Does the choice of anesthetic technique affect the recovery of bowel function after radical prostatectomy?

Stevens, Rosemary; Mikat-Stevens, Marianne; Flanigan, Robert C.; Waters, W. Bedford; Furry, Patricia A.; Sheikh, Taqdees; Frey, Kere; Olson, Mary; Kleinman, Bruce

doi:10.1016/s0090-4295(98)00147-2

Cited by 51 publications

(13 citation statements)

References 10 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Unter postoperativer TEA wurde ein früheres Wiedereinsetzen der gastrointestinalen Motilität nachgewiesen. Hierbei üben die TEA-induzierte intestinale Sympathikolyse und die Einsparung von Opioiden einen günstigen Einfluss aus [30,38]. Das Ziel dieser retrospektiven Studie war, die Auswirkung der kontinuierlichen postoperativen TEA auf die gastrointestinale Funktion sowie die postoperative Morbidität zu untersuchen.…”

Section: Diskussionunclassified

“…Die frühzeitige enterale Ernährung senkt den perioperativen Stress und steigert den Patientenkomfort [3]. Unsere Daten bestätigen die von Stevens et al gezeigten Resultate, dass es unter TEA zu einer signifikant früheren Wiederherstellung der gastrointestinalen Integrität kommt [30]. Insbesondere nach Rektumeingriffen kam es mit TEA als Ausdruck der wieder einsetzenden Motilität früher zum ersten Stuhlgang.…”

Section: Gastrointestinale Motilitätunclassified

“…Die epidurale Anästhesie (EDA) und im postoperativen Schmerzmanagement insbesondere die thorakale epidurale Analgesie (TEA) sind während und nach großen viszeralchirurgischen Eingriffen vor allem für Patienten mit erhöhtem kardiopulmonalem Risiko indiziert. Die spezifische Unterbrechung nozizeptiver Reflexe begrenzt die chirurgische Stressantwort [7,9], steigert durch Blockade der sympathischen Aktivierung die viszerale Durchblutung [14], verbessert die pulmonale Funktion und beeinflusst die gastrointestinale Motilität günstig [26,27,30]. Der Epiduralkatheter (EDK) wird präoperativ im thorakalen Epiduralraum platziert und ein Lokalanästhetikum in Kombination mit einem Opioid kontinuierlich appliziert.…”

unclassified

See 2 more Smart Citations

Einfluss der thorakalen Epiduralanalgesie auf die frühe postoperative Phase nach Eingriffen am Gastrointestinaltrakt

Zügel

Bruer

Breitschaft

et al. 2002

Chirurg

View full text Add to dashboard Cite

show abstract

Section: Diskussionunclassified

Section: Gastrointestinale Motilitätunclassified

unclassified

See 1 more Smart Citation

Einfluss der thorakalen Epiduralanalgesie auf die frühe postoperative Phase nach Eingriffen am Gastrointestinaltrakt

Zügel

Bruer

Breitschaft

et al. 2002

Chirurg

View full text Add to dashboard Cite

show abstract

“…Insbesondere konnte gezeigt werden, dass die TEA neben der geringeren motorischen Blockade der unteren Extremität [24], auch mit einer besseren Erhaltung sowohl der kardiopulmonalen [3,31,26] als auch der gastrointestinalen Funktion [34] einherging. Insbesondere konnte gezeigt werden, dass die TEA neben der geringeren motorischen Blockade der unteren Extremität [24], auch mit einer besseren Erhaltung sowohl der kardiopulmonalen [3,31,26] als auch der gastrointestinalen Funktion [34] einherging.…”

Section: Schlüsselwörterunclassified

“…Als weiterer Aspekt der perioperativen Morbidität hat die gastrointestinale Motilität eine wesentliche Bedeutung. Eine Reihe von Untersuchern hat unter postoperativer EA mit Lokalanästhetika ein schnelleres Wiedereinsetzen der gastrointestinalen Motilität nachweisen können [30,34]. Während sich die Motilität des Magens innerhalb von 24 h normalisiert [36], dauert die Motilitätsstörung des Kolon bis zu 3 Tage an [37].…”

