Randomized clinical trial of fluid restriction in colorectal surgery

Abraham-Nordling, Mirna; Hjern, Fredrik; Pollack, Johan; Prytz, Mattias; Borg, Tamer Farouk; Kressner, Ulf

doi:10.1002/bjs.7702

Cited by 84 publications

(71 citation statements)

References 32 publications

(40 reference statements)

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“…The use of carbohydrate loading facilitates accelerated recovery through early return of bowel function and a shorter hospital stay [3] . (iii) Intraoperative fluid overload causes intestinal edema, impaired wound healing, disturbed coagulation, and cardiopulmonary complications [4] . To date, no studies have shown whether the ERAS protocol is superior to the conventional protocol after robot-assisted laparoscopic radical prostatectomy (RALP) by a retrospective controlled cohort study.…”

Section: Introductionmentioning

confidence: 99%

Introduction of an Enhanced Recovery after Surgery Protocol for Robot-Assisted Laparoscopic Radical Prostatectomy

Sugi¹,

Matsuda²,

Yoshida³

et al. 2017

Urol Int

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Introduction: No studies have shown whether the enhanced recovery after surgery (ERAS) protocol is superior to the conventional protocol after robot-assisted laparoscopic radical prostatectomy (RALP). We compared intestinal function and perioperative parameters of patients with prostate cancer after the ERAS and conventional protocols to determine the superior protocol for recovery of intestinal function. Material and Methods: A retrospective analysis of 198 consecutive patients who underwent RALP between August 2013 and June 2015 was conducted. Our study design included 2 cohorts. Patients underwent conventional care in one group (n = 123) and the ERAS protocol in the other group (n = 75). The primary outcome was the time to first defecation. Secondary outcomes were perioperative parameters and the complication rate. Results: The ERAS group showed a significantly shorter time to first defecation than did the conventional group (p = 0.006). Multivariate analysis showed that selection of the ERAS protocol was significantly associated with the number of days for first time to defecation. Conclusions: Successful application of an ERAS protocol was applied to our patients who underwent RALP and did not have major complications. The ERAS protocol included enhanced intestinal recovery. The ERAS group showed a significantly shorter time to first defecation than did the conventional group.

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Section: Introductionmentioning

confidence: 99%

Introduction of an Enhanced Recovery after Surgery Protocol for Robot-Assisted Laparoscopic Radical Prostatectomy

Sugi¹,

Matsuda²,

Yoshida³

et al. 2017

Urol Int

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“…The effectiveness of intra-operative cardiovascular monitoring to reduce such complications has been proven in other published studies [25][26][27][28][29][30] . On the other hand, hypovolemia can lead to hypoperfusion, circulatory collapse, impaired wound healing, anastomotic leak [14,15] , bacterial translocations and endotoxaemia with activation of the systemic inflammatory response [31] ; all of which account for the need of prolonged stay in high level care facilities post-operatively. Noblett et al [2] have shown a reduction in peak systemic inflammatory cytokine (IL-6) levels for patients undergoing CO monitoring with Doppler.…”

Section: Discussionmentioning

confidence: 99%

“…Restrictive regimens have been shown to be advantageous, reducing post-operative complications [11][12][13][14][15] , whereas liberal fluid administration has been associated with fluid overload and complications such as a reduction in gut motility, mucosal oedema and an increased risk of anastomotic breakdown [16,17] . It is also associated with pulmonary oedema and cardiac dysrhythmias [15,[18][19][20] .…”

Section: Introductionmentioning

confidence: 99%

Does intra-operative cardiac output monitoring improve outcomes for patients undergoing elective colorectal surgery within an enhanced recovery programme?

Aslam¹,

Smith²,

Currow³

et al. 2018

MIS

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Aim: Intra-operative cardiac output (CO) monitoring became a standard of care in Northampton General Hospital, UK, at the end of 2013. This study aimed to assess the effectiveness of intra-operative CO monitoring with oesophageal Doppler or LiDCO for patients undergoing elective colorectal surgery for cancer within an enhanced recovery after surgery (ERAS).Methods: Data was prospectively collected over a 5-year period (March 2010 -Feb 2015 for patients undergoing elective colorectal surgery in the practice of a single surgeon. The ERAS protocol was applied for all the patients. There were 69 patients who had intra-operative CO monitoring with oesophageal Doppler or LiDCO and 144 patients who had no intra-operative CO monitoring. Results were analysed for post-operative outcomes (morbidity, mortality, readmission within 30 days, total length of hospital stay and admission to a high level of care facility). Results:There was no significant difference in 30-day morbidity and readmission rates between the two examined groups. Forty-six percent of patients in the intra-operative CO monitoring group were admitted to a low level of care facility (ward) in comparison to 24% of patients in the no intra-operative CO monitoring group (P = 0.01). Conclusion:Using intra-operative CO monitoring singnificantly might reduce the need for admission to critical care. A larger cohort study is needed to further confirm these findings and account for any co-founders.

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“…Clinical data on the effect of perioperative fluid management on the risk for PPCs during major abdominal surgery are extremely heterogeneous. In two recent prospective investigations a restrictive fluid management strategy was associated with a reduction in the overall complication rate, but the rate of PPCs did not differ among groups [75,76]. In a retrospective analysis of a large database, Blum et al [24 && ] identified a higher amount of intraoperative crystalloid infusion as a risk factor for the development of postoperative ARDS.…”

Section: Intravascular Volume Managementmentioning

confidence: 98%

Nonventilatory strategies to prevent postoperative pulmonary complications

Güldner

Pelosi²,

Abreu³

2013

Current Opinion in Anaesthesiology

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Randomized clinical trial of fluid restriction in colorectal surgery

Abstract: Restricted perioperative intravenous fluid administration does not reduce length of stay in a fast-track protocol.

Cited by 84 publications

References 32 publications

Introduction of an Enhanced Recovery after Surgery Protocol for Robot-Assisted Laparoscopic Radical Prostatectomy

Introduction of an Enhanced Recovery after Surgery Protocol for Robot-Assisted Laparoscopic Radical Prostatectomy

Does intra-operative cardiac output monitoring improve outcomes for patients undergoing elective colorectal surgery within an enhanced recovery programme?

Nonventilatory strategies to prevent postoperative pulmonary complications

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