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Zwißler B. [Joint recommendations from the German Societies of Anesthesiology and Intensive Care Medicine (DGAI), Surgery (DGCH) and Internal Medicine (DGIM) : Successful example for interdisciplinary cooperation]. DIE ANAESTHESIOLOGIE 2024; 73:291-293. [PMID: 38714555 DOI: 10.1007/s00101-024-01411-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 04/10/2024] [Indexed: 05/10/2024]
Affiliation(s)
- Bernhard Zwißler
- Klinik für Anaesthesiologie, LMU-Klinikum der Universität München, Marchioninistraße 15, 81377, München, Deutschland.
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Zöllner C. [Preoperative evaluation of adult patients before elective, non-cardiothoracic surgery : A joint recommendation of the German Society for Anesthesiology and Intensive Care Medicine, the German Society for Surgery and the German Society for Internal Medicine]. DIE ANAESTHESIOLOGIE 2024; 73:294-323. [PMID: 38700730 PMCID: PMC11076399 DOI: 10.1007/s00101-024-01408-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 03/26/2024] [Indexed: 05/09/2024]
Abstract
The 70 recommendations summarize the current status of preoperative risk evaluation of adult patients prior to elective non-cardiothoracic surgery. Based on the joint publications of the German scientific societies for anesthesiology and intensive care medicine (DGAI), surgery (DGCH), and internal medicine (DGIM), which were first published in 2010 and updated in 2017, as well as the European guideline on preoperative cardiac risk evaluation published in 2022, a comprehensive re-evaluation of the recommendation takes place, taking into account new findings, the current literature, and current guidelines of international professional societies. The revised multidisciplinary recommendation is intended to facilitate a structured and common approach to the preoperative evaluation of patients. The aim is to ensure individualized preparation for the patient prior to surgery and thus to increase patient safety. Taking into account intervention- and patient-specific factors, which are indispensable in the preoperative risk evaluation, the perioperative risk for the patient should be minimized and safety increased. The recommendations for action are summarized under "General Principles (A)," "Advanced Diagnostics (B)," and the "Preoperative Management of Continuous Medication (C)." For the first time, a rating of the individual measures with regard to their clinical relevance has been given in the present recommendation. A joint and transparent agreement is intended to ensure a high level of patient orientation while avoiding unnecessary preliminary examinations, to shorten preoperative examination procedures, and ultimately to save costs. The joint recommendation of DGAI, DGCH and DGIM reflects the current state of knowledge as well as the opinion of experts. The recommendation does not replace the individualized decision between patient and physician about the best preoperative strategy and treatment.
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Affiliation(s)
- Christian Zöllner
- Universitätsklinikum Hamburg-Eppendorf, Klinik und Poliklinik für Anästhesiologie, Zentrum für Anästhesiologie und Intensivmedizin, Martinistr. 52, 20246, Hamburg, Deutschland.
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Schindele D, Suralis A, Schlottke C, McDonough J, Müller-Wolff T. [Are we missing the first step? : An online expert survey in a mixed methods design on current state analysis of perioperative risk estimation and preoperative preparation of patients over 65 years old in Germany]. DIE ANAESTHESIOLOGIE 2023; 72:253-260. [PMID: 36799970 DOI: 10.1007/s00101-023-01261-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/02/2022] [Revised: 12/02/2022] [Accepted: 01/11/2023] [Indexed: 02/18/2023]
Abstract
BACKGROUND The proportion of patients over 65 years of age in surgical care is increasing in Germany. Frailty represents a relevant problem in the perioperative care of older patients and has a negative impact on the postoperative outcome. The individual degree of frailty can be influenced. Multimodal prehabilitation concepts can contribute to improving the degree of frailty in the perioperative care of affected patients. As a multidimensional syndrome, frailty is related to the aging process, affects multiple organ systems and typically leads to increased vulnerability to internal and external stressors. This is accompanied by a decrease in homeostatic reserves and resilience, which implies an increased risk of several adverse health outcomes, such as loss of physical function and quality of life. Prehabilitation is described as a multimodal concept to prepare patients preoperatively in the best possible way for elective surgical procedures, thereby minimizing postoperative complications and improving the patients' outcome. METHOD Current state analysis of perioperative care of patients over the age of 65 years in relation to frailty assessment and the use of prehabilitation concepts. Conducting a multicenter online survey of anesthesiology experts (n = 189) in German anesthesiology departments. Survey of the preoperative preparation and assessment routine in patients aged 65 years and over using a mixed methods design questionnaire. OBJECTIVE The aim of this study was to demonstrate the applied assessments and measures taken for specific perioperative risk assessment and preoperative preparation of patients aged 65 years and over. RESULTS Specific risk assessments or additional preoperative preparation of patients older than 65 years are currently not carried out routinely. The preoperative risk assessment and preparation usually focus on ascertaining the patient's previous illnesses or diseases. Assessment instruments for assessing frailty and multimodal prehabilitation concepts are not used in clinical practice in a noteworthy quantity. CONCLUSION In German clinical practice frailty assessment and structured prehabilitation approaches in perioperative care of older patients are not broadly known or established. Multimodal prehabilitation concepts can positively influence the outcome of older patients. To this end, it should be considered good clinical practice to assess and address frailty in older patients and to establish multimodal prehabilitation approaches tailored to this patient group.
