| 1. |
- Ahl, Rebecka, 1987-, et al.
(författare)
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Effect of beta-blocker therapy on early mortality after emergency colonic cancer surgery
- 2019
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Ingår i: British Journal of Surgery. - : John Wiley & Sons. - 0007-1323 .- 1365-2168. ; 106:4, s. 477-483
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Emergency colorectal cancer surgery is associated with significant mortality. Induced adrenergic hyperactivity is thought to be an important contributor. Downregulating the effects of circulating catecholamines may reduce the risk of adverse outcomes. This study assessed whether regular preoperative beta-blockade reduced mortality after emergency colonic cancer surgery.METHODS: This cohort study used the prospectively collected Swedish Colorectal Cancer Registry to recruit all adult patients requiring emergency colonic cancer surgery between 2011 and 2016. Patients were subdivided into those receiving regular beta-blocker therapy before surgery and those who were not (control). Demographics and clinical outcomes were compared. Risk factors for 30-day mortality were evaluated using Poisson regression analysis.RESULTS: A total of 3187 patients were included, of whom 685 (21·5 per cent) used regular beta-blocker therapy before surgery. The overall 30-day mortality rate was significantly reduced in the beta-blocker group compared with controls: 3·1 (95 per cent c.i. 1·9 to 4·7) versus 8·6 (7·6 to 9·8) per cent respectively (P < 0·001). Beta-blocker therapy was the only modifiable protective factor identified in multivariable analysis of 30-day all-cause mortality (incidence rate ratio 0·31, 95 per cent c.i. 0·20 to 0·47; P < 0·001) and was associated with a significant reduction in death of cardiovascular, respiratory, sepsis and multiple organ failure origin.CONCLUSION: Preoperative beta-blocker therapy may be associated with a reduction in 30-day mortality following emergency colonic cancer surgery.
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| 2. |
- Hausel, J, et al.
(författare)
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Randomized clinical trial of the effects of oral preoperative carbohydrates on postoperative nausea and vomiting after laparoscopic cholecystectomy.
- 2005
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Ingår i: British Journal of Surgery. - West Susssex, United Kingdom : John Wiley & Sons. - 0007-1323 .- 1365-2168. ; 92:4, s. 415-21
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Tidskriftsartikel (refereegranskat)abstract
- Background: A carbohydrate-rich drink (CHO) has been shown to reduce preoperative discomfort. It was hypothesized that it may also reduce postoperative nausea and vomiting (PONV).Methods: Patients undergoing elective laparoscopic cholecystectomy under inhalational anaesthesia (127 women and 45 men; mean(s.d.) 48(15) years) were randomized to either preoperative fasting, intake of CHO (50 kcal/100 ml, 290 mOsm/kg) or placebo. The non-fasting groups were double-blinded; patients ingested 800 ml of liquid on the evening before surgery and 400 ml 2 h before anaesthesia. Nausea and pain scores on a visual analogue scale (VAS) and episodes of PONV were recorded up to 24 h after surgery.Results: The incidence of PONV was lower in the CHO than in the fasted group between 12 and 24 h after surgery (P = 0.039). Nausea scores in the fasted and placebo groups were higher after operation than before admission to hospital (P = 0.018 and P < 0.001 respectively), whereas there was no significant change in the CHO group. No intergroup differences in VAS scores were seen. The use of anaesthetics, opioids, antiemetics and intravenous fluids was similar in all groups.Conclusion: CHO may have a beneficial effect on PONV 12-24 h after laparoscopic cholecystectomy.
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| 3. |
- Ljungqvist, Olle, 1954-, et al.
(författare)
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Preoperative fasting
- 2003
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Ingår i: British Journal of Surgery. - West Sussex, United Kingdom : John Wiley & Sons. - 0007-1323 .- 1365-2168. ; 90:4, s. 400-6
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Forskningsöversikt (refereegranskat)abstract
- Background and methods: To avoid pulmonary aspiration, fasting after midnight has become standard in elective surgery, but recent studies have found no scientific support for this practice. Several anaesthesia societies now recommend a 2-h preoperative fast for clear fluids and a 6-h fast for solids in most elective patients. The literature supporting such fasting recommendations was reviewed.Results: The recommendations are safe and improve well-being before operation, mainly by reducing thirst. A carbohydrate-rich beverage given before anaesthesia and surgery alters metabolism from the overnight fasted to the fed state. This reduces the catabolic response (insulin resistance) after operation, which may have implications for postoperative recovery.Conclusion: Most patients having elective operations can be allowed a free intake of clear fluids up to 2 h before anaesthesia. Preoperative carbohydrates reduce postoperative insulin resistance.
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| 4. |
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| 5. |
- Maessen, J, et al.
