| 1. |
- Andersson, Olov, 1979-, et al.
(author)
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Receding-Horizon Lattice-based Motion Planning with Dynamic Obstacle Avoidance
- 2018
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In: 2018 IEEE Conference on Decision and Control (CDC). - : Institute of Electrical and Electronics Engineers (IEEE). - 9781538613955 - 9781538613948 - 9781538613962 ; , s. 4467-4474
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Conference paper (peer-reviewed)abstract
- A key requirement of autonomous vehicles is the capability to safely navigate in their environment. However, outside of controlled environments, safe navigation is a very difficult problem. In particular, the real-world often contains both complex 3D structure, and dynamic obstacles such as people or other vehicles. Dynamic obstacles are particularly challenging, as a principled solution requires planning trajectories with regard to both vehicle dynamics, and the motion of the obstacles. Additionally, the real-time requirements imposed by obstacle motion, coupled with real-world computational limitations, make classical optimality and completeness guarantees difficult to satisfy. We present a unified optimization-based motion planning and control solution, that can navigate in the presence of both static and dynamic obstacles. By combining optimal and receding-horizon control, with temporal multi-resolution lattices, we can precompute optimal motion primitives, and allow real-time planning of physically-feasible trajectories in complex environments with dynamic obstacles. We demonstrate the framework by solving difficult indoor 3D quadcopter navigation scenarios, where it is necessary to plan in time. Including waiting on, and taking detours around, the motions of other people and quadcopters.
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| 2. |
- Currie, Andrew, et al.
(author)
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Enhanced Recovery After Surgery Interactive Audit System : 10 Years' Experience with an International Web-Based Clinical and Research Perioperative Care Database
- 2019
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In: Clinics in Colon and Rectal Surgery. - : Thieme Medical Publishers. - 1531-0043 .- 1530-9681. ; 32:1, s. 75-81
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Research review (peer-reviewed)abstract
- The Enhanced Recovery After Surgery (ERAS) is a managed care program that has shown the ability to reduce complications following elective colorectal surgery. In 2006, the ERAS (R) Society developed the ERAS (R) Interactive Audit System (EIAS), which has allowed centers in over 20 countries to enter perioperative patient data to benchmark against international practice within the audit system and act as a stimulus for quality improvement. The de-identified patient data are coded in SQL (a relational database), stored on secure servers, and data governance aspects have been secured in all involved countries. A collaborative approach is undertaken within involved units toward research questions with published cohort data from the audit system having demonstrated the importance of overall compliance on improving patient outcomes and less cost of care. The EIAS has shown that collaborative clinical effort can drive quality improvement in a short time frame in an international context.
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| 3. |
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| 4. |
- Currie, Andrew, et al.
(author)
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The Impact of Enhanced Recovery Protocol Compliance on Elective Colorectal Cancer Resection Results From an International Registry
- 2015
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In: Annals of Surgery. - : Lippincott Williams & Wilkins. - 0003-4932 .- 1528-1140. ; 261:6, s. 1153-1159
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Journal article (peer-reviewed)abstract
- Background: The ERAS (enhanced recovery after surgery) care has been shown in randomized clinical trials to improve outcome after colorectal surgery compared to traditional care. The impact of different levels of compliance and specific elements, particularly out with a trial setting, is poorly understood.Objective: This study evaluated the individual impact of specific patient factors and perioperative enhanced recovery protocol compliance on postoperative outcome after elective primary colorectal cancer resection.Methods: The international, multicenter ERAS registry data, collected between November 2008 and March 2013, was reviewed. Patient demographics, disease characteristics, and perioperative ERAS protocol compliance were assessed. Linear regression was undertaken for primary admission duration and logistic regression for the development of any postoperative complication.Findings: A total of 1509 colonic and 843 rectal resections were undertaken in 13 centers from 6 countries. Median length of stay for colorectal resections was 6 days, with readmissions in 216 (9.2%), complications in 948 (40%), and reoperation in 167 (7.1%) of 2352 patients. Laparoscopic surgery was associated with reduced complications [odds ratio (OR) = 0.68; P < 0.001] and length of stay (OR = 0.83, P < 0.001). Increasing ERAS compliance was correlated with fewer complications (OR = 0.69, P < 0.001) and shorter primary hospital admission (OR = 0.88, P < 0.001). Shorter hospital stay was associated with preoperative carbohydrate and fluid loading (OR = 0.89, P = 0.001), and totally intravenous anesthesia (OR= 0.86, P < 0.001); longer stay was associated with intraoperative epidural analgesia (OR = 1.07, P = 0.019). Reduced postoperative complications were associated with restrictive perioperative intravenous fluids (OR = 0.35, P < 0.001).Conclusions: This analysis has demonstrated that in a large, international cohort of patients, increasing compliance with an ERAS program and the use of laparoscopic surgery independently improve outcome.