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Affiliation(s)
- Denise Schindele
- RKH Akademie, RKH Kliniken Ludwigsburg-Bietigheim gGmbH, Kurt-Lindemann-Weg 10, 71706, Markgröningen, Deutschland.
| | - Amy Suralis
- University of North Florida Brooks College of Health, Jacksonville, FL, USA
| | | | - John McDonough
- University of North Florida Brooks College of Health, Jacksonville, FL, USA
| | - Tilmann Müller-Wolff
- RKH Akademie, RKH Kliniken Ludwigsburg-Bietigheim gGmbH, Kurt-Lindemann-Weg 10, 71706, Markgröningen, Deutschland.,Hochschule für angewandte Wissenschaften München, München, Deutschland
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Abstract
PURPOSE OF REVIEW Ambulatory surgery is increasingly performed in medically complex patients. This dynamic environment requires new approaches to ensure cost-effective, efficient, and ultimately safe preoperative evaluation of the patient. This review investigates recent advances in the assessment of ambulatory patients, with a special focus on patient screening, digital communication, and multidisciplinary team evaluation. RECENT FINDINGS Identifying suitable candidates for ambulatory surgery relies on a variety of medical, surgical, and institutional factors. Identification of high-risk patients and optimization of their treatment can be achieved through multidisciplinary protocols specific to the local institution and in line with current guidelines. Virtual assessment may be sufficient for most patients and provide an efficient evaluation strategy and high patient satisfaction. Prescreening can be supported by preoperative nursing teams. SUMMARY The increasing complexity of treatment provided in day surgery offers a unique opportunity to highlight the importance of anesthesiology staff as perioperative caregivers. Preoperative evaluation serves as a central junction to integrate a variety of surgical, medical, and institutional factors to provide safe, satisfactory, and efficient care for patients. Implementing technological innovation to streamline and facilitate this process is paramount.
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Schwenk W. Optimized perioperative management (fast-track, ERAS) to enhance postoperative recovery in elective colorectal surgery. GMS HYGIENE AND INFECTION CONTROL 2022; 17:Doc10. [PMID: 35909653 PMCID: PMC9284431 DOI: 10.3205/dgkh000413] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Aim This manuscript provides information on the history, principles, and clinical results of Fast-track or ERAS concepts to optimize perioperative management (OPM). Methods With the focus on elective colorectal surgery description of the OPM concept and its elements for with special attention to the prevention of infectious complications and clinical results compared to traditional care will be given using recent systematic literature reviews. Additionally, clinical results for other major abdominal procedures are given. Results An optimized perioperative management protocol for elective colorectal resections will currently consist of 25 perioperative elements. These elements include the time from before hospital admission (patient education, screening, and treatment of possible risk factors like anemia, malnutrition, cessation of nicotine or alcohol abuse, optimization of concurrent systemic disease, physical prehabilitation, carbohydrate loading, adequate bowel preparation) to the preoperative period (shortened fasting, non-sedative premedication, prophylaxis of PONV and thromboembolic complications), intraoperative measures (systemic antibiotic prophylaxis, standardized anesthesia, normothermia and normovolemia, minimally invasive surgery, avoidance of drains and tubes) as well as postoperative actions (early oral feeding, enforced mobilization, early removal of a urinary catheter, stimulation of intestinal propulsion, control of hyperglycemia). Most of these elements are based on high-level evidence and will also have effects on the incidence of postoperative infectious complications. Conclusion Optimized perioperative management should be mandatory for elective surgery today as it enhances postoperative patient recovery, reduces morbidity and infectious complications.
