scholarly journals Perioperative management in bariatric surgery using eras

2019 ◽  
Vol 1 (7) ◽  
pp. 61-70
Author(s):  
V. Cherniy ◽  
V. Yevsieieva ◽  
M. Serbul
Keyword(s):  
Bariatric Surgery ◽  
Best Practice ◽  
Enhanced Recovery ◽  
Bypass Graft ◽  
Perioperative Period ◽  
Multimodal Analgesia ◽  
Term Treatment ◽  
Successful Implementation ◽  
Operative Care ◽  
Long Term Treatment

Purpose of review. The aim of the work is to collect in a single whole the disparate information devoted to certain aspects of ERAS methods application for the creation of the project of Ukrainian-language recommendations on optimization of perioperative period in the bariatric patients. Recent findings. Bariatric surgery today is a gold standard in the long-term treatment of morbid obesity and associated comorbid conditions such as metabolic syndrome, type 2 diabetes, and others. Laparoscopic longitudinal resection of the stomach (LPRS) and gastric bypass graft (LSH) are the most common bariatric interventions in the world. But despite the fact that the global epidemic of obesity for several decades has had an impact on perioperative tactics of the management of barrier patients, there is currently a relative lack of management in the treatment of this group of patients. They still feel pain and are traditionally injecting opioids for early postoperative analgesia, suffering from nausea and vomiting, which significantly delay the onset of enteral nutrition and prolong the duration of hospitalization. Consequently, postoperative pain, PONV and malnutrition, rather than factors associated with the operation, often lead to prolonged hospitalization and elimination of which benefits the healthcare system and patients by returning them home earlier. Protocols of Enhanced Recovery After Surgery (ERAS), introduced in medical practice Prof. Kehlet in the nineties of the last century, widely used in various fields of surgeons. The most studied application of these protocols in colorectal, thoracic surgery and operative urology. There are recent studies and meta-analyzes that have demonstrated the feasibility of introducing ERAS into bariatric surgery. In 2016, recommendations were published on the implementation of ERAS components in bariatric surgery. The ERABS protocol has been implemented in many Western European bariatric centers and includes the best practice of preoperative preparation and standardization of perioperative and post-operative care that will provide rapid recovery and improve treatment outcome. But it remains unclear whether all components of the classical protocol, namely, epidural anesthesia, are necessary for successful implementation in bariatric surgery. Conclusions. ERAS protocols are successfully used in obese patients after bariatric surgery, and the principles of multimodal analgesia minimize the need for opioids. The principles of ERAS have already proved themselves in many clinics and should be reflected in the National Clinical Recommendations for Bariatric Surgery.

Thrombotic Complications in Gliomas

2019 ◽  
Vol 45 (04) ◽  
pp. 326-333
Author(s):  
Alexandra L. Czap ◽  
Ashley Becker ◽  
Patrick Y. Wen
Keyword(s):  
Perceived Risk ◽  
Perioperative Period ◽  
High Grade Glioma ◽  
Term Treatment ◽  
Long Term Treatment ◽  
High Incidence ◽  
Risk Patients ◽  
Thrombotic Complications ◽  
Recurrent Nature

AbstractArterial and venous thromboses are common in glioma patients, both in the perioperative period and throughout the course of the disease. High-grade glioma patients harbor underlying hypercoagulability, which predisposes these high-risk patients with prolonged immobility and neurologic deficits to thrombotic events. Despite the high incidence and recurrent nature of these complications, there is no standardized approach to the management of glioma patients, and many challenges remain. Historically, the perceived risk of intracranial and intratumoral hemorrhage limited the use of anticoagulation, favoring nonpharmacological prophylaxis and treatment. Multiple studies have demonstrated the safety and efficacy of anticoagulation when indicated, with low molecular weight heparin as the preferred short- or long-term treatment. This review will discuss the epidemiology, risk factors, and therapeutic management of both venous and arterial thrombotic complications in glioma.

scholarly journals Why are long-acting injectable antipsychotics still underused?

2015 ◽  
Vol 21 (2) ◽  
pp. 98-105 ◽  
Author(s):  
Peter Bosanac ◽  
David Jonathan Castle
Keyword(s):  
Best Practice ◽  
Treatment Guidelines ◽  
Term Treatment ◽  
Key Factors ◽  
Long Term Treatment ◽  
Service Barriers ◽  
Long Acting ◽  
Evidence Based Care

Summary‘Depot antipsychotics' (‘long-acting injectable antipsychotic medications' or LAIs) are underused in the treatment of schizophrenia (including first episodes) and, possibly, of schizophrenia with comorbid substance use disorders. Patients' and clinicians' beliefs and attitudes, and service barriers, affect best practice and evidence-based care in LAI prescription. Poor medication adherence is a key reason for LAI prescription, but patients receiving LAIs may still relapse or experience significant side-effects. Patients' and clinicians' attitudes towards antipsychotic medication, as well as the quality of their recovery-focused relationship, are key factors in adherence. Clinicians should avoid a dichotomous ‘oralv. LAI’ choice: LAIs may have a place at various stages in the continuum of care and they should be one of the options discussed with any patient requiring long-term treatment, even early in the illness course. Many clinicians need better education about LAIs and greater familiarity with schizophrenia treatment guidelines.

scholarly journals Bariatric Surgery in Adolescents: To Do or Not to Do?

