https://www.thelancet.com/pdfs/journals/lancet/PIIS0140-6736(03)14966-5.pdf

Anaesthesia, surgery, and challenges in postoperative recovery

Background Occult hypovolaemia is a key factor in the aetiology of postoperative morbidity and may not be detected by routine heart rate and arterial pressure measurements. Intraoperative gut hypoperfusion during major surgery is associated with increased morbidity and postoperative hospital stay. We assessed whether using intraoperative oesophageal Doppler guided fluid management to minimize hypovolaemia would reduce postoperative hospital stay and the time before return of gut function after colorectal surgery. Methods This single centre, blinded, prospective controlled trial randomized 128 consecutive consenting patients undergoing colorectal resection to oesophageal Doppler guided or central venous pressure (CVP)-based (conventional) intraoperative fluid management. The intervention group patients followed a dynamic oesophageal Doppler guided fluid protocol whereas control patients were managed using routine cardiovascular monitoring aiming for a CVP between 12 and 15 mm Hg. Results The median postoperative stay in the Doppler guided fluid group was 10 vs 11.5 days in the control group P Conclusions Intraoperative oesophageal Doppler guided fluid management was associated with a 1.5-day median reduction in postoperative hospital stay. Patients recovered gut function significantly faster and suffered significantly less gastrointestinal and overall morbidity.

Intraoperative oesophageal Doppler guided fluid management shortens postoperative hospital stay after major bowel surgery

BACKGROUND Quality of recovery (QoR) after anesthesia is an important measure of the early postoperative health status of patients The aim was to develop a short-form postoperative QoR score, and test its validity, reliability, responsiveness, and clinical acceptability and feasibility METHODS Based on extensive clinical and research experience with the 40-item QoR-40, the strongest psychometrically performing items from each of the five dimensions of the QoR-40 were selected to create a short-form version, the QoR-15 This was then evaluated in 127 adult patients after general anesthesia and surgery RESULTS There was good convergent validity between the QoR-15 and a global QoR visual analog scale (r = 068, P < 00005) Construct validity was supported by a negative correlation with duration of surgery (r = -049, P < 00005), time spent in the postanesthesia care unit (r = -041, P < 00005), and duration of hospital stay (r = -053, P < 00005) There was also excellent internal consistency (085), split-half reliability (078), and test-retest reliability (ri = 099), all P < 00005 Responsiveness was excellent with an effect size of 135 and a standardized response mean of 104 The mean ± SD time to complete the QoR-15 was 24 ± 08 min CONCLUSIONS The QoR-15 provides a valid, extensive, and yet efficient evaluation of postoperative QoR

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Development and psychometric evaluation of a postoperative quality of recovery score: the QoR-15.

BACKGROUND: Nitrous oxide is widely used in anesthesia, often administered at an inspired concentration around 70%. Although nitrous oxide interferes with vitamin B12, folate metabolism, and deoxyribonucleic acid synthesis and prevents the use of high inspired oxygen concentrations, the consequences of these effects are unclear. METHODS: Patients having major surgery expected to last at least 2 h were randomly assigned to nitrous oxide-free (80% oxygen, 20% nitrogen) or nitrous oxide-based (70% N2O, 30% oxygen) anesthesia. Patients and observers were blind to group identity. The primary endpoint was duration of hospital stay. Secondary endpoints included duration of intensive care stay and postoperative complications; the latter included severe nausea and vomiting, and the following major complications: pneumonia, pneumothorax, pulmonary embolism, wound infection, myocardial infarction, venous thromboembolism, stroke, awareness, and death within 30 days of surgery. RESULTS: Of 3,187 eligible patients, 2,050 consenting patients were recruited. Patients in the nitrous oxide-free group had significantly lower rates of major complications (odds ratio, 0.71; 95% confidence interval, 0.56-0.89; P = 0.003) and severe nausea and vomiting (odds ratio, 0.40; 95% confidence interval, 0.31-0.51; P < 0.001), but median duration of hospital stay did not differ substantially between groups (7.0 vs. 7.1 days; P = 0.06). Among patients admitted to the intensive care unit postoperatively, those in the nitrous oxide-free group were more likely to be discharged from the unit on any given day than those in the nitrous oxide group (hazard ratio, 1.35; 95% confidence interval, 1.05-1.73; P = 0.02). CONCLUSIONS: Avoidance of nitrous oxide and the concomitant increase in inspired oxygen concentration decreases the incidence of complications after major surgery, but does not significantly affect the duration of hospital stay. The routine use of nitrous oxide in patients undergoing major surgery should be questioned.

Avoidance of nitrous oxide for patients undergoing major surgery - A randomized controlled trial

BACKGROUND:Dexmedetomidine (Dex), an α2 agonist, has well-known anesthetic and analgesic-sparing effects. We designed this prospective, randomized, double-blind, and placebo-controlled dose-ranging study to evaluate the effect of Dex on both early and late recovery after laparoscopic bariatric surge

Dexmedetomidine infusion during laparoscopic bariatric surgery: the effect on recovery outcome variables.

A variety of methods have been used to quantify aspects of recovery after anesthesia.Most are narrowly focused, are not patient-rated, and have not been validated. We therefore set out to develop a patient-rated quality of recovery score. We constructed a 61-item questionnaire that asked individuals

Alan Rubinstein

Papers

Development and psychometric testing of a quality of recovery score after general anesthesia and surgery in adults.