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Affiliation(s)
- Wolfgang Schwenk
- GOPOM GmbH, Gesellschaft für Optimiertes PeriOperatives Management, Düsseldorf, Germany,*To whom correspondence should be addressed: Wolfgang Schwenk, GOPOM GmbH, Gesellschaft für Optimiertes PeriOperatives Management, Oberlörickerstrasse 390 B, 40547 Düsseldorf, Germany, Phone: +49 175 1839827, E-mail:
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Metze M, Platz M, Pfrepper C, Petros S. [Coagulation diagnostics in the clinical routine-Part 1 : Evaluation of the risk of bleeding before surgery, interventions and diagnostics in bleeding diathesis]. INNERE MEDIZIN (HEIDELBERG, GERMANY) 2022; 63:619-630. [PMID: 35925131 DOI: 10.1007/s00108-022-01331-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 04/04/2022] [Indexed: 06/15/2023]
Abstract
This article on coagulation diagnostics is published in two parts covering five common clinical scenarios for coagulation diagnostics. Part 1 deals with the diagnostics prior to invasive interventions and coagulation diagnostics to clarify a tendency to bleeding. The global parameters Quick and activated partial thromboplastin time are established for monitoring certain anticoagulants; however, they are not predictive with respect to the risk of bleeding prior to elective invasive interventions. In this context, disorders of primary hemostasis are frequent, which are insufficiently detected by the global parameters. Most clinical bleeding tendencies are due to acquired causes. These include anticoagulants and diseases which can be accompanied by tendency to bleeding. For coagulation tests preanalytical issues are essential in order to avoid false results. The interpretation should always be made in the context of the current physiological state.
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Affiliation(s)
- Michael Metze
- Klinik und Poliklinik für Kardiologie, Universitätsklinikum Leipzig, Liebigstr. 20, 04103, Leipzig, Deutschland.
| | - Martin Platz
- Klinik und Poliklinik für Kardiologie, Universitätsklinikum Leipzig, Liebigstr. 20, 04103, Leipzig, Deutschland
| | - Christian Pfrepper
- Klinik und Poliklinik für Hämatologie, Zelltherapie und Hämostaseologie, Bereich Hämostaseologie, Universitätsklinikum Leipzig, Leipzig, Deutschland
| | - Sirak Petros
- Klinik und Poliklinik für Hämatologie, Zelltherapie und Hämostaseologie, Bereich Hämostaseologie, Universitätsklinikum Leipzig, Leipzig, Deutschland
- Interdisziplinäre Internistische Intensivmedizin, Universitätsklinikum Leipzig, Leipzig, Deutschland
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7
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Gromer A, Pflüger P, Dommasch M, Kanz KG, Kirchhoff C, Biberthaler P. [Operation preparation in trauma surgery]. Unfallchirurg 2021; 124:839-852. [PMID: 34292350 PMCID: PMC8296827 DOI: 10.1007/s00113-021-01037-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/01/2021] [Indexed: 11/06/2022]
Abstract
The success of a surgical procedure is significantly influenced by several critical factors. The safety of the patient is the primary goal. To this end, the term surgical preparation covers a number of procedures aiming to ensure the safety for the patient and a successful surgical intervention: verifying the indications, planning the intervention, identification of potential harmful factors, risks and countermeasures, patient education and documentation. Trauma surgery poses a particular challenge to preoperative preparation, especially due to urgent surgical interventions. Here, a standardized and evidence-based preoperative evaluation ensures a successful treatment of the patient.
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Affiliation(s)
| | | | | | | | - C Kirchhoff
- Klinik und Poliklinik für Unfallchirurgie, Klinikum rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81675, München, Deutschland.
