Meta analysis of the application of ERAS concept in orthopedic surgery / 中国医师杂志

Objective:To evaluate the value and effectiveness of the enhanced recovery after surgery (ERAS) theory in orthopedic surgery, and to provide a theoretical basis for optimizing rehabilitation plans during the perioperative period of orthopedic surgery.Methods:Relevant literature on the application of accelerated rehabilitation in orthopedic perioperative period officially published in Pubmed and the Chinese Medical Journal Database From January 2000 to October 2022 was searched and included in randomized controlled and clinical case studies. The patients were divided into the experimental group (ERAS group) and the control group (conventional treatment group). The patients in the experimental group were treated with ERAS mode after surgery, while the patients in the control group were treated with conventional rehabilitation mode after surgery. The hospital stay, postoperative complications, postoperative nausea and vomiting, and postoperative incidence rate of deep vein thrombosis in the two groups were statistically analyzed.Results:Finally, a total of 1 301 patients were included in 9 articles, divided into an experimental group (ERAS group, n=643) and a control group (conventional treatment group, n=652). There was a statistically significant difference in hospital stay between the experimental group and the control group ( MD=-4.11, 95% CI: -6.73 to -1.49, P=0.002); The overall effect tendency of the incidence of complications between the experimental group and the control group was statistically significant ( P=0.005); Compared with the control group, the incidence rate of postoperative nausea and vomiting in the experimental group was lower ( P=0.04); The incidence rate of postoperative deep vein thrombosis in the experimental group was lower than that in the control group ( P=0.02). Conclusions:The application of accelerated rehabilitation concept in orthopedic surgery patients can reduce the length of hospital stay, and reduce the incidence rate of postoperative complications, nausea and vomiting, and deep vein thrombosis.

The use of dexmedetomidine in puncture techniques for degenerative diseases of the lumbar spine / Uso de dexmedetomidina em técnicas de punção para doenças degenerativas da coluna lombar / Uso de dexmedetomidina en técnicas de punción para enfermedades degenerativas de la columna lumbar

ABSTRACT Objective To analyze the results of the use of dexmedetomidine (D) in the treatment of patients with degenerative diseases of the lumbar spine using puncture techniques. Methods The study included 77 patients who underwent surgical puncture for degenerative diseases of the lumbar spine with the use of alpha-2-adrenomimetic D: percutaneous laser denervation of the facet joints (n = 46) and posterolateral transforaminal endoscopic discectomy (n = 31). We assessed: the level of sedation using the Ramsay Sedation Scale (RSS) and the Richmond Agitation Sedation Scale (RASS); intraoperative dynamics of the cardiovascular and respiratory system parameters; the level of pain syndrome according to VAS. Results A high intraoperative level of sedation was determined, with RASS -2, -3 and Ramsay III, IV; when transferring a patient to a department (in 90 minutes) this parameter was RASS 0 and Ramsay II. There were no significant changes in central hemodynamics and respiratory depression. The minimum level of pain was determined immediately after surgery, at 30 and 60 minutes after surgery, and before transfer to the department (90 minutes): 6 (4;9); 10 (8;12); 12 (9;13); 16 (13;19) respectively. The absence of the need for additional analgesia on the first postoperative day was verified. Conclusion The use of D significantly reduces the level of pain, while maintaining the necessary verbal contact with the patient, and provides the necessary neurovegetative protection without respiratory depression or lowered hemodynamic parameters during the perioperative period. Level of evidence II; Prognostic Studies - Investigating the Effect of a Patient Characteristic on Disease Outcome. Case series, retrospective study.

RESUMO Objetivo Analisar os resultados do uso de dexmedetomidina (D) no tratamento de pacientes com doenças degenerativas da coluna lombar com técnicas de punção. Métodos O estudo incluiu 77 pacientes submetidos à punção cirúrgica em doenças degenerativas da coluna lombar com o uso de um agonista alfa-2 adrenérgico: denervação percutânea das articulações facetárias com laser (n = 46) e discectomia endoscópica transforaminal posterolateral (n = 31). Foram avaliados o nível de sedação usando a Escala de Sedação de Ramsay (RSS) e a Escala de Sedação e Agitação de Richmond (RASS); a dinâmica intraoperatória dos parâmetros dos sistemas cardiovascular e respiratório; o nível de síndrome de dor de acordo com a EVA. Resultados Determinou-se um alto nível intraoperatório de sedação pela RASS (-2, -3) e pela Ramsay (III, IV). Ao transferir um paciente para outro setor (depois de 90 minutos), esse parâmetro era 0 em RASS e II em Ramsay. Não houve alterações significativas na hemodinâmica central e na depressão respiratória. O nível mínimo de dor foi determinado imediatamente após a cirurgia, 30 e 60 minutos depois da cirurgia e antes da transferência para o outro setor (90 minutos depois): 6 (4; 9); 10 (8; 12); 12 (9; 13); 16 (13; 19), respectivamente. Constatou-se que não era necessária analgesia adicional no primeiro dia pós-operatório. Conclusões O uso de D reduz significativamente o nível de dor mantendo a comunicação verbal necessária com o paciente e fornece a proteção neurovegetativa necessária sem depressão respiratória e os parâmetros hemodinâmicos reduzidos durante o período perioperatório. Nível de evidência II; Estudos prognósticos - Investigação do efeito de característica de um paciente sobre o desfecho da doença. Série de casos, Estudo retrospectivo.