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| 5. |
- Degens, Hans, et al.
(author)
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Post-operative effects on insulin resistance and specific tension of single skeletal muscle fibres
- 1999
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In: Clinical Science. - : Lippincott Williams & Wilkins. - 0143-5221 .- 1470-8736. ; 97:4, s. 449-455
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Journal article (peer-reviewed)abstract
- Surgery and accidental trauma are associated with a transient period of insulin resistance, substrate catabolism and muscle weakness. In the present study, we evaluated the changes in the force-generating capacity of chemically skinned single muscle fibresfollowing abdominal surgery. Biopsies of the m. vastus lateralis were obtained in three patients 1 day before and 3 or 6 days after surgery. Part of the biopsy was frozen for histochemical analysis of the fibre cross-sectional area (FCSA) and myofibrillar protein content, and another part was used for single-fibre contractile measurements. All patients developed insulin resistance following surgery. The maximum velocity of unloaded shortening of single muscle fibres did not change following surgery. The FCSA did not decrease after surgery, as determined either from histochemical sections or from singlefibres measured at a fixed sarcomere length of 2.76+/-0.09 microm (mean+/-S.D.). Further, the force-generating capacity of the single fibres, measured as maximal Ca(2+)-activated force (P(0)) or as P(0) normalized to FCSA (specific tension), remained unchanged, as did the myofibrillar protein content of the muscle. In conclusion, the muscle weakness associated with post-operative insulin resistance is not related to a decreased specifictension or a loss of myofibrillar proteins. Other potential cellular mechanisms underlying post-operative weakness are discussed.
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| 6. |
- Fatehi, Hesameddin, et al.
(author)
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Effects of In-Cylinder Flow Structures on Soot Formation and Oxidation in a Swirl-Supported Light-Duty Diesel Engine
- 2019
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In: 14th International Conference on Engines & Vehicles: Technical paper. - 400 Commonwealth Drive, Warrendale, PA, United States : SAE International. - 0148-7191.
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Conference paper (peer-reviewed)abstract
- In this paper, computation fluid dynamics (CFD) simulations are performed to describe the effect of in-cylinder flow structures on the formation and oxidation of soot in a swirl-supported light-duty diesel engine. The focus of the paper is on the effect of swirl motion and injection pressure on late cycle soot oxidation. The structure of the flow at different swirl numbers is studied to investigate the effect of varying swirl number on the coherent flow structures. These coherent flow structures are studied to understand the mechanism that leads to efficient soot oxidation in late cycle. Effect of varying injection pressure at different swirl numbers and the interaction between spray and swirl motions are discussed. The complexity of diesel combustion, especially when soot and other emissions are of interest, requires using a detailed chemical mechanism to have a correct estimation of temperature and species distribution. In this work, Representative Interactive Flamelets (RIF) method is employed to describe the chemical reactions, ignition, flame propagation and emissions in the engine. The CFD simulations are validated using experimental measurement of light-duty diesel engine at two different loads. A good agreement is achieved between the model results and the pressure, heat release rates and emissions from the experiment. These cases are considered as the base-line for the parameter study cases.
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| 7. |
- Fridriksson, Helgi, et al.