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Rupprecht B, Stöckl A, Stöckl S, Dietrich C. [Treatment of diabetes mellitus in perioperative medicine-an update]. Anaesthesist 2021; 70:451-465. [PMID: 33141238 DOI: 10.1007/s00101-020-00875-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/23/2020] [Indexed: 12/15/2022]
Abstract
Patients with diabetes who undergo a surgical intervention have an increased risk of metabolic derailment, anesthesiological complications, postoperative infections and cardiovascular events. The treatment of diabetes mellitus is subject to a continuous further development due to pharmaceutical and technical innovations. This article presents the implications of the current concepts of diabetes treatment for perioperative medicine, particularly the changes due to new oral antidiabetic agents and insulin pump treatment. Some of the currently available guidelines are discussed with respect to the care of diabetes patients in childhood and adulthood in connection with an operation. Finally, possible perspectives in the field of monitoring and treatment of diabetes patients are discussed.
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Affiliation(s)
- B Rupprecht
- Klinik für Anästhesiologie und Operative Intensivmedizin, Universitätsklinikum Augsburg, Stenglinstr. 2, 86156, Augsburg, Deutschland.
| | - A Stöckl
- Gemeinschaftspraxis Diedorf, Zertifiziertes Diabeteszentrum DDG Dres. Huß, Baur, Ziesing und Kollegen, Bei den Zäunen 2, 86420, Diedorf, Deutschland
| | - S Stöckl
- Klinik für Anästhesiologie und Operative Intensivmedizin, Universitätsklinikum Augsburg, Stenglinstr. 2, 86156, Augsburg, Deutschland
| | - C Dietrich
- Pädiatrische Anästhesiologie, Klinik für Anästhesiologie und Operative Intensivmedizin, Klinikum St. Marien Amberg, Mariahilfbergweg 7, 92224, Amberg, Deutschland
- Pädiatrische Anästhesiologie, Klinik für Anästhesiologie und Operative Intensivmedizin, Klinikum Weiden - Kliniken Nordoberpfalz AG, Söllnerstr. 16, 92637, Weiden, Deutschland
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Engelhard K. [The unrecognized danger]. Anaesthesist 2021; 70:1-2. [PMID: 33452555 DOI: 10.1007/s00101-020-00876-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Kristin Engelhard
- Klinik für Anästhesiologie, Universitätsmedizin Mainz, Johannes Gutenberg-Universität, Mainz, Deutschland.
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10
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[Summary of the S3 guideline on abdominal aortic aneurysm from an anesthesiological perspective]. Anaesthesist 2021; 69:20-36. [PMID: 31820017 DOI: 10.1007/s00101-019-00703-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
The current article is a summary of the 2018 revised S3 guideline on screening, diagnosis, therapy, and follow-up of the abdominal aortic aneurysm (AAA) from an anesthesiological point of view. It is the only interdisciplinary guideline that describes in particular the perioperative anesthesiological and intensive care management.
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Löser B, Werner YB, Löser A, Rösch T, Petzoldt M. [Anesthesia in gastrointestinal endoscopy: peroral endoscopic myotomy]. Anaesthesist 2020; 68:607-614. [PMID: 31520094 DOI: 10.1007/s00101-019-00655-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Idiopathic achalasia is a motility disorder of the esophagus characterized by a dysfunction of the lower esophageal sphincter, which typically manifests as dysphagia. Peroral endoscopic myotomy (POEM) is an interventional endoscopic procedure for achalasia, which was introduced in 2010. Although results from randomized studies comparing short-term and long-term safety and efficacy are yet to be published, POEM is regarded to be less invasive than the standard treatment of achalasia (laparoscopic Heller myotomy). POEM is the first endoscopic procedure routinely performed with the patient under general anesthesia. During the preoperative assessment particular attention must be paid to the specific fasting intervals and the risk of aspiration during induction of anesthesia. For the purpose of temporary surgical access, the integrity of the esophageal wall is deliberately interrupted to create a long submucosal tunnel. As a result, unwanted fistulas can arise between the esophageal lumen, the mediastinum, the pleura or the intraperitoneal cavity. Endoscopically insufflated CO2 may escape into these surrounding compartments with subsequent systemic CO2 accumulation, capnomediastinum, tension capnoperitoneum or pneumothorax. As a result substantial cardiorespiratory instability can arise. Thus, the attending anesthesiologist must be familiar with these typical complications and with specific emergency measures, such as compensatory hyperventilation, percutaneous needle decompression and thoracic drainage. The POEM procedure is a therapeutic innovation and interdisciplinary challenge. However, anesthesia standards of care have not yet been specified. The aim of this review is therefore to outline some clinical recommendations for the daily clinical practice based on existing evidence.