RESUMEN Objetivo Analizar los resultados del uso de dexmedetomidina (D) en el tratamiento de pacientes con enfermedades degenerativas de la columna lumbar con técnicas de punción. Métodos El estudio incluyó a 77 pacientes con enfermedades degenerativas de la columna lumbar que se sometieron a punción quirúrgica mediante el uso de un agonista adrenérgico alfa-2: denervación percutánea de las articulaciones facetarias con láser (n = 46) y discectomía endoscópica transforaminal posterolateral (n = 31). Fueron evaluados el nivel de sedación mediante la Escala de Sedación de Ramsay (RSS) y la Escala de Sedación y Agitación de Richmond (RASS); la dinámica intraoperatoria de los parámetros de los sistemas cardiovascular y respiratorio; el nivel del síndrome de dolor según la EVA. Resultados Se determinó un alto nivel de sedación intraoperatoria en RASS (-2, -3) y por Ramsay (III, IV)Al transferir un paciente a otro sector (después de 90 minutos), este parámetro fue 0 en RASS y II en Ramsay. No hubo cambios significativos en la hemodinámica central y la depresión respiratoria.El nivel mínimo de dolor se determinó después de la cirugía, 30 y 60 minutos después de la cirugía y antes del traslado al otro sector (90 minutos después): 6 (4; 9); 10 (8; 12); 12 (9; 13); 16 (13; 19), respectivamente. Se verificó que no era necesaria analgesia adicional el primer día postoperatorio. Conclusiones El uso de D reduce significativamente el nivel de dolor al mismo tiempo que se mantiene la necesaria comunicación verbal con el paciente y brinda la protección neurovegetativa necesaria sin depresión respiratoria y parámetros hemodinámico reducidos durante el período perioperatorio. Nivel de evidencia II; Estudios de pronóstico: Investigación del efecto de la característica de un paciente sobre el desenlace de la enfermedad. Serie de casos, Estudio retrospectivo.

Programas de Optimización Perioperatoria, Enhanced Recovery y Fast-track: ¿Por qué están en auge? ¿Qué son realmente y cómo se implementan en la práctica? / Perioperative optimization, enhanced recovery and fast-track programs: why are they booming? What are these programs actually and how are they implemented into practice?

RESUMEN Desde 2015 a la fecha, los autores de esta revisión hemos implementado numerosos programas de optimización perioperatoria en Latinoamérica. En el siguiente artículo, presentamos una introducción general a los conceptos de optimización perioperatoria y resumimos nuestra experiencia trabajando en la región. También a lo largo de esta revisión, los lectores podrán encontrar desarrollados los tres elementos centrales de la optimización perioperatoria. En primer lugar, la constitución y los roles dentro un equipo perioperatorio. En segundo término, el registro sistemático y estandarizado de la práctica quirúrgica y sus resultados. Y, por último, la descripción del ciclo de mejoría continua como método de trabajo para ajustar la práctica diaria sobre la base del análisis de datos propios.

ABSTRACT From 2015 to date, the authors of this review have implemented several enhanced recovery periope rative programs in Latin America. In the following article, we present a general introduction to the con cepts of perioperative optimization and summarize our experience working in the region. Throughout this review, readers will also find the three fundamental elements of perioperative optimization. First, the creation and roles of a perioperative team. Second, the systematic and standardized registration of the surgical practice and its outcomes. And finally, the description of the continuous improvement cycle as a working method for adjusting daily practice based on the analysis of one's own data.