(författare)
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A protocol is not enough to implement an enhanced recovery programme for colorectal resection
- 2007
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Ingår i: British Journal of Surgery. - West Sussex, United Kingdom : John Wiley & Sons. - 0007-1323 .- 1365-2168. ; 94:2, s. 224-31
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Tidskriftsartikel (refereegranskat)abstract
- Background: Single-centre studies have suggested that enhanced recovery can be achieved with multimodal perioperative care protocols. This international observational study evaluated the implementation of an enhanced recovery programme in five European centres and examined the determinants affecting recovery and length of hospital stay.Methods: Four hundred and twenty-five consecutive patients undergoing elective open colorectal resection above the peritoneal reflection between January 2001 and January 2004 were enrolled in a protocol that defined multiple perioperative care elements. One centre had been developing multimodal perioperative care for 10 years, whereas the other four had previously undertaken traditional care.Results: The case mix was similar between centres. Protocol compliance before and during the surgical procedure was high, but it was low in the immediate postoperative phase. Patients fulfilled predetermined recovery criteria a median of 3 days after operation but were actually discharged a median of 5 days after surgery. Delay in discharge and the development of major complications prolonged length of stay. Previous experience with fast-track surgery was associated with a shorter hospital stay.Conclusion: Functional recovery in 3 days after colorectal resection could be achieved in daily practice. A protocol is not enough to enable discharge of patients on the day of functional recovery; more experience and better organization of care may be required.
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| 6. |
- Soop, M, et al.
(författare)
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Randomized clinical trial of the effects of immediate enteral nutrition on metabolic responses to major colorectal surgery in an enhanced recovery protocol
- 2004
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Ingår i: British Journal of Surgery. - West Sussex, United Kingdom : John Wiley & Sons. - 0007-1323 .- 1365-2168. ; 91:9, s. 1138-45
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Tidskriftsartikel (refereegranskat)abstract
- Background: The effects of immediate postoperative enteral nutrition on postoperative nitrogen balance and insulin resistance were studied in patients subjected to an enhanced-recovery protocol.Methods: Eighteen patients undergoing major colorectal surgery in an enhanced-recovery protocol were randomized to immediate postoperative enteral feeding for 4 days with either complete or hypocaloric nutrition. Nitrogen balance and changes in glucose kinetics, substrate utilization (indirect calorimetry) and insulin sensitivity (hyperinsulinaemic-euglycaemic clamp) were measured. Values are mean(s.e.m.).Results: Mean postoperative urinary nitrogen losses were low (10.7(1.0) versus 10.5(0.7) g per day for complete versus hypocaloric nutrition) and insulin resistance was insignificant (-20(7) versus -27(11) per cent), with no difference between groups. Complete enteral feeding was given without hyperglycaemia (blood glucose concentration 5.8(0.4) versus 5.0(0.4) mmol/l) and resulted in nitrogen balance (+0.1(0.8) versus -12.6(0.6) g nitrogen per day; P < 0.001).Conclusion: This enhanced-recovery protocol was associated with minimal postoperative insulin resistance and nitrogen losses after surgery. Immediate postoperative enteral nutrition was provided without hyperglycaemia and resulted in nitrogen balance.
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| 7. |
- Svanfeldt, M, et al.
(författare)
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Randomized clinical trial of the effect of preoperative oral carbohydrate treatment on postoperative whole-body protein and glucose kinetics
- 2007
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Ingår i: British Journal of Surgery. - West Sussex, United Kingdom : John Wiley & Sons. - 0007-1323 .- 1365-2168. ; 94:11, s. 1342-50
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Forskningsöversikt (refereegranskat)abstract
- Background: Preoperative oral carbohydrate (CHO) reduces postoperative insulin resistance. In this randomized trial, the effect of CHO on postoperative whole-body protein turnover was studied.Methods: Glucose and protein kinetics ([6,6(2)H(2)]D-glucose, [(2)H(5)]phenylalanine, [(2)H(2)]tyrosine and [(2)H(4)]tyrosine) and substrate oxidation (indirect calorimetry) were studied at baseline and during hyperinsulinaemic normoglycaemic clamping before and on the first day after colorectal resection. Fifteen patients were randomized to receive a preoperative beverage with high (125 mg/ml) or low (25 mg/ml) CHO content.Results: Three patients were excluded after the intervention, leaving six patients in each group. After surgery whole-body protein balance did not change in the high oral CHO group, whereas it was more negative in the low oral CHO group after surgery at baseline (P = 0.003) and during insulin stimulation (P = 0.005). Insulin-stimulated endogenous glucose release was similar before and after surgery in the high oral CHO group, but was higher after surgery in the low oral CHO group (P = 0.013) and compared with the high oral CHO group (P = 0.044).Conclusion: Whole-body protein balance and the suppressive effect of insulin on endogenous glucose release are better maintained when patients receive a CHO-rich beverage before surgery.