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Affiliation(s)
- B Löser
- Klinik und Poliklinik für Anästhesiologie und Intensivtherapie, Universitätsmedizin Rostock, Schillingallee 35, 18057, Rostock, Deutschland
| | - Y B Werner
- Klinik und Poliklinik für Interdisziplinäre Endoskopie, Universitätsklinikum Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Deutschland
| | - A Löser
- Onkologisches Zentrum, Klinik für Strahlentherapie und Radioonkologie, Universitätsklinikum Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Deutschland
| | - T Rösch
- Klinik und Poliklinik für Interdisziplinäre Endoskopie, Universitätsklinikum Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Deutschland
| | - M Petzoldt
- Zentrum für Anästhesiologie und Intensivmedizin, Klinik und Poliklinik für Anästhesiologie, Universitätsklinikum Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Deutschland.
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Abstract
Perioperative stroke is defined as an ischemic cerebrovascular event that occurs during or within 30 days after surgery and is associated with an increased perioperative risk of morbidity and mortality. Depending on the type of surgery stroke is diagnosed in up to 11% of all patients in the perioperative period. Patients with a history of ischemic stroke or transitory ischemic attack have an increased risk for perioperative stroke. Therefore, a critical assessment of indications and the timing of surgery are crucial to prevent recurring stroke in this patient population. Importantly, individualized blood pressure management is essential for optimization of cerebral perfusion during the perioperative period.This article provides a summary of the epidemiology, risk factors, and etiology of perioperative stroke. Moreover, possible preventive strategies relevant for the anesthesiologist are reviewed.
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Affiliation(s)
- M Fischer
- Klinik und Poliklinik für Anästhesiologie, Universitätsklinikum Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Deutschland.
| | - U Kahl
- Klinik und Poliklinik für Anästhesiologie, Universitätsklinikum Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Deutschland
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[Missing frailty-missing the point.]. Anaesthesist 2020; 69:149-150. [PMID: 32130448 DOI: 10.1007/s00101-020-00728-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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[67-year-old female before extended gastrectomy for antral cancer : Preparation for the medical specialist examination: part 36]. Anaesthesist 2019; 68:247-250. [PMID: 31624880 DOI: 10.1007/s00101-019-00666-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Piegeler T, Stehr SN, Pfirrmann D, Knödler M, Lordick F, Mehnert A, Selig L, Weimann A, Mehdorn M, Gockel I, Simon P. [Special situations of preconditioning and prehabilitation in oncological visceral surgery]. Chirurg 2019; 89:903-908. [PMID: 30377726 DOI: 10.1007/s00104-018-0708-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
BACKGROUND Prehabilitation prior to complex visceral oncological surgery is playing an increasingly important role. OBJECTIVE The aim of this review article is to present special situations of preconditioning in visceral oncological patient cohorts. The following conditions were defined as special situations with subsequently increased risk profile: cardiopulmonary comorbidities, geriatric patients, neoadjuvant therapy and simultaneous fatigue. MATERIAL AND METHODS A selective literature review based on a search in the electronic databases MEDLINE, PubMed, Cochrane Library and the International Standard Randomization Controlled Trial Number (ISRCTN) was performed. RESULTS The identification of high-risk patients is an essential part of the preoperative evaluation conducted by the anesthesiologist prior to surgery. The cardiovascular and the pulmonary risk profile are determined by means of prediction indices evaluating patient-specific and surgery-related risk factors. The increased use of new oral anticoagulants and dual platelet aggregation inhibition requires individualized treatment strategies. Numerous studies have shown clinically relevant effects of exercise therapy interventions throughout all phases of oncological treatment. In addition to positive effects on therapy-associated side effects, sport can also counteract the effects of sedentary behavior in cancer patients and improve the health-related quality of life. The effectiveness of sport and exercise therapies as well as psychological interventions in oncological patients with fatigue (CRF) is broad, with important components being motivation and compliance. DISCUSSION In high-risk patients an interdisciplinary approach to planning and conduction of prehabilitation is essential for the early detection and optimization of perioperative risk factors and potential complications. The aim is faster recovery, reduced morbidity and mortality and the possibility to improve long-term survival and quality of life.