Resultados de una encuesta multicentros sobre recuperación posoperatoria y razones para cambiar prácticas / Results of a multicenter survey on postoperative recovery and reasons for changing practices

Introducción: Los Programas de Recuperación Posoperatoria Mejorada (Enhanced Revovery After Surgery, ERAS, por sus siglas en inglés), también denominados de "rehabilitación multimodal quirúrgica" o "Fast-track" constituyen estrategias perioperatorias para mejorar la recuperación postoperatoria de forma segura. Objetivo: Evaluar el conocimiento y la aplicación práctica de evidencias científicas actuales que sostienen a los programas de Recuperación Posoperatoria Mejorada. Métodos: Se realizó una investigación cualitativa en 5 servicios de cirugía general de hospitales universitarios de la capital. Se aplicó un cuestionario anónimo a 107 médicos especialistas y residentes de 3er. y 4to. año de la especialidad. Resultados: El 40 por ciento de los encuestados no tenía conocimiento de la existencia de los programas de rehabilitación multimodal. Las evidencias relacionadas con la descompresión naso-gástrica, el ayuno preoperatorio y la preparación mecánica del colon, fueron las menos conocidas, con porcientos de respuestas no acordes a evidencias actuales de 62,2 por ciento, 50,1 por ciento y 50,1 por ciento, respectivamente. Conclusiones: Importantes evidencias científicas actuales en varias acciones claves de la recuperación postoperatoria no son bien conocidas y por ende no han sido incorporadas a la práctica médica(AU)

Introduction: Enhanced recovery after surgery (ERAS) programs, also known as "surgical multimodal rehabilitation" or "fast-track," are perioperative strategies to improve postoperative recovery safely. Objective: To assess the knowledge and practical application of current scientific evidence that supports enhanced postoperative recovery programs. Methods: A qualitative investigation was carried out in five general surgery services of university hospitals in the capital of Cuba. An anonymous questionnaire was applied to 107 specialist physicians, as well as residents from the third and fourth academic years. Results: 40% of the respondents did not have any knowledge about the existence of multimodal rehabilitation programs. The evidences related to nasogastric decompression, preoperative fasting and mechanical preparation of the colon were the least known, with percentages of responses not in accordance with current evidence, being of 62.2 percent, 50.1 percent and 50.1 percent, respectively. Conclusions: Important current scientific evidences concerning several key actions of postoperative recovery are not well known and, therefore, have not been incorporated into medical practice(AU)

Historical inspiration and practical thinking of enhanced recovery after surgery / 中华消化外科杂志

In recent years,enhance recovery after surgery (ERAS) has attracted many attentions in the surgical field.ERAS is a new model of perioperative management,in which more attention is paid to patients' perception to the medical treatment.This new medical model is different from the past one which is completely led by medical practitioners,thus full of humanistic concerns and rationality.With the premise of medical safety guaranteed,a series of measures,especially evidence-based medical interventions,are implemented to optimize the perioperative management and promote the recovery of patients in ERAS.A certain level of economic and social benefit will be gained with this process.The development history of ERAS was systemically reviewed in current editorial to help the readers to get a better understanding of the origin and evolving process of ERAS.It tracked back to the 1960s when "two reductions and one guarantee" and "removal of two tubes and one prohibition " were proposed as a revolutional perioperative management mode by the surgical community in our country.The goals pursued and measures implemented by our surgical predecessors back in those days were astonishingly similar to those in today's ERAS practice.They actually enlightened the initiation of ERAS in China.While ERAS is widely implemented nowadays,this new medical model should be objectively evaluated.A patient-centered medical system should be built,and ERAS should be promoted from an academic perspective,through which the ultimate goal of "surgery without danger and pain" could be finally achieved.

Effect of low-frequency electrical acupoint stimulation on gastrointestinal motility function following radical gastrectomy in patients with gastric cancer / 针刺研究

OBJECTIVE: To observe the effect of low-frequency electrical acupoint stimulation on gastrointestinal motility in patients undergoing radical gastrectomy, and its impact on regulation of inflammatory response, so as to evaluate its clinical value. METHODS: A total of 177 patients undergoing radical gastrectomy were randomly divided into conventional group (n＝43), low-frequency electrical acupoint stimulation (LEAS) group (n＝45), fast track surgery (FTS) group (n＝46) and FTS＋LEAS group (n＝43). Patients of the conventional group received conventional treatment (pre-surgical mechanical bowel preparation, post-surgical fasting, and indwelling abdominal drainage tube, etc.). Patients in the LEAS group were treated by low-frequency electrical stimulation at bilateral Zusanli (ST36), Shangjuxu(ST37), Xiajuxu(ST39) and Sanyinjiao(SP6) for 30 min, once daily from 1 day after the operation to first postoperative flatus. FTS group was given fast track surgery treatment, such as preoperative education, preoperative nutritional support, early oral feeding, early removal of abdominal drainage tube, etc. The FTS＋LEAS group was given low-frequency electrical acupoint stimulation on the basis of the FTS treatment. Levels of white blood cells (WBC), neutrophils (N), C-reactive protein (CRP), interleukin-6 (IL-6) and tumor necrosis factor-α (TNF-α) at 1, 3, and 6 d after the operation in the 4 groups were assayed. The first postoperative flatus and defecation time were recorded. RESULTS: After the treatment, the first postoperative flatus and defecation time in the LEAS, FTS and FTS＋LEAS groups were significantly shorter than those of the conventional group (P0.05). The CRP levels in the 4 groups on 3 and 6 d after operation were higher than those on the 1st postoperative day, and the highest level was on 3 d after the operation. Compared with the conventional group, CRP level on 3 d and CRP and IL-6 levels on 3 and 6 d in the LEAS and FTS＋LEAS groups were significantly lower (P<0.05). Compared with the LEAS group, the levels of N, CRP on 3 d and the levels of N, CRP, IL-6 on 6 d in the FTS group were significantly increased (P<0.05). Compared with the FTS group, the level of CRP on 3 d and the levels of N, CRP, IL-6 on 6 d in the FTS＋LEAS group were significantly decreased (P<0.05). CONCLUSION: FTS combined with LEAS is superior to simple FTS or LEAS treatment in shortening the first flatus and defecation time and promoting the recovery of gastrointestinal motility function in patients undergoing radical gastrectomy, which may be associated with its effect in alleviating postoperative inflammatory responses.

