| 1. |
- Lassen, Kristoffer, et al.
(författare)
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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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Ingår i: Archives of surgery (Chicago. 1960). - : American Medical Association (AMA). - 0004-0010 .- 1538-3644. ; 144:10, s. 961-969
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Forskningsöversikt (refereegranskat)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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| 2. |
- Ljungqvist, Olle, 1954-, et al.
(författare)
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Metabolic perioperative management : novel concepts
- 2005
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Ingår i: Current Opinion in Critical Care. - Philadelphia, USA : Lippincott Williams & Wilkins. - 1070-5295 .- 1531-7072. ; 11:4, s. 295-9
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Forskningsöversikt (refereegranskat)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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| 3. |
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| 4. |
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| 5. |
- Nygren, Jonas, et al.
(författare)
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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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Ingår i: Diseases of the Colon & Rectum. - 0012-3706 .- 1530-0358. ; 52:5, s. 978-985
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Tidskriftsartikel (refereegranskat)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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| 6. |
- Soop, Mattias, et al.
(författare)
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Optimizing perioperative management of patients undergoing colorectal surgery : what is new?
- 2006
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Ingår i: Current Opinion in Critical Care. - Philadelphia, USA : Lippincott Williams & Wilkins. - 1070-5295 .- 1531-7072. ; 12:2, s. 166-70
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Forskningsöversikt (refereegranskat)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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| 7. |
- Soop, Mattias, et al.
(författare)
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Stress-induced insulin resistance : recent developments
- 2007
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Ingår i: Current opinion in clinical nutrition and metabolic care. - Philadelphia, USA : Lippincott Williams & Wilkins. - 1363-1950 .- 1473-6519. ; 10:2, s. 181-6
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Forskningsöversikt (refereegranskat)abstract
- Purpose of review: Interest in stress-induced insulin resistance has increased during the past 5 years. Relevant clinical and mechanistic investigations during the past year will be reviewed.Recent findings: Recent trials of intensive insulin therapy in intensive care units have brought attention to a high incidence of hypoglycemic episodes with such treatment. The clinical relevance of such hypoglycemia has been shown to be minor, however. Furthermore, animal and in-vitro work further supports the finding that glucose control, rather than glycemia-independent effects of insulin, is the primary mechanism of action of intensive insulin therapy. In elective surgery, cohort studies show an association between intraoperative hyperglycemia and postoperative morbidity. Beneficial effects of preoperative oral carbohydrate treatment on immunocompetence and cardiac contractility have been demonstrated. Laparoscopic segmental colectomy was associated with considerably attenuated derangements in glucose metabolism compared with conventional, open surgery.Summary: Better methods of insulin dosing and administration and glucose monitoring are warranted to further minimize the risks of intensive insulin therapy. In elective surgery, perioperative measures such as preoperative oral carbohydrate treatment and laparoscopic techniques attenuate metabolic and other physiological derangements and such methods should be integrated into perioperative care protocols to minimize morbidity and enhance recovery.
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| 8. |
- Svanfeldt, Monika, et al.
(författare)
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Effect of "preoperative" oral carbohydrate treatment on insulin action : a randomised cross-over unblinded study in healthy subjects
- 2005
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Ingår i: Clinical Nutrition. - Edinburgh, United Kingdom : Churchill Livingstone. - 0261-5614 .- 1532-1983. ; 24:5, s. 815-21
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Tidskriftsartikel (refereegranskat)abstract
- Background and aims: Preoperative intake of a clear carbohydrate-rich drink reduces insulin resistance after surgery. In this study, we evaluated whether this could be related to increased insulin sensitivity at the onset of surgery. Furthermore, we aimed to establish the optimal dose-regimen.Methods: Six healthy volunteers underwent hyperinsulinaemic (0.8 mU/kg/min), normoglycaemic (4.5 mmol/l) clamps and indirect calorimetry on four occasions in a crossover-randomised order; after overnight fasting (CC), after a single evening dose (800 ml) of the drink (LC), after a single morning dose (400 ml, CL) and after intake of the drink in the evening and in the morning before the clamp (LL). Data are presented as mean+/-SD. Statistical analysis was performed using the Student's t-test and ANOVA.Results: Insulin sensitivity was higher in CL and LL (9.2+/-1.5 and 9.3+/-1.9 mg/kg/min, respectively) compared to CC and LC (6.1+/-1.6 and 6.6+/-1.9 mg/kg/min, P<0.01 vs. CL and LL).Conclusions: A carbohydrate-rich drink enhances insulin action 3 h later by approximately 50%. Enhanced insulin action to normal postprandial day-time level at the time of onset of anaesthesia or surgery is likely to, at least partly, explain the effects on postoperative insulin resistance.
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