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Affiliation(s)
- T Piegeler
- Klinik und Poliklinik für Anästhesiologie und Intensivmedizin (KAI), Universitätsklinikum Leipzig, AöR, Leipzig, Deutschland
| | - S N Stehr
- Klinik und Poliklinik für Anästhesiologie und Intensivmedizin (KAI), Universitätsklinikum Leipzig, AöR, Leipzig, Deutschland
| | - D Pfirrmann
- Abteilung Sportmedizin, Prävention und Rehabilitation am Institut für Sportwissenschaft, Johannes Gutenberg-Universität Mainz, Mainz, Deutschland
| | - M Knödler
- Universitäres Krebszentrum Leipzig (UCCL), Universitätsklinikum Leipzig, AöR, Leipzig, Deutschland
| | - F Lordick
- Universitäres Krebszentrum Leipzig (UCCL), Universitätsklinikum Leipzig, AöR, Leipzig, Deutschland
| | - A Mehnert
- Abteilung für Medizinische Psychologie und Medizinische Soziologie, Sektion Psychosoziale Onkologie, Universitätsklinikum Leipzig, AöR, Leipzig, Deutschland
| | - L Selig
- Klinik und Poliklinik für Gastroenterologie und Rheumatologie; Ernährungsteam, Universitätsklinikum Leipzig, AöR, Leipzig, Deutschland
| | - A Weimann
- Klinik und Poliklinik für Allgemein‑, Viszeral- und Onkologische Chirurgie, Klinikum St. Georg gGmbH, Leipzig, Deutschland
| | - M Mehdorn
- Klinik und Poliklinik für Viszeral‑, Transplantations‑, Thorax‑ und Gefäßchirurgie, Universitätsklinikum Leipzig, AöR, Liebigstr. 20, 04103, Leipzig, Deutschland
| | - I Gockel
- Klinik und Poliklinik für Viszeral‑, Transplantations‑, Thorax‑ und Gefäßchirurgie, Universitätsklinikum Leipzig, AöR, Liebigstr. 20, 04103, Leipzig, Deutschland.
| | - P Simon
- Abteilung Sportmedizin, Prävention und Rehabilitation am Institut für Sportwissenschaft, Johannes Gutenberg-Universität Mainz, Mainz, Deutschland
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Abstract
BACKGROUND Postoperative complications after complex visceral oncological surgery can lead to substantial impairment of patients. In addition, preoperative physical performance and the severity of postoperative complications determine the long-term recovery process of physical function. Therefore, preconditioning in the preoperative period should be an important part of the preoperative/neoadjuvant treatment. OBJECTIVE The aim of this article is a critical appraisal of current concepts of prehabilitation as well as their development potential and applicability in visceral surgery. MATERIAL AND METHODS Based on a selective literature review, current studies and implemented concepts are presented and therapy algorithms are provided. RESULTS This study differs in primary outcome, design and temporal framework of the intervention. The study results showed positive effects of an active increase in physical fitness in the preoperative period with respect to the quality of life, convalescence and postoperative pulmonary complication rate. DISCUSSION In addition to the assessment of the individual risk of complications by means of spiroergometry, a targeted nutrition and exercise program can increase the individual performance level prior to visceral surgery and, thus, influence the postoperative risk of complications. The performance should be understood as a modifiable risk factor, which can also be positively influenced in the preoperative phase, even in a short time period. Individual preoperative care optimizes the physical and psychological situation of patients. To ensure the required individual care, approaches must be created and pursued, which can be implemented in a decentralized way.