Historical inspiration and practical thinking of enhanced recovery after surgery / 中华消化外科杂志

In recent years, enhance recovery after surgery (ERAS) has attracted many attentions in the surgical field. ERAS is a new model of perioperative management, in which more attention is paid to patients′ perception to the medical treatment. This new medical model is different from the past one which is completely led by medical practitioners, thus full of humanistic concerns and rationality. With the premise of medical safety guaranteed, a series of measures, especially evidence-based medical interventions, are implemented to optimize the perioperative management and promote the recovery of patients in ERAS. A certain level of economic and social benefit will be gained with this process. The development history of ERAS was systemically reviewed in current editorial to help the readers to get a better understanding of the origin and evolving process of ERAS. It tracked back to the 1960s when "two reductions and one guarantee" and "removal of two tubes and one prohibition" were proposed as a revolutional perioperative management mode by the surgical community in our country. The goals pursued and measures implemented by our surgical predecessors back in those days were astonishingly similar to those in today′s ERAS practice. They actually enlightened the initiation of ERAS in China. While ERAS is widely implemented nowadays, this new medical model should be objectively evaluated. A patient-centered medical system should be built, and ERAS should be promoted from an academic perspective, through which the ultimate goal of "surgery without danger and pain" could be finally achieved.

Programas para mejorar la recuperación posoperatoria / Enhanced Recovery After Surgery Programs

RESUMEN Los programas de recuperación mejorada después de cirugía (Enhanced Recovery After Surgery, ERAS por sus siglas en inglés) constituyen un conjunto de acciones aplicadas al paciente quirúrgico en el periodo perioperatorio. Estos buscan reducir el impacto de la cirugía en la respuesta metabólica y endocrina y logran una recuperación más temprana de mayor calidad. El objetivo del trabajo fue difundir los principios y ventajas potenciales de estos programas, para su implementación en centros de nuestro país. Se realizó una revisión de publicaciones relacionadas con programas ERAS y sus intervenciones, desde enero 1995 hasta marzo 2018 en base de datos, MEDLINE, CUMED, y bibliotecas SciELO y Cochrane- Cochrane Library Plus, así como revista de acceso abierto PLoS Medicine. Los programas ERAS, se han extendido gradualmente a otros procedimientos y especialidades quirúrgicas. Investigaciones enfocadas en ellos están demostrando sus potencialidades y expansión. Para implementarlos se necesita voluntad institucional y enfoque multidisciplinario, y para sostener sus resultados es esencial auditarlos periódicamente. La aplicación de los programas ERAS se ha relacionado con reducción de estadía hospitalaria, complicaciones y costos, sin aumento en reingresos ni en mortalidad. Su implementación adecuada se considera segura y conveniente para pacientes e instituciones(AU)

ABSTRACT Enhanced Recovery After Surgery, ERAS, programs are a set of actions applied to the surgical patient in the perioperative period. These seek to reduce the impact of surgery on the metabolic and endocrine response and to achieve an earlier recovery of higher quality. The objective of the work was to spread the principles and potential advantages of these programs, for their implementation in centers of our country. A review was carried out of publications related to ERAS programs and their interventions, from January 1995 to March 2018, in the database MEDLINE, CUMED, and the libraries SciELO and Cochrane-Cochrane Library Plus, as well as the open access journal PLoS Medicine. The ERAS programs have been gradually extended to other surgical procedures and specialties. Research focused on them is demonstrating their potential and expansion. To implement them, institutional will and a multidisciplinary approach are needed, while, in order to sustain their results, it is essential to audit them periodically. The application of the ERAS programs has been related to reduction of hospital stay, complications and costs, without increase in readmissions or mortality. Its proper implementation is considered safe and convenient for patients and institutions(AU)

