Reduction of heart rate variability after colorectal resections.

BACKGROUND: Heart rate variability (HRV) is a sensitive marker of altered sympathetic-parasympathetic function and is reduced in inflammation, illness, and trauma. The effect of major abdominal surgery on the course of HRV parameters is still an issue requiring further investigation. MATERIALS AND METHODS: A prospective, observational study including 40 consecutive patients undergoing elective colorectal surgery under "fast-track" perioperative management. Time and frequency domain parameters of HRV were measured 1 day prior to operation and on days 1-5 postoperatively. General and surgical complications as well as the course of leucocytes and C-reactive protein (CRP) were documented and correlated to the HRV measurements. RESULTS: Time domain parameters of HRV showed a significant decrease compared to the preoperative values on postoperative day 1 and returned to baseline on day 2, demonstrating impaired autonomic regulation in the early postoperative period. No correlation to complications or course of leukocytes or CRP was significant in our study. CONCLUSIONS: Colorectal resections significantly influence the HRV course. The autonomic regulation is reduced in the early postoperative time and all parameters return to baseline until the third day.

"Fast-track" rehabilitation after colonic surgery in elderly patients--is it feasible?

BACKGROUND AND AIMS: The aim of the "fast-track" rehabilitation after elective colonic surgery is to lower the extent of general complications. Elderly patients may especially profit from this multi-modal peri-operative treatment including enforced early mobilisation and oral nutrition. MATERIALS AND METHODS: In this prospective study using a well-defined post-operative multi-modal treatment programme, we examined the feasibility of this so-called fast-track rehabilitation in elderly patients. The programme employed combined thoracic peri-dural analgesia, early enforced mobilisation and rapid oral nutrition. RESULTS: Seventy-four consecutive patients older than 70 years with benign or malignant disease of the large intestine were operated on. All patients were treated peri-operatively using the "fast-track" rehabilitation programme. Of the patients, 84% were able to have liquids orally on the day of surgery and 86% had solid food on the 1st post-operative day. The median time until the first bowel movement was 2 days. Only 12 (16%) patients had a total of 16 local complications, including 2 (3%) patients with anastomotic leakages. Nine patients (12%) had a total of 14 general complications; mortality rate was 1% (n=1). Patients were discharged from the hospital 5 (5th-95th percentile=4-6 days) days after surgery. CONCLUSION: Using the "fast-track" rehabilitation programme on elderly patient is not only feasible but may also lower the number of general complications and the duration of the hospital stay.

Subcutaneous gentamycin implant to reduce wound infections after loop-ileostomy closure: a randomized, double-blind, placebo-controlled trial.

BACKGROUND: After loop-ileostomy closure subcutaneous wound infection is the most frequent postoperative complication. Implantation of local antibiotics has been shown to reduce the incidence of wound infection after different surgical procedures, therefore, a subcutaneous application of a gentamycin implant may also decrease infection rate after ileostomy-closure. METHODS: We conducted a randomized, double-blind, placebo-controlled trial to evaluate the effectiveness of a subcutaneous gentamycin-collagen implant to reduce wound infection after loop-ileostomy closure. Patients had the same perioperative treatment and standardized anastomotic and closure technique. A collagen sponge with gentamycin was used in the treatment group and an identical collagen implant without antibiotics was used in the placebo group. RESULTS: Eighty patients (40 per group) were included. There was no difference between the groups with respect to demographics or in the postoperative course. The total wound infection rate was 10 percent with no difference between the gentamycin (n=4) and the collagen group (n=4) (P = 1.0). CONCLUSION: Subcutaneous implantation of a gentamycin sponge yields no clinically relevant reduction of the wound infection rate after loop-ileostomy closure so that routine use is not recommended in this procedure.

'Fast-track' multimodal rehabilitation program improves outcome after laparoscopic sigmoidectomy: a controlled prospective evaluation.

BACKGROUND: Laparoscopic colorectal resection improves patient outcome by reducing pain, postoperative pulmonary dysfunction, gastrointestinal paralysis, and fatigue. A multimodal rehabilitation program ("fast-track") with epidural analgesia, early oral feeding, and enforced mobilization may further improve the excellent results of laparoscopic colorectal resection, enabling early ambulation of these patients. METHODS: Fifty two consecutive patients underwent laparoscopic sigmoidectomy with standardized regular perioperative treatment (standard) or multimodal rehabilitation program ("fast-track"). Outcome measures included pulmonary function, duration of postoperative ileus, pain perception, fatigue, morbidity, and mortality. RESULTS: Twenty nine standard-care patients (19 men and 10 women) and 23 fast-track patients (15 men and eight women) were evaluated. Demographic and operative data were similar for the two groups. On the 1st postoperative day, pulmonary function was improved (p = 0.01) in fast-track patients. Oral feeding was achieved earlier (p < 0.01) and defecation occurred earlier (p < 0.01) in the fast-track group. Visual analogue scale scores for pain were similar for the two groups (p > 0.05), but fatigue was increased in the standard-care group on the 1st (p = 0.06) and 2nd (p < 0.05) postoperative days. Morbidity was not different for the two groups. Fast-track patients were discharged on day 4 (range, 3-6) and standard-care patients on day 7 (range, 4-14) (p < 0.001). CONCLUSION: Multimodal rehabilitation can improve further on the excellent results of laparoscopic sigmoidectomy and decrease the postoperative hospital stay.

[Clinical uses of ultraviolet light radiation]. / Klinischer Einsatz von UV-Strahlern

The main use of ultraviolet light radiation in hospitals is for the disinfection of the air. A study was made of the disinfecting efficiency of indirect ultraviolet radiation (lifts, cleaning of bedding), direct irradiation of rooms overnight or after use, ultraviolet curtains (irradiation of the whole width of passages, doorways and entrances) and ultraviolet irradiation of the filter of air-conditioners. The results are analysed. With the exception of the barrier technique ultraviolet light irradiation did not substantially reduce the number of micro-organisms in the air. Knowledge of the limitations and side-effects of this technique, control of the intensity of ultraviolet irradiation and bacterial counts are regular intervals are some of the factors that determine the success of this mode of disinfection. Detailed studies of the acceptable upper limits of the number of micro-organisms in the air of hospital wards and operating theatres is of prime importance for evaluating the effectiveness of air-disinfection by ultraviolet light irradiation.