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Perioperative kardiovaskuläre Morbidität und Letalität bei nichtherzchirurgischen Eingriffen. Anaesthesist 2019; 68:653-664. [DOI: 10.1007/s00101-019-0616-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
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[70-year-old male with more than 40 pack years scheduled for implant removal : Preparation for the medical specialist examination: Part 1]. Anaesthesist 2019; 68:80-84. [PMID: 30989296 DOI: 10.1007/s00101-019-0566-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Monnard M, Larmann J. [74-year-old female for a low anterior rectal resection : Preparation for the medical specialist examination: Part 3]. Anaesthesist 2019; 68:90-94. [PMID: 30989290 DOI: 10.1007/s00101-019-0572-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- M Monnard
- Klinik für Anästhesiologie, Universitätsklinikum Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Deutschland
| | - J Larmann
- Klinik für Anästhesiologie, Universitätsklinikum Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Deutschland.
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[63-year-old male with nodule in the left upper lobe : Preparation for the medical specialist examination: Part 20]. Anaesthesist 2019; 68:170-174. [PMID: 30989293 DOI: 10.1007/s00101-019-0568-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Short version of the S3 guideline on screening, diagnosis, therapy and follow-up of abdominal aortic aneurysms. GEFASSCHIRURGIE 2018. [DOI: 10.1007/s00772-018-0465-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
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Debus ES, Heidemann F, Gross-Fengels W, Mahlmann A, Muhl E, Pfister K, Roth S, Stroszczynski C, Walther A, Weiss N, Wilhelmi M, Grundmann RT. Kurzfassung S3-Leitlinie zu Screening, Diagnostik, Therapie und Nachsorge des Bauchaortenaneurysmas. GEFÄSSCHIRURGIE 2018. [DOI: 10.1007/s00772-018-0435-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
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Kieninger M, Eissnert C, Seitz M, Judemann K, Seyfried T, Graf B, Sinner B. [Analysis and options for optimization of preoperative assessment for anesthesia at a university hospital]. Anaesthesist 2017; 67:93-108. [PMID: 29230500 DOI: 10.1007/s00101-017-0392-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2017] [Revised: 11/09/2017] [Accepted: 11/15/2017] [Indexed: 12/17/2022]
Abstract
BACKGROUND Risk assessment prior to elective surgery is an important tool in the context of perioperative patient care; however, only a few studies have been carried out to address the processes and problems during preoperative assessment for anesthesia. AIM Over a period of several weeks all preoperative anesthesia evaluations prior to elective surgery were prospectively recorded in order to generate a data pool with a view to identifying options for process optimization. MATERIAL AND METHODS All preoperative evaluations over a period of 38 working days at the University Medical Center Regensburg were recorded and analyzed with respect to waiting time for the patient and the duration of the preoperative consultation on medication. Also documented were the patient age, ASA score, the faculty carrying out the operation, type and risk of surgery, planned time of surgery, professional experience of the anesthesiologist and the approval status for surgery. In addition, all problems which occurred during the preoperative anesthesia evaluation were documented using a questionnaire. RESULTS Overall 2233 preoperative assessments for anesthesia were recorded and analyzed. The number of patients attending the preoperative assessment clinic differed markedly in the course of a day and was lower at the end of the week. Approval for surgery with no reservations was given more frequently by anesthesiologists with more than 5 years professional experience and consultants compared to younger colleagues. The main reason for approval with reservations or no approval was the lack of patient records and test results, which should have been presented according to the in-house standard for preoperative assessment for anesthesia. The mean waiting time was 58.6 ± 30.3 min, the mean duration of the patient documentation review and physician-patient consultation together was 33.6 ± 16.3 min. Anesthesiologists with 2-5 years professional experience needed significantly less time for patient documentation reviews and physician-patient consultations than younger and more experienced colleagues. The duration of the preoperative assessment for anesthesia correlated with the ASA score and risks of surgery. CONCLUSION The analysis of processes and problems in the context of preoperative assessment for anesthesia revealed several options for optimization. Major efforts should be the implementation of an appointment system for the preoperative assessment clinic in order to generate a homogeneous distribution of patients during the course of a day. Furthermore, surgeons and case managers should be requested to refer patients to the preoperative assessment clinic only with complete records and test results according to the in-house standard.