Application of tubless therapy in the treatment of pulmonary bulla resection / 中国胸心血管外科临床杂志

@#Objective    To evaluate the efficacy of tubless therapy for pulmonary bulla resection under the concept of fast track surgery. Methods    We retrospectively analyzed the clinical data of 45 patients (29 males and 16 females at an average age of 26.1 years) with pulmonary bullae in our hospital between January 2015 and December 2017. These patients were divided into two groups. Among them, 25 patients were treated with preoperative gastric tubes and catheters, tracheal intubation anesthesia and postoperative drainage tubes (a tube group). And 20 patients were treated with no preoperative gastric tube or catheter, sublaryngeal anesthesia and no postoperative drainage tube (a tubless group). Results    There was a statistical difference in postoperative pain index (2.60±1.14 vs. 5.16±1.24, P<0.001) and larynx complication (P=0.00) between the two groups. Shorter period of epidural analgesic tubes (1.40±0.50 d vs. 2.84±0.75 d, P<0.001), shorter operation and anesthesia time (15.00±2.59 min vs. 18.56±2.10 min, P<0.001; 95.30±4.38 min vs. 105.50±4.59 min, P<0.001), shorter hospital stay (9.45±1.66 d vs. 12.80±1.87 d, P<0.001), and less expense (20 245.96±1 113.02 yuan vs. 22 147.06±1 735.01 yuan, P<0.001) in the tubless group were found compared with the tube group. But there was no statistical difference in incidence of complication of lung (P=0.43) between the two groups. Conclusion    Tubless therapy in the treatment of pulmonary bulla resection can accelerate the postoperative recovery with shorter hospital stay and less expense, and is an advantageous treatment.

Influence of applying fast-track surgery to optimize the process in perioperative period of cardiac intervention on rehabilitation of patients with radial artery stenting surgery: A randomized controlled trial / 中国胸心血管外科临床杂志

@#Objective To explore the influence of applying the fast-track surgery (FTS) to optimize the process in the perioperative period of cardiac intervention on the rehabilitation of patients with radial artery stenting surgery. Methods A total of 190 patients with radial artery stenting surgery in the Department of Cardiology, West China Hospital from June 2017 to May 2018 were enrolled. They were randomized into a control group (n=95) and a FTS group (n=95) by random umber table. There were 60 males and 35 females aged 35-88 (65.2±9.6) years in the control group as well as 62 males and 33 females aged 34-86 (61.5±11.3) years in the FTS group. Patients in the control group received routine perioperative care, but patients in the FTS group received individual precision interventions by applying the FTS concept to optimize the process of perioperative care, including individual care management before being admitted into hospital, during hospital, and after discharge from hospital. Duration of hospital stay, satisfaction scores, number of comorbidities after surgery, disease self-management ability, and readmission rates were compared between the two groups. Results Compared to the control group, the FTS group had significantly shorter duration of hospital stay, less comorbidities, higher satisfaction scores and disease self-management ability, and lower readmission rate to hospital (P<0.05). Conclusion Applying FTS into the perioperative period of cardiac interventions to optimize its process can help patients recover from radial artery stenting surgery, increase patients’ self-management abilities, shorten duration of hospital stay and decrease comorbidities and cardiac adverse events.

The influence of fast tract surgery on postoperative recovery and stress reaction for hepatectomy / 中华肝胆外科杂志

Objective To analyze the effects of rapid rehabilitation surgical procedures on recovery and stress response in patients undergoing hepatectomy.Methods Retrospective analysis of 60 patients with liver resection in Zhujiang Hospital of Southern Medical University from January 2012 to December 2015,40 males and 20 females.According to the rehabilitation method,it was divided into intervention group (n=30) and control group (n=30).The operation time,intraoperative blood loss,postoperative complications,and interleukin-6 (IL-6),C-reactive protein (CRP),and white blood cell count (WBC) on days 1st,3rd,and 5 th before and after surgery were compared between the two groups.Results Both groups completed the operation successfully.There was no significant difference in intraoperative blood loss and operation time between the two groups (P＞0.05).The duration of postoperative ventilation and postoperative hospitalization in the intervention group was less than that in the control group,and the incidence of postoperative complications (23.3％ vs.50.0％) and the first and second day after surgery were lower than those in the control group,with statistically significant differences (P＜0.05).On the first,third and fifth days after surgery,IL-6 and CRP in the intervention group were lower than those in the control group,respectively (64.96± 24.10) μg/L vs.(286.74±67.98) μg/L,(60.52±18.31)μg/L vs.(162.33±52.62) μg/L,(31.61± 9.42) μg/L vs.(77.44±24.54)μg/L and (24.64±17.45) mg/L vs.(41.46±20.79) mg/L,(81.11± 36.58) mg/L vs.(117.23±44.80) mg/L,(44.90±22.31) mg/L vs.(65.27±38.05) mg/L,the differences were statistically significant (P＜0.05).Conclusion The concept of rapid rehabilitation surgery applied to patients with hepatectomy can reduce postoperative stress response,reduce postoperative complications,and accelerate the recovery process.