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| 8. |
- Syk, Erik, et al.
(författare)
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Radiological findings do not support lateral residual tumour as a major cause of local recurrence of rectal cancer
- 2006
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Ingår i: British Journal of Surgery. - West Sussex, United Kingdom : Oxford University Press (OUP). - 0007-1323 .- 1365-2168. ; 93:1, s. 113-119
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Tidskriftsartikel (övrigt vetenskapligt/konstnärligt)abstract
- BACKGROUND: The aim of this study was to determine the sites of local recurrence following radical (R0) total mesorectal excision (TME) for rectal cancer in an effort to elucidate the reasons for recurrence. METHODS: Thirty-seven patients with recurrence following curative resection for rectal cancer were identified from a population of 880 patients operated on by surgeons trained in the TME procedure. Two radiologists independently examined 33 available computed tomograms and magnetic resonance images taken when the recurrence was detected. RESULTS: Twenty-nine of the 33 recurrences were found in the lower two-thirds of the pelvis. Two recurrent tumours appeared to originate from lateral pelvic lymph nodes. Evidence of residual mesorectal fat was identified in 15 patients. Fourteen of the recurrent tumours originated from primary tumours in the upper rectum; all of these tumours recurred at the anastomosis and 12 of the 14 patients had evidence of residual mesorectal fat. CONCLUSION: Lateral pelvic lymph node metastases are not a major cause of local recurrence after TME. Partial mesorectal excision may be associated with an increased risk of local recurrence from tumours in the upper rectum.
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| 9. |
- Thorell, Anders, et al.
(författare)
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Insulin resistance after abdominal surgery
- 1994
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Ingår i: British Journal of Surgery. - : Oxford University Press (OUP). - 0007-1323 .- 1365-2168. ; 81:1, s. 59-63
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Tidskriftsartikel (refereegranskat)abstract
- A study was carried out to determine the time course and degree of postoperative insulin resistance in patients undergoing elective abdominal surgery. Mean(s.e.m.) insulin sensitivity was determined before and on the first (n = 10), fifth, ninth and 20th (n = 5) days after elective open cholecystectomy using the normoglycaemic (4.(0.1) mmol/l), hyperinsulinaemic (402(12) pmol/l) glucose clamp technique. Preoperative insulin sensitivity expressed as the M value varied from 2.3 to 8.2 mg per kg per min. The relative reduction in insulin sensitivity was most pronounced on the first day after surgery, at a mean(s.e.m) of 54(2) per cent. Thereafter, a large variation between individuals was found during the course of recovery, and insulin sensitivity returned to normal 20 days after operation. On the first day after surgery, plasma concentrations of glucose, C peptide, noradrenaline and glucagon were slightly but significantly higher than before operation (P<0.05), whereas insulin, growth hormone, cortisol and adrenaline levels were unaltered. Marked insulin resistance thus develops after elective upper abdominal surgery and persists for at least 5 days after operation. Factors other than simultaneous changes in levels of the hormones studied seem to regulate the maintenance of postoperative insulin resistance
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| 10. |
- Varadhan, Krishna K, et al.
(författare)
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The enhanced recovery after surgery (ERAS) pathway for patients undergoing major elective open colorectal surgery : a meta-analysis of randomized controlled trials
- 2010
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Ingår i: Clinical Nutrition. - Edinburgh, United Kingdom : Churchill Livingstone. - 0261-5614 .- 1532-1983. ; 97, s. 35-36
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Tidskriftsartikel (refereegranskat)abstract
- Background & aims: The aim of the Enhanced Recovery After Surgery (ERAS) pathway is to attenuate the stress response to surgery and enable rapid recovery. The objective of this meta-analysis was to study the differences in outcomes in patients undergoing major elective open colorectal surgery within an ERAS pathway and those treated with conventional perioperative care.Methods: Medline, Embase and Cochrane database searches were performed for relevant studies published between January 1966 and November 2009. All randomized controlled trials comparing ERAS with conventional perioperative care were selected. The outcome measures studied were length of hospital stay, complication rates, readmission rates and mortality.Results: Six randomized controlled trials with 452 patients were included. The number of individual ERAS elements used ranged from 4 to 12, with a mean of 9. The length of hospital stay [weighted mean difference (95% confidence interval): -2.55 (-3.24, -1.85)] and complication rates [relative risk (95% confidence interval): 0.53 (0.44, 0.64)] were significantly reduced in the enhanced recovery group. There was no statistically significant difference in readmission and mortality rates.Conclusion: ERAS pathways appear to reduce the length of stay and complication rates after major elective open colorectal surgery without compromising patient safety.
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