Children ◽  
2021 ◽  
Vol 8 (6) ◽  
pp. 453
Author(s):  
Valeria Calcaterra ◽  
Hellas Cena ◽  
Gloria Pelizzo ◽  
Debora Porri ◽  
Corrado Regalbuto ◽  
...  
Keyword(s):  
Bariatric Surgery ◽  
Weight Loss ◽  
Severe Obesity ◽  
Treatment Options ◽  
Term Treatment ◽  
Physical And Mental Health ◽  
Long Term Treatment ◽  
Healthy Growth ◽  
Inadequate Weight Loss

Pediatric obesity is a multifaceted disease that can impact physical and mental health. It is a complex condition that interweaves biological, developmental, environmental, behavioral, and genetic factors. In most cases lifestyle and behavioral modification as well as medical treatment led to poor short-term weight reduction and long-term failure. Thus, bariatric surgery should be considered in adolescents with moderate to severe obesity who have previously participated in lifestyle interventions with unsuccessful outcomes. In particular, laparoscopic sleeve gastrectomy is considered the most commonly performed bariatric surgery worldwide. The procedure is safe and feasible. The efficacy of this weight loss surgical procedure has been demonstrated in pediatric age. Nevertheless, there are barriers at the patient, provider, and health system levels, to be removed. First and foremost, more efforts must be made to prevent decline in nutritional status that is frequent after bariatric surgery, and to avoid inadequate weight loss and weight regain, ensuring successful long-term treatment and allowing healthy growth. In this narrative review, we considered the rationale behind surgical treatment options, outcomes, and clinical indications in adolescents with severe obesity, focusing on LSG, nutritional management, and resolution of metabolic comorbidities.

scholarly journals Changes of Taste, Smell and Eating Behavior in Patients Undergoing Bariatric Surgery: Associations with PROP Phenotypes and Polymorphisms in the Odorant-Binding Protein OBPIIa and CD36 Receptor Genes

Nutrients ◽  
2021 ◽  
Vol 13 (1) ◽  
pp. 250
Author(s):  
Melania Melis ◽  
Stefano Pintus ◽  
Mariano Mastinu ◽  
Giovanni Fantola ◽  
Roberto Moroni ◽  
...  
Keyword(s):  
Bariatric Surgery ◽  
Oleic Acid ◽  
Eating Behavior ◽  
Positive Impact ◽  
Term Treatment ◽  
Acid Sensitivity ◽  
Long Term Treatment ◽  
Increased Sensitivity ◽  
Odorant Binding ◽  
Taste And Smell

Bariatric surgery is the most effective long-term treatment for severe obesity and related comorbidities. Although patients who underwent bariatric surgery report changes of taste and smell perception, results from sensory studies are discrepant and limited. Here, we assessed taste and smell functions in 51 patients before, one month, and six months after undergoing bariatric surgery. We used taste strip tests to assess gustatory function (including sweetness, saltiness, sourness, umaminess, bitterness and oleic acid, a fatty stimulus), the “Sniffin’ Sticks” test to assess olfactory identification and the 3-Factor Eating Questionnaire to assess eating behavior. We also explored associations between these phenotypes and flavor-related genes. Results showed an overall improvement in taste function (including increased sensitivity to oleic acid and the bitterness of 6-n-propylthiouracil (PROP)) and in olfactory function (which could be related to the increase in PROP and oleic acid sensitivity), an increase in cognitive restraint, and a decrease in disinhibition and hunger after bariatric surgery. These findings indicate that bariatric surgery can have a positive impact on olfactory and gustatory functions and eating behavior (with an important role of genetic factors, such PROP tasting), which in turn might contribute to the success of the intervention.

scholarly journals Enhanced recovery after surgery: anesthesia-related components

2021 ◽  
Vol 64 (12) ◽  
pp. 813-819
Author(s):  
Ah-Reum Cho
Keyword(s):  
Enhanced Recovery ◽  
Enhanced Recovery After Surgery ◽  
Postoperative Nausea And Vomiting ◽  
Perioperative Period ◽  
Temperature Management ◽  
Multidisciplinary Teams ◽  
Successful Implementation ◽  
Comprehensive Management ◽  
Care Processes ◽  
Essential Components

