ARDS and were admitted to the ICU in the Clinic for Anesthesiology at the Clinical Center Nis from 14 April 2020 to 25 May 2020. Upon admission, blood was collected for biochemical and coagulation testing. The data obtained were analyzed using the Statistical Package for Social Sciences (SPSS v. 25, Chicago, IL, USA). Results: Among all the parameters assessed, older age; increased levels of fibrinogen, INR, D-dimer, and presepsin; and higher results in the platelet aggregation tests (aggregation induced by adenosine diphosphate based on the ADP test (AU/min), aggregation induced by arachidonic acid based on the ASPI test (AU/min), and aggregation induced by thrombin based on the TRAP test (AU/min)) and some assays of the viscoelastic test (clot amplitude after 5 min in the extrinsic coagulation pathway based on the A5 EX-test (mm), clot amplitude after 10 min in the extrinsic coagulation pathway based on the A10 EX-test (mm), clot amplitude after 5 min regarding functional fibrinogen based on the A5 FIB-test (mm), clot amplitude after 10 min regarding functional fibrinogen based on the A10 FIB-test (mm), and maximum clot firmness based on the MCF FIB-test (mm)); and lower values of viscoelastic clotting time in the extrinsic coagulation pathway based on the CT EX-test (s) were significantly correlated with mortality. In the multivariate analysis, D-dimer levels above 860 ng/mL, higher TRAP test value bins, and values above the normal reference range of the A10 FIB test were found to be independent predictors of mortality. Conclusions: Sophisticated hemostasis parameters can contribute to early risk assessment, which has initially been performed only on the basis of patients’ clinical status. Hypercoagulability is the main coagulation disorder in COVID-19 infection.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
customersupport@researchsolutions.com
10624 S. Eastern Ave., Ste. A-614
Henderson, NV 89052, USA
This site is protected by reCAPTCHA and the Google Privacy Policy and Terms of Service apply.
Copyright © 2025 scite LLC. All rights reserved.
Made with 💙 for researchers
Part of the Research Solutions Family.