(author)
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Effect of Piston Shape and Swirl Ratio on Engine Heat Transfer in a Light-Duty Diesel Engine
- 2014
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In: SAE Technical Papers. - 400 Commonwealth Drive, Warrendale, PA, United States : SAE International. - 0148-7191.
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Conference paper (peer-reviewed)abstract
- Heat transfer losses are one of the largest loss contributions in a modern internal combustion engine. The aim of this study is to evaluate the contribution of the piston bowl type and swirl ratio to heat losses and performance. A commercial CFD tool is used to carry out simulations of four different piston bowl geometries, at three engine loads with two different swirl ratios at each load point. One of the geometries is used as a reference point, where CFD results are validated with engine test data. All other bowl geometries are scaled to the same compression ratio and make use of the same fuel injection, with a variation in the spray target between cases. The results show that the baseline case, which is of a conventional diesel bowl shape, provides the best emission performance, while a more open, tapered, lip-less combustion bowl is the most thermodynamically efficient. The results also show that the effects of swirl are not consequent throughout all piston geometries, as the flow field response to swirl variations is different in the various piston geometries.
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| 8. |
- Gustafsson, Ulf O., et al.
(author)
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Adherence to the enhanced recovery after surgery protocol and outcomes after colorectal cancer surgery
- 2011
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In: Archives of surgery (Chicago. 1960). - : American Medical Association (AMA). - 0004-0010 .- 1538-3644. ; 146:5, s. 571-577
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Journal article (peer-reviewed)abstract
- Objectives: To study the impact of different adherence levels to the enhanced recovery after surgery (ERAS) protocol and the effect of various ERAS elements on outcomes following major surgery. Design: Single-center prospective cohort study before and after reinforcement of an ERAS protocol. Comparisons were made both between and across periods using multivariate logistic regression. All clinical data (114 variables) were prospectively recorded. Setting: Ersta Hospital, Stockholm, Sweden. Patients: Nine hundred fifty-three consecutive patients with colorectal cancer: 464 patients treated in 2002 to 2004 and 489 in 2005 to 2007. Main Outcome Measures: The association between improved adherence to the ERAS protocol and the incidence of postoperative symptoms, complications, and length of stay following major colorectal cancer surgery was analyzed. Results: Following an overall increase in preoperative and perioperative adherence to the ERAS protocol from 43.3% in 2002 to 2004 to 70.6% in 2005 to 2007, both postoperative complications (odds ratio, 0.73; 95% confidence interval, 0.55-0.98) and symptoms (odds ratio, 0.53; 95% confidence interval, 0.40-0.70) declined significantly. Restriction of intravenous fluid and use of a preoperative carbohydrate drink were major independent predictors. Across periods, the proportion of adverse postoperative outcomes (30-day morbidity, symptoms, and readmissions) was significantly reduced with increasing adherence to the ERAS protocol (>70%, >80%, and >90%) compared with low ERAS adherence (<50%). Conclusion: Improved adherence to the standardized multimodal ERAS protocol is significantly associated with improved clinical outcomes following major colorectal cancer surgery, indicating a dose-response relationship.
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| 9. |
- Jönsson, Mattias, et al.
(author)
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Technical evaluation of different motion-monitoring systems for respiratory gating in radiation therapy
- 2013
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In: Medical Physics in the Baltic States. - 1822-5721. ; , s. 38-41
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Conference paper (peer-reviewed)abstract
- The purpose of this work was to evaluate three motion-monitoring systems: Sentinel (TM), Catalyst (TM) (both C-RAD) and Real-time Position Management (RPM (TM)) system (Varian Medical Systems Inc) for respiratory gating in radiotherapy. To measure the systems. latency, an in-house built circuit with a microcontroller operating a piston was used. The trigger pulse was sent from the gating systems to the accelerator within 300 mu s. However, the response time of the accelerator could be over 300 ms
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| 10. |
- Lassen, Kristoffer, et al.