Application progress of enhanced recovery after surgery in perioperative anesthesia management / 局解手术学杂志

Enhanced recovery after surgery is the path of perioperative multi-modal management.It is coordinated by anesthesiologists, surgeons, nursing staff, nutritionists and rehabilitation physician to reduce the perioperative stress response of patients.Maintenance of the body and organ functions before and after surgery to achieve early rehabilitation.Enhanced recovery after surgery integrates a series of interventions during the perioperative period to maintain physiological function and promote postoperative recovery.Its core goal is to reduce trauma and stress, to reduce pain and complications of patient, shorten hospital stay and reduce hospitalization costs.The ultimate goal is to accelerate patients recovery. so it is the direction of perioperative medical development. As an indispensable part of anesthesia management,the professionalism and ability of anesthesiologists will be critical to accelerating the success of rehabilitation surgery.

Application of fast-track surgery in thoracoscopic and laparoscopic minimally invasive esophageal cancer operation for thoracic segment esophageal cancer / 重庆医学

Objective To evaluate the influence of fast track surgery on the early outcomes of thoracoscopic and laparoscopic minimally invasive esophageal cancer operation for thoracic segment esophageal cancer.Methods The inpatients with thoracic segment esophageal squamous cancer in this hospital from January 2012 to June 2016 were retrospectively analyzed,who in the same operation group performed thoracoscopic and laparoscopic minimally invasive esophageal cancer resection,gastroesophageal left neck anastomosis and two-field lymphadenectomy.Among them,the conventional group had 156 cases from January 2012 to December 2014 and the fast track surgery group had 93 cases from January 2015 to June 2016.Their perioperative related indicators were recorded and analyzed.Results The age,sex,BMI,complications index,ASA score,tumor segment,pathological stage had no statistical difference between the fast track surgery group and conventional group;the postoperative pain score in the fast track surgery group was significantly lower than that in the conventional group(on 1 d:5.13±1.16 vs.5.69±1.17,P=0.000;on 3 d:2.63±0.76 vs.2.86±0.78,P=0.032;on 7 d:1.82±0.71 vs.2.56±0.47,P=0.005);the pneumonia occurrence rate in the fast track surgery group was much lower(7.5％ vs.17.3％,P=0.030) and sacrococcygeal skin injury was much less(4.3％ vs.12.2％,P=0.038);the occurrence rates of pulmonary atelectasi,ARDS,re-tracheal intubation,neck anastomosis fistula,atrial fibrillation and re-operation had no statistical difference between the two groups;the hospitalization stay time in the fast track surgery was shorter than that in the conventional group[(13.89 ±7.36)d vs.(17.41±6.77)d,P=0.000].Conclusion Implementing fast-track surgery measure intervention during perioperative period in the patients with thoracic segment esophageal cancer resection can alleviative postoperative pain,decreases postoperative complications and shortens the hospitalization length.

Application of fast track surgery in Ttonsillectomy or adenoidectomy perioperative nursing / 中国实用护理杂志

Objective To explore the application effect of fast track surgery in tonsillectomy or adenoidectomy perioperative nursing. Methods Totally 123 Patients with tonsillectomy or adenoidectomy were selected as study group to receive the nursing care under the guidance of the concept of fast track surgery.74 patients with the same surgery from early clinical data who were treated by traditional nursing care were selected as control group. Postoperative pain score, length of hospital stay, the incidence of complications and the families of children with satisfaction were compared between the two groups. Results The average hospital stay was(4.56±1.28)d in the study group and(6.32±1.56)d in the control group. The difference was statistically significant (t=2.35, P<0.01). The postoperative hospital stay was (2.37±1.17)d,the control group was(3.18±1.34)d,the difference between the two groups was statistically significant(t=1.97,P<0.05).Pain score in the study group was 1.73±0.91,in the control group was 3.77± 0.84,the difference between the two groups was statistically significant(t=20.37,P<0.01).There was no significant difference in the incidence of complications between the two groups(P>0.05),and there were statistically significant differences in the satisfaction of children and their families (χ2=23.05,P<0.01). Conclusion Application of fast track surgery concept in the perioperative care of pediatric tonsil adenoidectomy can relieve postoperative pain,shorten the length of hospital stay,improve the satisfaction degree of the patients and their families and is worth of being generalized.