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Affiliation(s)
- M Kieninger
- Klinik für Anästhesiologie, Universitätsklinikum Regensburg, Franz-Josef-Strauß-Allee 11, 93053, Regensburg, Deutschland.
| | - C Eissnert
- Klinik für Anästhesiologie, Universitätsklinikum Regensburg, Franz-Josef-Strauß-Allee 11, 93053, Regensburg, Deutschland
| | - M Seitz
- Klinik für Anästhesiologie, Universitätsklinikum Regensburg, Franz-Josef-Strauß-Allee 11, 93053, Regensburg, Deutschland
| | - K Judemann
- Klinik für Anästhesiologie, Universitätsklinikum Regensburg, Franz-Josef-Strauß-Allee 11, 93053, Regensburg, Deutschland
| | - T Seyfried
- Klinik für Anästhesiologie, Universitätsklinikum Regensburg, Franz-Josef-Strauß-Allee 11, 93053, Regensburg, Deutschland
| | - B Graf
- Klinik für Anästhesiologie, Universitätsklinikum Regensburg, Franz-Josef-Strauß-Allee 11, 93053, Regensburg, Deutschland
| | - B Sinner
- Klinik für Anästhesiologie, Universitätsklinikum Regensburg, Franz-Josef-Strauß-Allee 11, 93053, Regensburg, Deutschland
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Schwenk W, Hoffmann PC. [CAVE - A checklist system for preoperative risk evaluation : Guideline-conform cardiopulmonary diagnostics before general and visceral surgical interventions]. Chirurg 2017; 88:1046-1056. [PMID: 28761966 DOI: 10.1007/s00104-017-0482-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
BACKGROUND Preoperative evaluation of patient risk is an essential component of patient preparation before surgery. Guidelines provide evidence-based algorithms for preoperative assessment of cardiac risk; however, even experienced physicians correctly apply evidence-based algorithms in only 50% of all cases or less. OBJECTIVE A checklist system for guideline-based cardiopulmonary risk evaluation in adult patients undergoing abdominal or visceral surgery (CAVE checklists) was created to assist in preoperative cardiopulmonary risk assessment and increase correct application of evidence-based algorithms before elective visceral surgery. MATERIAL UND METHODS International guidelines were transformed into a checklist system. These checklists were than evaluated in a department of general and visceral surgery. The main goal was to determine whether preoperative examinations, such as electrocardiograph (ECG), chest-x-ray, spirometry and advanced assessment by a cardiologist, are performed according to evidence-based guidelines. The frequency of recommended as well as unnecessary and missed examinations was assessed. RESULTS In this study 541 patients with a median age of 64.5 years (interquartile range: 52-73 years) were examined using the checklist system. Of the patients 90.4% underwent ECG and 98.5% chest-X-ray as recommended in the guidelines. Spirometry was not recommended in any patient and not performed in any case. Advanced assessment by a cardiologist was performed in 45.5% of cases as recommended in the guidelines. When guidelines did not recommend ECG, x‑ray, spirometry or advanced cardiac assessment, 69.4%, 99.6%, 99.3% and 99.8% of patients, respectively, actually did not receive these examinations. Only 2.8% of all patients did not receive an examination that was recommended by the guidelines: 1.5% ECG, 0.2% x‑ray and 1.1% advanced cardiological assessment. None of these patients suffered from postoperative cardiopulmonary complications. CONCLUSION These simple checklists are easy to use and provide a higher degree of evidence-based preoperative cardiopulmonary risk evaluation than previously reported in the literature. Adaptation of the checklists to changing guidelines is easy to perform. Whether the application of these checklists will result in a reduction of morbidity and costs have to be determined in further clinical trials.
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Affiliation(s)
- W Schwenk
- Abteilung für Allgemein- und Viszeralchirurgie - Zentrum für minimalinvasive und onkologische Chirurgie, Asklepios Klinik Altona, Hamburg, Deutschland. .,, Zedernweg 16, 22605, Hamburg, Deutschland.
| | - P C Hoffmann
- Abteilung für Allgemein- und Viszeralchirurgie - Zentrum für minimalinvasive und onkologische Chirurgie, Asklepios Klinik Altona, Hamburg, Deutschland
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