(author)
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Consensus review of optimal perioperative care in colorectal surgery : Enhanced Recovery After Surgery (ERAS) Group recommendations
- 2009
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In: Archives of surgery (Chicago. 1960). - : American Medical Association (AMA). - 0004-0010 .- 1538-3644. ; 144:10, s. 961-969
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Research review (peer-reviewed)abstract
- OBJECTIVES: To describe a consensus review of optimal perioperative care in colorectal surgery and to provide consensus recommendations for each item of an evidence-based protocol for optimal perioperative care. DATA SOURCES: For every item of the perioperative treatment pathway, available English-language literature has been examined. STUDY SELECTION: Particular attention was paid to meta-analyses, randomized controlled trials, and systematic reviews. DATA EXTRACTION: A consensus recommendation for each protocol item was reached after critical appraisal of the literature by the group. DATA SYNTHESIS: For most protocol items, recommendations are based on good-quality trials or meta-analyses of such trials. CONCLUSIONS: The Enhanced Recovery After Surgery (ERAS) Group presents a comprehensive evidence-based consensus review of perioperative care for colorectal surgery. It is based on the evidence available for each element of the multimodal perioperative care pathway.
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| 11. |
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| 12. |
- Ljungqvist, Mattias, 1969
(author)
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Fluid and Solid Particle Dynamics in Stirred Vessels
- 1999
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Doctoral thesis (other academic/artistic)abstract
- The present thesis deals with the fluid dynamics of stirred vessels and particularly those that are to be used in conjunction with solids suspensions. Stirred vessels are very common in the process industry and large amounts of energy can be saved by optimising their operation. Several types of unit operations such as chemical reaction, leaching, dissolution and crystallisation involve solids suspensions. Axial flow impellers are best suited for suspension of solids and therefore, pitched blade turbines were used in the present work. A standard type of stirred vessel with a single impeller and an industrial type of tank with two parallel impellers, were studied. The single-phase flow and the simultaneous flow of particles and liquid were investigated. Measurements were made on the single-phase flow using Laser-Doppler anemometry and on the two-phase flow using Phase-Doppler anemometry. Numerical computations were performed using the commercially available CFD-code CFX4. The two-phase calculations were done using the multi-fluid approach. Good agreement between the experiments and calculations was obtained for the fluid phase but the particle phase predictions were less satisfactory. The axial component of the slip velocity was generally slightly overestimated and the radial and tangential components severely underestimated by the computational model. The single-phase flow in a completely filled vessel equipped with a lid was investigated in detail and compared with results for a vessel lacking a lid. It was found that the influence of the lid was small and changes in the impeller discharge flow were observed only after lowering the lid to half of the vessel height. The simultaneous measurement of fluid and particle velocities revealed that generally, particles lag when the fluid is moving upwards and vice versa but also, that exceptions to this are common. The largest differences between the velocities of the two phases where found in regions with large mean velocity gradients such as the impeller discharge. For the industrial type of tank, it was found that horizontal displacement of the two impellers in opposite directions could break-up the segregated mixing zones that tended to form in the tank.
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| 13. |
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| 14. |
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| 15. |
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| 16. |
- Ljungqvist, Olle, 1954-, et al.
(author)
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Metabolic perioperative management : novel concepts
- 2005
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In: Current Opinion in Critical Care. - Philadelphia, USA : Lippincott Williams & Wilkins. - 1070-5295 .- 1531-7072. ; 11:4, s. 295-9
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Research review (peer-reviewed)abstract
- Purpose of review: This review summarizes novel information regarding the role of metabolic control in the perioperative period.Recent findings: Managing perioperative metabolism has recently been shown to be an important way to improve outcomes in surgical care. In particular, postoperative insulin resistance and hyperglycemia have been linked to many common complications. Recent studies have explored the toxicity of hyperglycemia and suggest a causal relation between insulin resistance and complications in the postoperative state. Controlling glucose concentrations with insulin has been shown to also improve protein balance and fat metabolism. In addition, insulin may affect other hormones including insulinlike growth factor-I during surgical stress. Lastly, recent data suggest that hyperglycemia plays an important role in aggravating the inflammatory response, in that overflow of substrates in the mitochondria causes the formation of excess free oxygen radicals and may also alter gene expression to enhance cytokine production. Although overcoming insulin resistance by insulin infusion is one way of combating hyperglycemia, prevention of its development can also be achieved by using epidural blockade to reduce the release of adrenal stress hormones and to control pain, by preoperative carbohydrates instead of overnight fasting, and by minimal invasive surgical techniques.Summary: Minimizing the effects of insulin resistance has been shown to substantially improve outcome after surgical stress.