Effect of fast-track surgery on perioperative nursing care for patients with abdominal surgery: a Meta analysis / 中国实用护理杂志

Objective To evaluate the effect of fast-track surgery on perioperative nursing care for patients with abdominal surgery. Methods Using FTS and perioperative nursing as keywords, relevant literature was retrieved from the CNKI, Wanfang Med, Cochrane Library and PubMed databases. Articles including patients who underwent abdominal surgery as the research subjects were screened and analyzed with RevMan 5.3. Results Seven articles were included, covering 288 experimental cases and 290 control cases. Patients with FTS nursing had a higher satisfaction with nursing(P<0.05), shorter postoperative hospital stay(Z=6.71,P<0.05), shorter postoperative anal exhaust time(Z=9.08,P<0.05), and lower incidence of postoperative incision infection(Z=2.65,P=0.05),Hospitalization costs were also reduced(Z=11.75,P<0.05). The incidence of complications, including postoperative abdominal infection, anastomotic fistula, intestinal obstruction, and lower extremity deep vein thrombosis, did not increase. Conclusions FTS nursing can improve the satisfaction of patients with abdominal surgery and reduce their hospitalization expenses and recovery time these results indicate that FTS is a safe and feasible nursing measure.

Influence of the concept of fast track surgery on clinical effect,anal dynamics and living quality in treatment of low retcal cancer anus saving patients / 临床外科杂志

Objective To investigate the influence of fast track surgery on clinical effect,anal dynamics and living quality in treatment of low retcal cancer anus saving patients.Methods Screening 100 cases of low retcal cancer anus saving patients as research subjects.According to a random number ta-ble method,100 cases were divided into twe group:study group(50 cases)and control group(50 cases). Patients in control group were given traditional perioperative treatment,and patients in study group were given FTS perioperative treatment,then the two groups were compared in terms of the clinical effect and a-nal dynamics.Results There was no statistically significant difference in operation time between the two groups(P>0.05).The Intraoperative blood loss of study group and control group were(221.4 ± 93.1)ml and(263.2 ± 76.4)ml(P<0.05),first exhaust time after operation of the two group were(3.7 ± 0.6)d and(5.6 ± 0.8)d(P<0.05),intraoperative infusion volume of the two group were(2261.5 ± 670.2)ml and(2574.2 ± 635.0)ml(P<0.05),hospital stay after operation of the two group were(8.5 ± 2.1)d and (13.2 ± 2.0)d(P<0.05),first feeding time of the two group were(4.1 ± 1.2)d and(6.6 ± 1.8)d(P<0.05).The postoperative complication rate in study group(18.0%)was lower than the control group (36.0%)(P<0.05);3 months after operation,the anal function good rate of the two group were 74.0%and 54.0%(P<0.05),anal maximum systolic blood pressure,anus maximum resting pressure,static vec-tor volume and contraction vector volume of study group were(245.2 ± 20.1)mmHg,(165.0 ± 17.3) mmHg,(32792.4 ± 3887.6)cm(mmHg)2and(68647.5 ± 2865.3)cm(mmHg)2),respectively.While in control group were(189.5 ± 18.5)mmHg、(88.9 ± 16.8)mmHg、(28986.6 ± 3946.8)cm(mmHg)2and(43462.9 ± 3013.0)cm(mmHg)2),respectively(P<0.05).The score of FACT-G of one year after op-eration in in the study group were higher than the control group(P<0.05).Conclusion The fast track surgery on low retcal cancer anus saving patients has a more significant advantage,it can improve clinical effect,reduce the postoperative complication rate and improve the anal dynamics,thus it is worthy of cini-cal promotion.

Enhanced recovery after surgery: an anesthesiologist's perspective

Enhanced recovery after surgery (ERAS) is a multimodal and multidisciplinary approach to maintaining physiologic function and improving recovery for surgical patients. The ERAS protocol is based on a range of empirical evidence, and consensus ERAS guidelines for various surgical procedures have been published. The elements of the ERAS protocol include minimal preoperative fasting and carbohydrate treatment instead of overnight fasting; no routine use of preoperative bowel preparation; minimally invasive surgical techniques; standard anesthetic protocol; optimal fluid management rather than generous intravenous fluid administration; prevention and treatment of postoperative nausea and vomiting; active prevention of perioperative hypothermia; multimodal approaches to controlling postoperative pain; and early oral intake and mobilization. Implementation of ERAS shortened hospital stays by 30% to 50% and reduced postoperative complications by 50%. A recent study reported that, when patient compliance with the colorectal ERAS protocol was over 70%, 5-year mortality fell by 42% compared with when compliance was below 70%. Auditing process compliance and patient outcomes are key measures for assisting clinicians implementing the ERAS program. As a perioperativist, an anesthesiologist can play a crucial role in implementing the ERAS program and contribute to protocol establishment, auditing, team education and team leadership. While the ERAS protocol was first implemented for colorectal surgery, as a result of its efficacy, it is now being used in nearly all major surgical specialties.

