martes, 12 de noviembre de 2013

Cirugía de vía rápida

Cirugía de vía rápida: un nuevo concepto de manejo perioperatorio de los pacientes quirúrgicos

Fast-track surgery: A new concept of perioperative management of surgical patients.
Rodrigues G, Ravi C, Prabhu R.
J Health Spec [serial online] 2013 [cited 2013 Oct 30];1:114-21.
In the past few decades, surgery has advanced greatly because of an improved understanding of perioperative pathophysiology, development of minimally invasive operative techniques and advanced anaesthetic techniques. Fewer operations are requiring extended periods of hospital stay and a growing number of procedures are performed on an ambulatory basis. The pressure on medical systems is continuously growing as a result of economic constraints, increasing numbers of patients undergoing surgical procedures and greater patient autonomy. Patient awareness is steadily increasing along with their participation in their own care, leading to expectations of a higher standard of care. This has led to the development of a new concept of fast-track surgery.
Keywords: Anaesthesia, hospital stay, perioperative, recovery, surgery

Resecciones laparoscópicas de colon con alta en menos de 24 horas

Laparoscopic colon resections with discharge less than 24 hours.

Dobradin A, Ganji M, Alam SE, Kar PM.

Winter Park Memorial Hospital, Winter Park, FL, USA.

JSLS. 2013 Apr-Jun;17(2):198-203. doi: 10.4293/108680813X13654754535791.


BACKGROUND AND OBJECTIVES:A short hospital stay is one of the main advantages of laparoscopic surgery. Previous studies have shown that after a multimodal fast-track process, the hospital length of stay can be shortened to between 2 and 5 days. The objective of this review is to show that the hospital length of stay can, in some cases, be reduced to <24 hours.METHODS: This study retrospectively reviews a surgeon's experience with laparoscopic surgery over a 12-month period. Seven patients were discharged home within 24 hours after minimally invasive laparoscopic surgical treatment, following a modified fast-track protocol that was adopted for perioperative care. RESULTS: Of the 7 patients, 4 received laparoscopic right hemicolectomy for malignant disease and 3 underwent sigmoid colectomies for recurrent diverticulitis. The mean hospital stay was 21 hours, 47 minutes; the mean volume of intraoperative fluid (lactated Ringer) was 1850 mL; the meansurgical blood loss was only 74.3 mL; the mean duration of surgery was 118 minutes; and the patients were ambulated and fed a liquid diet after recovery from anesthesia. The reviewed patients had functional gastrointestinal tracts and were agreeable to the timing of discharge. On the follow-up visit, they showed no adverse consequences such as bleeding, infection, or anastomotic leak. CONCLUSION: Laparoscopic colon surgery that incorporated multimodal perioperative care allowed patients to be discharged within the first 24 hours. Careful postoperative outpatient follow-up is important in monitoring complications such as anastomotic leak, which may not present until postoperative day 5.

Impacto de la calidad de sueño sobre la recuperación de histerectomía abdominal de vía rápida
The impact of quality of sleep on recovery from fast-track abdominal hysterectomy.
Kjølhede P, Langström P, Nilsson P, Wodlin NB, Nilsson L.
Division of Obstetrics and Gynecology, Department of Clinical and Experimental Medicine, Faculty of Health Sciences, Linköping University, County Council of Östergötland, Sweden.
J Clin Sleep Med. 2012 Aug 15;8(4):395-402. doi: 10.5664/jcsm.2032.
STUDY OBJECTIVES:To examine the impact of mode of anesthesia on perceived quality of sleep and to analyze the perceived quality of sleep in affecting recovery from surgery. METHODS:A randomized, controlled, open multicenter trial was conducted in 5 hospitals in Southeast Sweden. One-hundred eighty women scheduled for fast-track abdominal hysterectomy for benign conditions were randomized to spinal anesthesia or general anesthesia; 162 women completed the trial; 82 allocated to spinal anesthesia and 80 to general anesthesia. Symptoms and perceived quality of sleep after surgery were registered daily in the Swedish Postoperative Symptoms Questionnaire.RESULTS:Women in the general anesthesia group experienced bad quality of sleep the night after surgery significantly more often than the women who had spinal anesthesia (odds ratio [OR] 2.45; p = 0.03). This was almost exclusively attributed to a significantly higher consumption of opioids postoperatively in the general anesthesia group. Risk factors for bad quality of sleep during the first night postoperatively were: opioids (OR 1.07; p = 0.03); rescue antiemetics (OR 2.45; p = 0.05); relative weight gain (OR 1.47; p = 0.04); summary score of postoperative symptoms (OR 1.13; p = 0.02); and stress coping capacity (OR 0.98; p = 0.01). A longer hospital stay was strongly associated with a poorer quality of sleep the first night postoperatively (p = 0.002). CONCLUSIONS:The quality of sleep the first night after abdominal hysterectomy is an important factor for recovery. In fast-track abdominal hysterectomy, it seems important to use anesthesia and multimodal analgesia reducing the need for opioids postoperatively and to use strategies that diminish other factors that may interfere negatively with sleep. Efforts to enhance quality of sleep postoperatively by means of preventive measures and treatment of sleep disturbances should be included in fast-track programs.
KEYWORDS:Abdominal hysterectomy, fast track, general anesthesia, postoperative recovery, quality of sleep, spinal anesthesia

Anestesiología y Medicina del Dolor
Publicar un comentario