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| 17. |
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| 18. |
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| 19. |
- Markeby Ljungqvist, Hampus, et al.
(author)
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A realistic view on heat reuse from direct free air-cooled data centres
- 2023
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In: Energy Conversion and Management. - : Elsevier. - 2590-1745. ; 20
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Journal article (peer-reviewed)abstract
- This paper examines the opportunities to reuse excess heat from direct free air-cooled data centres without incorporating heat pumps to upgrade the heat. The operation of a data centre in northern Sweden, Luleå, was simulated for a year. It was established that heat losses through the thermal envelope and from the humidification of the cooling airflow influenced the momentary energy reuse factor, iERF, with up to 7%. However, for the annual energy reuse factor, ERF, the heat losses could be neglected since they annually contributed to an error of less than 1%. It was shown that the ideal heat reuse temperature in Luleå was 13, 17, and 18 °C with an exhaust temperature of 30, 40 and 50 °C. The resulting ERF was 0.50, 0.59 and 0.66, meaning that a higher exhaust temperature resulted in potentially higher heat reuse. It could also be seen that raising the exhaust temperature lowered the power usage effectiveness, PUE, due to more efficient cooling. Using heat reuse applications with different heat reuse temperatures closer to the monthly average instead of an ideal heat reuse temperature for the whole year improved the ERF further. The improvement was 11–31% where a lower exhaust temperature meant a higher relative improvement.
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| 20. |
- Markeby Ljungqvist, Hampus, et al.
(author)
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Data center heated greenhouses, a matter for enhanced food self-sufficiency in sub-arctic regions
- 2021
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In: Energy. - : Elsevier Ltd. - 0360-5442 .- 1873-6785. ; 215
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Journal article (peer-reviewed)abstract
- This paper examines the possibility of increasing Northern Sweden's degree of self-sufficiency in food supply, at the 65th latitude, by using a data center as a heating source for greenhouse production. A dynamic building energy simulation software was used to compute both the hourly exhaust air output from a 1 MW data center for one year and the corresponding heating demand for two different greenhouse sizes, 2000 m2 and 10 000 m2, and two different production scenarios. Partial year production, 1 Mars – 15 October, without grow lights and full-year production with grow lights. The study showed that 5.5–30.5% of the electrical input to a 1 MW data center could be recovered. The 2000 m2 greenhouse could operate almost entirely, 89.7–97.9%, on excess heat while only 50.0–61.5% of the 10 000 m2 greenhouse heating demand could be met for full- and partial-year production, respectively. Furthermore, it is concluded that the 10 000 m2 greenhouse with full year production was the most prominent case and would cost-effectively yield 7.6% of northern Sweden's vegetable self-sufficiency.
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| 21. |
- Nygren, Jonas, et al.