Section: Diskussionunclassified

Kombinierte Anästhesie mit Epiduralkatheter

et al. 2000

View full text Add to dashboard Cite

Patients requiring radical prostatectomy (rPE), including retroperitoneal lymphadenectomy are often aged and have coexisting cardiopulmonary diseases, increasing the risk of perioperative complications. The aim of the present study was to evaluate our perioperative anaesthesiologic regimen over the last five years, in terms of safety and patients comfort. Records of 433 patients who underwent rPE between 1994 and 1999 in our hospital were retrospectively reviewed. Patients were divided in those who received: 1. general anaesthesia (GA) alone, 2. a combination of lumbar epidural anaesthesia (LEA) + GA or, 3. thoracic epidural anaesthesia (TEA) + GA. General anaesthesia was performed as balanced anaesthesia, and epidural administered local anaesthetics were bupivacaine 0.25% or ropivacaine 0.2%, 8-12 ml/h. In terms of intra- and postoperative numbers of tachycardiac and hypertensive episodes, a reduced stress response was observed under epidural anaesthesia (EA). Moreover, the weaning duration was shorter under EA and onset of gastrointestinal motility was found earlier ([h] GA: 50.6 +/- 11.1/LEA: 39.3 +/- 13.6/TEA: 33.8 +/- 13.0). Furthermore, a trend to rarer phases of postoperative vomiting and a significant decrease of in hospital stay of about one day ([d] GA: 12.4 +/- 5.8/LEA: 11.1 +/- 3.1/TEA: 11.5 +/- 3.8) was observed. The duration of personnel binding in the OR did not differ significantly between GA and TEA ([min] GA: 222.9 +/- 43.5/LEA: 238.2 +/- 41.8/TEA: 227.0 +/- 46.2), but ICU stay was shortened under TEA. Besides this, TEA reduced the number of pathologic postoperative thorax-x-rays. Senso-motor blockades, decreases of SaO2 and cardiac complications were experienced more frequent under LEA as compared with TEA. Combination of GA and EA, especially TEA, appears to improve perioperative care of patients undergoing rPE, in terms of patients safety and comfort.

show abstract

Surgical and postoperative factors affecting length of hospital stay after radical prostatectomy

Gardner

Bissonette

Petroni

et al. 2000

Cancer

View full text Add to dashboard Cite

BACKGROUND Radical prostatectomy continues to comprise the mainstay of therapy for localized prostate carcinoma. However, caring for radical prostatectomy patients accounts for approximately half of the $1.7 billion annual cost of prostate carcinoma treatment. Length of stay (LOS) after surgery appears to be one of the main components of this cost. The first step in reducing cost is to identify those variables associated with LOS. Radical prostatectomy can be performed using two very different surgical techniques and with each technique different costs are incurred. The objective of the current study was to identify factors associated with LOS as a function of surgical approach. To reduce potential biases due to patient requests for longer hospitalization or physician preferences in that regard, secondary objectives were to identify factors associated with time to fluid intake (TTF) and time to consume solid foods (TTS). METHODS An institutional‐based, retrospective chart review of 313 men with clinically localized prostate carcinoma who underwent either a perineal (RPP) or retropubic (RRP) prostatectomy at a single university center from March 1988 to October 1996 was undertaken. Information regarding LOS was available for 311 patients. Linear regression models were used to assess the association between covariables and LOS. Poisson regression models for count data were used to assess associations between covariables and the secondary endpoints of TTF and TTS. Covariables included: preoperative (age, race, prostate specific antigen, Gleason score, clinical stage, lymph node resection, comorbidity, and admission time), intraoperative (surgical approach, surgeon, operative time, estimated blood loss, transfusion requirement, anesthetic approach, and American Society of Anesthesiologists score), and postoperative (pain management complications and transfusions) parameters. RESULTS The median LOS was 4 days (range, 1–19 days) for RPP and 5 days (range, 3–16 days) for RRP approaches. The final model included six main effects and three interaction terms. Overall, LOS decreased over time with LOS decreasing at a faster rate in patients who underwent RPP. In general, patients who underwent RRP had an increased LOS compared with patients who underwent RPP. Complications from surgery and age increased the LOS for all patients; however, the increase was greater in patients who underwent RPP. In addition, the use of intraoperative epidural anesthesia and the increased use of postoperative narcotics were associated with increased LOS for patients undergoing both surgical approaches. TTF and TTS were significantly longer for patients who underwent the retropubic approach compared with those patients who underwent the perineal approach. After adjustment for surgical approach no other covariables were found to be associated with TTF. After adjustment for surgical approach, the occurrence of complications was found to be associated with TTS, indicating that patients who experienced complications took longer before they ...

show abstract

Does the choice of anesthetic technique affect the recovery of bowel function after radical prostatectomy?

Cited by 51 publications

References 10 publications

Einfluss der thorakalen Epiduralanalgesie auf die frühe postoperative Phase nach Eingriffen am Gastrointestinaltrakt

Einfluss der thorakalen Epiduralanalgesie auf die frühe postoperative Phase nach Eingriffen am Gastrointestinaltrakt

Kombinierte Anästhesie mit Epiduralkatheter

Surgical and postoperative factors affecting length of hospital stay after radical prostatectomy

Contact Info

Product

Resources

About