Application effect of fast track surgery for patients with esophageal cancer: A systematic review and meta-analysis / 中国胸心血管外科临床杂志

@#Objective    To evaluate the effect of fast track surgery (FTS) after esophageal cancer surgery. Methods    The randomized controlled trial (RCT) and observational studies about FTS for esophageal cancer in PubMed、EMbase、The Cochrane Library、Web of Science、CBM、CNKI and WanFang databases were searched up to May 2017. Then the studies were screened according to the inclusion and exclusion criteria by two researchers. Data were analyzed by Stata12.0 software. Results     Totally 13 RCTs and 5 observational studies with 2 447 patients were eligible for analysis. Compared with the control group, incidence of postoperative complications (OR=0.53, 95%CI 0.40 to 0.71, P<0.05) significantly reduced in the FTS group, but there was no significant difference between the two groups in readmission rate (OR=1.21, 95%CI 0.83 to 1.76, P=0.313) and 30 d mortality rate (OR=0.72, 95%CI 0.43 to 1.20, P=0.207). Conclusion    FTS can safely and effectively accelerate the recovery of patients with esophageal cancer and it owns important clinical values.

Multimodal analgesia in laparoscopic splenectomy and pericardial devascularization around perioperative period / 中国现代普通外科进展

Objective:To discuss the clinical reference value of multimodal analgesia in laparoscopic splenectomy and pericardial devascularization around perioperative period (LS+PDA) based on FTS (fast track surgery) concept.Methods:Previously from September 2015 and March 2017,69 patients with portal hypertension were given LS+PDA,37 patients were given traditional perioperative analgesia program (named traditional group),other 32 patients were given multimodal analgesia around perioperative period (named FTS group).The degree of postoperative pain,ambulation time,eating time,anal exhaust time,gastric tube decompression,indwelling time,postoperative 72 hours sleep time,postoperative hospital stay,postoperative adverse reactions were compared between two groups.Results:When operation finished,1,4,8,12,24,48 and 72 hours,pain digital assessment scale of FTS group was significantly lower than traditional group (P＜0.05).FTS group's ambulation,feeding,anal exhaust,gastric tube indwelling and postoperative hospital time all were significantly shorter than traditional group (P＜0.01),its sleeping time after 72 hours was obviously longer than traditional group (P＜0.01).Nausea and vomiting,regurgitation and gastrointestinal reactions,breathing difficulties,splenopyretic incidence of FTS group was significantly lower than traditional group (P＜0.05),and other adverse reactions were no statistical significance between two groups.The all approval rate of postoperative analgesia in FTS group was significantly higher than that in traditional group (P＜0.05).Conclusion:Multimodal analgesia in LS+PDA based on FTS concept has been safe and effective,which nearly can achieve painless surgery.

A Randomized Controlled Study on Efficacy of Perioperative Administration of Houpupaiqi Mixture on Fast Track Surgery in Patients With Laparoscopic Colorectal Cancer / 胃肠病学

Background:Studies have shown that Houpupaiqi mixture is beneficial to the recovery of postoperative gastrointestinal function in patients undergoing open gastrointestinal surgery. However,there is no randomized controlled trial focusing on the efficacy of Houpupaiqi mixture on laparoscopic colorectal cancer patients. Aims:To investigate the efficacy of perioperative administration of Houpupaiqi mixture on fast track surgery in patients with laparoscopic colorectal cancer. Methods:A total of 170 colorectal cancer patients at Renji Hospital from January 2016 to February 2017 were enrolled into the prospective randomized double-blind controlled clinical trial. The patients were randomly divided into experimental group and control group,and Houpupaiqi mixture(50 mL)or placebo(50 mL)were administered 6 hours before surgery, as well as 6 and 12 hours after surgery,respectively. The clinical efficacy and safety were compared between the two groups. Results:The patients in experimental and control groups were well balanced with respect to the baseline characteristics. Compared with the control group,time to first anal exhaust,time to recovery of regular bowel sounds and time of postoperative hospital stay were significantly decreased in experimental group(P<0.05). However,no significant differences were observed in first time to defecation,first time to drink,first time to eat fluid diet and first time to eat solid food between the two groups(P>0.05). One patient with anastomotic fistula was found in each group. Conclusions:Houpupaiqi mixture significantly promotes the recovery of gastrointestinal function of patients undergoing laparoscopic colorectal cancer surgery,with reduction of time to recovery of regular bowel sounds,time to first anal exhaust,and shortening the postoperative hospital stay,which is in favor of rapid rehabilitation.