(author)
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An enhanced-recovery protocol improves outcome after colorectal resection already during the first year : a single-center experience in 168 consecutive patients
- 2009
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In: Diseases of the Colon & Rectum. - 0012-3706 .- 1530-0358. ; 52:5, s. 978-985
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Journal article (peer-reviewed)abstract
- PURPOSE: This study was designed to investigate the clinical outcome and recovery before and immediately after implementation of the enhanced recovery after surgery enhanced recovery after surgery protocol in colonic and rectal resection. METHODS: One hundred and sixty-eight consecutive patients in a single center underwent colorectal surgery before (traditional, n = 69) and immediately after implementing enhanced recovery after surgery (n = 99). Rectal surgery was performed in 77 patients. Postoperative food and fluid intake, mobilization, physiologic function, and clinical outcome were measured prospectively. RESULTS: Resumption of oral diet was achieved on postoperative day postoperative day 1 in the enhanced recovery after surgery group. In the enhanced recovery after surgery group, mobilization more than 6 hours daily was achieved on postoperative day 2 to 3 and passage of stool occurred on postoperative day 2 vs. postoperative day 5 in the traditional group (P < 0.0001). Muscle strength and lung function were less reduced in the enhanced recovery after surgery group (P < 0.05). Median hospital stay was reduced by 2 days (P < 0.01). Readmission rates increased (4 percent vs. 15 percent, P < 0.01) but total hospital stay was still lower in the enhanced recovery after surgery group (P < 0.01). After colonic resection, postoperative complications decreased in enhanced recovery after surgery (37 percent vs. 18 percent, P < 0.05), whereas no change was found after rectal resection. CONCLUSION: Immediately after implementing enhanced recovery after surgery, recovery was improved and length of hospital stay was reduced. Notably, postoperative morbidity decreased only in patients undergoing colonic resection.
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| 22. |
- Nygren, Jonas O., et al.
(author)
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Perioperative insulin and glucose infusion maintains normal insulin sensitivity after surgery
- 1998
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In: American Journal of Physiology. - : American Physiological Society. - 0002-9513 .- 2163-5773. ; 275:1 Part 1, s. E140-E148
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Journal article (peer-reviewed)abstract
- Elective surgery was performed after overnight fasting, a routine that may affect the metabolic response to surgery. We investigated the effects of insulin and glucose infusions before and during surgery on postoperative substrate utilization and insulin sensitivity. Seven patients were given insulin and glucose infusions 3 h before and during surgery (insulin group), and a control group of six patients underwent surgery after fasting overnight. Insulin sensitivity and glucose kinetics (D-[6,6-2H2]glucose) were measured before and immediately after surgery using a hyperinsulinemic, normoglycemic clamp. Glucose infusion rates and whole body glucose disposal decreased after surgery in the control group (-40 and -29%, respectively), whereas no significant change was found in the insulingroup (+16 and +25%). Endogenous glucose production remained unchanged in both groups. Postoperative changes in cortisol, glucagon, fat oxidation, and free fatty acids were attenuated in the insulin group (vs. control). We conclude that perioperative insulin and glucose infusions minimize the endocrine stress response and normalize postoperative insulin sensitivity and substrate utilization.
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| 23. |
- Nygren, Jonas, et al.
(author)
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Preoperative oral carbohydrate administration reduces postoperative insulin resistance
- 1998
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In: Clinical Nutrition. - : Elsevier. - 0261-5614 .- 1532-1983. ; 17:2, s. 65-71
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Journal article (peer-reviewed)abstract
- Infusions of carbohydrates before surgery reduce postoperative insulin resistance. We investigated the effects of a carbohydrate drink, given shortly before surgery, on postoperative metabolism. Method: Insulin sensitivity, glucose turnover ([6,6, 2H2]-D-glucose) and substrate utilization were measured using hyperinsulinemic normoglycemic clamps and indirect calorimetry in two matched groups of patients before and after elective colorectal surgery. The drink group (n = 7) received 800 ml of an isoosmolar carbohydrate rich beverage the evening before the operation (100 g carbohydrates), as well as another 400 ml (50 g carbohydrates) 2 h before the initiation of anesthesia. The fasted group (n = 7) was operated after an overnight fast. Results: After surgery, energy expenditure increased in both groups. Endogenous glucose production was higher after surgery and the difference was significant during low insulin infusion rates in both groups (P < 0.05). The supressibility of endogenous glucose production by the two step insulin infusion was similar pre- and postoperatively in both groups. At the high insulin infusion rate postoperatively, whole body glucose disposal was more reduced in the fasted group (-49 ± 6% vs -26 ± 8%, P < 0.05 vs drink). Furthermore, during high insulin infusion rates, glucose oxidation decreased postoperatively only in the fasted group (P < 0.05) and postoperative levels of fat oxidation were greater in the fasted group (P < 0.05 vs drink). Only minor postoperative changes in cortisol and glucagon were found and no differences were found between the treatment groups. Conclusions: Patients given a carbohydrate drink shortly before elective colorectal surgery displayed less reduced insulin sensitivity after surgery as compared to patients who were operated after an overnight fast.