Background: Enhanced recovery after surgery (ERAS) is a multidisciplinary and multimodal evidence-based approach aimed at improving the recovery of surgical patients. Successful implementation of ERAS protocols requires proper perioperative communication and collaboration among surgeons, anesthesiologists, nurses, and other medical personnel.Current Concepts: The anesthesiologist is the clinical leader responsible for the ERAS program. Preoperative patient evaluation, optimization, and patient education are essential components of the ERAS program. The program also involves preoperative fasting and carbohydrate loading to minimize catabolic effects. Selection of an appropriate anesthetic regimen, fluid and temperature management, avoidance of intra/postoperative nausea and vomiting, and multimodal pain management are the key components of ERAS for which the anesthesiologist is responsible.Discussion and Conclusion: Factors that enable the successful implementation of ERAS include the willingness to change to ERAS, formation of multidisciplinary teams to improve cooperation, and support from the hospital management, as well as standardization of order sets and care processes and the appropriate use of audits. As the leader of the ERAS team, the anesthesiologist should be actively involved in comprehensive management of the patient during the perioperative period.

scholarly journals The importance of psychological and nutritional follow-up after bariatric surgery: Literature review

2021 ◽  
pp. 20-44
Author(s):  
Carla Viana Dendasck ◽  
Rogério Bongestab dos Santos ◽  
Vitor Maia Santos ◽  
Tadeu Uggere de Andrade ◽  
Adriano Ribeiro Meyer Pflug
Keyword(s):  
Bariatric Surgery ◽  
Literature Review ◽  
Postoperative Period ◽  
Term Treatment ◽  
Psychological Status ◽  
Postoperative Treatment ◽  
Long Term Treatment ◽  
The Individual

Obesity is a multifactorial chronic disease. The patient may present several clinical conditions associated with it. The clinical picture is complex, which can hinder the use of conventional treatments and methods. Bariatric surgery is an effective long-term treatment for this condition. Based on a literature review, the article aims to discuss the importance of post-bariatric psychological and nutritional follow-up. The fundamental question that underpits this study is: how can typical strategies in the postoperative period contribute to the individual undergoing surgery to give greater importance to his diet and mental health? The most effective treatment strategy has been bariatric surgery, however, the multidisciplinary evaluation that scores the patient’s biological, social and psychological status is fundamental, since psychopathological changes are common to obese individuals. Although bariatric surgery contributes to the improvement in the quality of life of patients, there needs to be greater attention to postoperative treatment. These individuals should be encouraged to continue with nutritional and psychological follow-up in the postoperative period, so that it is possible to prevent possible complications in the medium and long term.

Assessment of a multimodal analgesia protocol in goats undergoing claw amputation

2019 ◽  
Vol 20 (4) ◽  
pp. 37-46
Author(s):  
Usama Fekry ◽  
Awad Rizk ◽  
Esam Mosbah ◽  
Adel Zaghloul
Keyword(s):  
Behavioral Effect ◽  
Multimodal Analgesia ◽  
Term Treatment ◽  
Analgesic Effects ◽  
Post Surgery ◽  
Intravenous Regional Anesthesia ◽  
Long Term Treatment ◽  
Randomized Experimental Design ◽  
Preset Time ◽  
The Right

Objective: To evaluate the anti-nociceptive, sedative and behavioral effect of multimodal analgesic drugs in goat's undergoing unilateral claw amputation. Design: A randomized experimental design. Animals: Sixteen goats were randomly assigned into 4 groups (4 bucks per group). Procedure: Animals used in this study were randomly assigned into 4 groups, four animals for each group. All goats were anaesthetized by intravenous regional anesthesia (IVRA) of the right forelimb cephalic vein with 2% lidocaine in a dose of 3mg/kg body weight (BW) before surgery. Administration of carprofen (50 mg/ml) at a dose 0.1 mg/kg BW took place before surgery on day 0 and was then repeated once daily for another 3 consecutive days postoperatively in groups Lidocaine (L), carprofen_lidocaine (CL), carprofen – romifidine - lidocaine (CRL), and carprofen – romifidine - butorphenol - lidocaine (CRBL). Heart rate (HR), respiratory rate (RR), rectal temperature (RT), serum IL-6 level, sedation score, and lameness score were determined at preset time intervals and the animals’ behavior was recorded. Results: The mean average of HR, RR and RT in IVRA treated animals was significantly increased until the end of surgery followed by gradual decrease up to 90 min post-surgery. In CRL and CRBL it showed a significant decrease compared to controls. There was a significant decrease in lameness score in CRL and CRBL treated animals from 30 min until 2 hours and for 3 days post-surgery. After injection of romifidine it showed a significant decrease of IL-6 levels compared to lidocaine and CL treated animals. Conclusion and clinical relevance: It was concluded that, the use of romifidine and buterphanol in the analgesic protocol during claw amputation in goats, alleviate pain response and potentiate the analgesic effects of IVRA. Addition of carprofen to the analgesic protocol can be used for long- term treatment of orthopedic pain in goats without complications.

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