Enhanced recovery in liver surgery.

Enhanced recovery in liver surgery has been shown to improve outcomes including patient-reported outcomes, length of stay, return to intended oncology therapy, and cost. The goal of this chapter will be to review the elements of a modern enhanced recovery pathway that is utilized across the entire episode of care in liver surgery.

Comparing the effects of sustained and transient spatial attention on the orienting towards and the processing of electrical nociceptive stimuli.

We examined whether sustained vs. transient spatial attention differentially affect the processing of electrical nociceptive stimuli. Cued nociceptive stimuli of a relevant intensity (low or high) on the left or right forearm required a foot pedal press. The cued side varied trial wise in the transient attention condition, while it remained constant during a series of trials in the sustained attention condition. The orienting phase preceding the nociceptive stimuli was examined by focusing on lateralized EEG activity. ERPs were computed to examine the influence of spatial attention on the processing of the nociceptive stimuli. Results for the orienting phase showed increased ipsilateral alpha and beta power above somatosensory areas in both the transient and the sustained attention conditions, which may reflect inhibition of ipsilateral and/or disinhibition of contralateral somatosensory areas. Cued nociceptive stimuli evoked a larger N130 than uncued stimuli, both in the transient and the sustained attention conditions. Support for increased efficiency of spatial attention in the sustained attention condition was obtained for the N180 and the P540 component. We concluded that spatial attention is more efficient in the case of sustained than in the case of transient spatial attention.

Lateralized power spectra of the EEG as an index of visuospatial attention.

The electroencephalogram (EEG) was measured in an endogenous orienting paradigm where symbolic cues indicated the likely side of to-be-discriminated targets. Combined results of event-related lateralizations (ERLs) and a newly derived measure from wavelet analyses that we applied on the raw EEG and individual event-related potentials (ERPs), the lateralized power spectra (LPS) and the LPS-ERP, respectively, confirmed the common view that endogenous orienting operates by anterior processes, probably originating from the frontal eye fields, modulating processing in parietal and occipital areas. The LPS data indicated that modulation takes place by increased inhibition of the irrelevant visual field and/or disinhibition of the relevant to-be-attended visual field. Combined use of ERLs, the LPS, and the LPS-ERP indicated that most of the involved processes can be characterized as externally evoked, either or not with clear individual differences as some evoked effects were only visible in the LPS-ERERP, whereas few processes seemed to have an internally induced nature. Use of the LPS and the LPS-ERP may be advantageous as it enables to determine the involvement of internally generated lateralized processes that are not strictly bound to an event like stimulus onset.