Patterns in current anaesthesiological peri‐operative practice for colonic resections: a survey in five northern‐European countries

Hannemann, P. F. W.; Lassen, Kristoffer; Hausel, Jonatan; Nimmo, Susan; Ljungqvist, Olle; Nygren, Jonas; Soop, Mattias; Fearon, K. C. H.; Andersen, Jens T.; Revhaug, Arthur; Meyenfeldt, M.F. von; Dejong, Cornelis H. C.; Spies, Claudia

doi:10.1111/j.1399-6576.2006.01121.x

Cited by 52 publications

(34 citation statements)

References 40 publications

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“…1 One of the current recommendations to control postoperative pain is the use of epidurals. 4 In addition to providing effective analgesia, epidurals reduce the stress response by providing sympathetic block at the level of the spinal cord with a resultant reduction in cortisol secretion. [5][6][7][8][9][10][11] However, vasodilation is a significant side-effect of this sympathetic blockade and creates a relative hypovolaemic state.…”

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confidence: 99%

Low Plasma Albumin Linked to Fluid Overload in Postoperative Epidural Patients

Malhotra

Axisa

2009

annals

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INTRODUCTION Hypotension is commonly associated with epidural use in postoperative patients and is usually treated with fluid or vasopressor therapy. The former can result in fluid overload, associated with significant morbidity. This study aimed to identify factors increasing the likelihood of fluid overload in elective patients. PATIENTS AND METHODS A prospective audit of fluid therapy in elective, postoperative, epidural patients was carried out over a 6-week period in a teaching hospital in England. Demographic, biochemical, and fluid balance data were collected and analysed to determine which factors had the strongest correlation with fluid overload. Fluid overload was calculated as the percentage of net fluid input relative to pre-operative body weight (%FO). RESULTS Thirty-two patients were included in this study. An overload of 10% of the patients' pre-operative body weight was considered significant. The mean fluid overload incurred by patients in this study was 8.17 l (range, 2.89-14.62 l); %FO was 11.32% (range, 3.67-26.10%). The strongest independently correlating factor to fluid overload was initial, postoperative plasma albumin. Patients with a plasma albumin less than 27 g/l developed significant overload: mean overload 9.75 l (range, 2.89-14.62 l), %FO 15.12% (range, 4.81-26.10%), whilst those with an albumin level greater than 27 g/l did not: mean overload 6.77 l (range, 3.34-11.48 l), %FO 7.96% (range, 3.67-13.93%); P = 0.0001. CONCLUSIONS Patients receiving epidurals with initial, postoperative, plasma albumin levels below 27 g/l are at increased risk of significant fluid overload. Earlier instigation of vasopressor therapy in this subgroup of patients may help prevent this.

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confidence: 99%

Low Plasma Albumin Linked to Fluid Overload in Postoperative Epidural Patients

Malhotra

Axisa

2009

annals

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“…Nevertheless, a somewhat higher acceptance of evidence-based methods seems to be reported in questionnaires concerning the surgeon's preferences than in surveys based on the actual registration of clinical parameters and ERAS items. One [37,38] , prevailing routines for colonic surgery deviated considerably from the best available evidence, with a wide variation between countries. In another survey on colonic surgery, conducted in 295 hospitals in the United States and Europe (United Kingdom, France, Germany, Italy and Spain), most centers still adhered to traditional perioperative care [39] .…”

Section: Adherence To the Eras Protocolmentioning

confidence: 99%

Evidence or eminence in abdominal surgery: Recent improvements in perioperative care

Segelman

Nygren

2014

WJG

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Repeated surveys from Europe, the United States, Australia, and New Zealand have shown that adherence to an evidence-based perioperative care protocol, such as Enhanced Recovery After Surgery (ERAS), has been generally low. It is of great importance to support the implementation of the ERAS protocol as it has been shown to improve outcomes after a number of surgical procedures, including major abdominal surgery. However, despite an increasing awareness of the importance of structured perioperative management, the implementation of this complex protocol has been slow. Barriers to implementation involve both patient-and staff-related factors as well as practice-related issues and resources. To support efficient and successful implementation, further educational and structural measures have to be made on a national or regional level to improve the standard of general health care. Besides postoperative morbidity, biological and physiological variables have been quite commonly reported in previous ERAS studies. Little information, however, has been obtained on cost-effectiveness, long-term outcomes, quality of life and patient-related outcomes, and these issues remain important areas of research for future studies.© 2014 Baishideng Publishing Group Inc. All rights reserved. Key words: Enhanced recovery; Surgery; Fast track; Perioperative management; Postoperative outcomeCore tip: There is a strong and evolving evidence base to support Enhanced Recovery After Surgery (ERAS) programs in abdominal surgery. Such pathways are safe and efficient in enhancing recovery and reducing morbidity. However, patient-related outcomes, cost effectiveness and long-term benefits from ERAS protocols need to be studied more carefully in the future. To support efficient and successful implementation, further educational efforts have to be performed on a national or regional level to improve the standard of care in the general population.

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“…Im Hinblick auf die praktische Umsetzung der "Fast-track"-Konzepte zeigten mehrere Untersuchungen, dass diese nur partiell Eingang in die alltägliche Routine gefunden haben [12,13,21,24].…”

Section: Hintergrund Und Fragestellungunclassified

“…Eine Befragung in fünf nordeuropäischen Län-dern zeigte, dass die meisten Anästhesis-ten zwar im Hinblick auf die präoperative Nüchternheit, dem Einsatz periduraler Analgesieformen und der Verwendung kurz wirksamer Anästhetika, den evidenzbasierten Strategien folgen, bezüg-lich der zur Prämedikation eingesetzten Medikamente und der Volumentherapie aber mehrheitlich tradierten Ansichten folgen [12].…”

Section: Hintergrund Und Fragestellungunclassified