Prophylactic belladonna suppositories on anesthetic recovery after robotic assisted laparoscopic prostatectomy.

INTRODUCTION: Two prospective trials have demonstrated prophylactic antimuscarinics following prostatectomy reduce pain from bladder spasms. Our practice adopted the routine administration of prophylactic belladonna and opium (B&O) suppositories to patients undergoing robotic assisted laparoscopic radical prostatectomy (RALP). The aim of this study is to determine if this change in clinical practice was associated with improvement of postoperative outcomes. MATERIALS AND METHODS: The medical records of 202 patients that underwent RALP surgery who were or were not administered prophylactic B&O suppositories in the immediate postoperative period were abstracted for duration of anesthesia recovery, pain and analgesic use. RESULTS: Patient and surgical characteristics between groups were similar except B&O group were slightly older (p = 0.04) and administered less opioid analgesics (p = 0.05). There was no difference between groups in the duration of phase I recovery from anesthesia (p = 0.96). Multivariable adjustments for age, body mass index, American Society of Anesthesiologists physical status, and surgical duration were made, and again it was found that suppository administration had no association with phase I recovery times (p = 0.94). The use of antimuscarinic medication for bladder spams in the B&O group was less during phase I recovery (p < 0.01), but was similar during the first 24 hours (p = 0.66). Postoperative sedation, opioid analgesic requirements and pain scales were similar during phase I recovery and the first 24 postoperative hours. Hospital length of stay was similar. DISCUSSION: The introduction of prophylactic B&O suppositories at the immediate conclusion of RALP surgery was not associated with improvements of the postoperative course.

Acute kidney injury following bariatric surgery.

BACKGROUND: Postoperative acute kidney injury (AKI) following bariatric surgery has not been well studied. The aim of this study is to identify factors associated with risk of AKI. METHODS: The medical records of adult patients who underwent bariatric surgery between March 1, 2005 and March 31, 2011 at the Mayo Clinic were reviewed to identify patients who experienced AKI, defined as postoperative increase in serum creatinine (sCr) by 0.3 mg/dL within 72 h. For each AKI case, two controls were matched for surgical approach (laparotomy vs. laparoscopic). A chart review was conducted and conditional logistic regression analyses were performed to identify risk factors for AKI. RESULTS: There were 1,227 patients who underwent bariatric surgery, and of these, 71 developed AKI (5.8 %). The median sCr increase was 0.4 (interquartile range 0.3-0.6) mg/dL. Independent patient factors associated with increased risk included higher body mass index [odds ratio (OR) 1.24, 95 % CI 1.06-1.46 per 5 unit increase, P = 0.01] and medically treated diabetes mellitus (OR 2.77, 1.36-5.65, P = 0.01). Patients experiencing AKI had higher rates of blood transfusions (P < 0.01), postsurgical complications (P < 0.01), and longer hospital stays (P < 0.01). Another 30 patients developed kidney injury after 72 postoperative hours, usually in the setting of dehydration. CONCLUSIONS: Kidney injury following bariatric surgery is not uncommon and is associated with higher body mass index and diabetes. Further, there should be a high risk of suspicion for kidney injury in postoperative patients developing volume depletion.