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| 24. |
- Nygren, Jobas, et al.
(author)
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Preoperative oral carbohydrates and postoperative insulin resistance
- 1999
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In: Clinical Nutrition. - : Elsevier. - 0261-5614 .- 1532-1983. ; 18:2, s. 117-120
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Journal article (peer-reviewed)abstract
- Infusions of carbohydrates before surgery have been shown to reduce postoperative insulin resistance. Presently, we investigated the effects of a carbohydrate drink, given shortly before surgery, on postoperative insulin sensitivity. Methods: Insulin sensitivity and glucose turnover (16, 6, 2H2]-D-glucose) were measured using hyperinsulinemic, normoglycemic clamps before and after elective surgery. Sixteen patients undergoing total hip replacement were randomly assigned to preoperative oral carbohydrate administration (CHO-H, n = 8) or the same amount of a placebo drink (placebo, n = 8) before surgery. Insulin sensitivity was measured before and immediately after surgery. Patients undergoing elective colorectal surgery were studied before surgery and 24 h postoperatively (CHO-C (n = 7), and fasted (n = 7), groups). The fasted group underwent surgery after an overnight fast. In both studies, the CHO groups received 800 ml of an isoosmolar carbohydrate rich beverage the evening before the operation (100 g carbohydrates), as well as another 400 ml (50 g carbohydrates) 2 h before the initiation of anesthesia. Results: Immediately after surgery, insulin sensitivity was reduced 37% in the placebo group (P < 0.05 vs. preoperatively) while no significant change was found in the CHO-H group (-16%, p = NS). During clamps performed 24 h postoperatively, insulin sensitivity and whole-body glucose disposal was reduced in both groups, but the reduction was greater compared to that in the CHO-C group (-49 ± 6% vs. -26 ± 8%, P < 0.05 fasted vs. CHO-C). Conclusions: Patients given a carbohydrate drink shortly before elective surgery displayed less reduced insulin sensitivity after surgery as compared to patients undergoing surgery after an overnight fast.
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| 25. |
- Soop, Mattias, et al.
(author)
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Optimizing perioperative management of patients undergoing colorectal surgery : what is new?
- 2006
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In: Current Opinion in Critical Care. - Philadelphia, USA : Lippincott Williams & Wilkins. - 1070-5295 .- 1531-7072. ; 12:2, s. 166-70
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Research review (peer-reviewed)abstract
- Purpose or review: This review highlights recent developments in individual perioperative interventions in colorectal surgery, and progress in so-called fast-track or enhanced-recovery programmes.Recent findings: A new survey from five northern European countries has revealed that best clinical practice in perioperative care, based on previously published high-grade evidence, is only partially in use in daily clinical practice. Recently, a number of trials contrasting clinical results in enhanced-recovery protocols versus traditional care clearly show that such protocols indeed enhance recovery, although effects on morbidity are less obvious. Further evidence supporting preoperative oral carbohydrate treatment, avoidance of oral bowel preparation and wound drainage in elective colonic surgery and avoidance of intraoperative fluid excess has emerged. The oral opioid antagonist alvimopan has recently been shown to limit postoperative gastrointestinal paralysis. The role of laparoscopic surgery in the era of enhanced-recovery programmes is unclear.Summary: There is strong evidence on how to enhance recovery after colorectal surgery, but many interventions are not utilized in daily practice. Further evidence has emerged supporting several perioperative treatments, and successful experiences of enhanced-recovery programmes have now been reported from several centres.
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