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Minz EE, Salhotra R, Tyagi A, Aggarwal AN, Mehndiratta M, Madhu SV, Toppo VG, Almeida EA. Effect of Preoperative Oral Carbohydrate Intake on Perioperative Hyperglycemia in Indian Patients Undergoing Hip Fracture Fixation. Turk J Anaesthesiol Reanim 2024; 52:68-75. [PMID: 38700117 DOI: 10.4274/tjar.2024.231506] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/05/2024] Open
Abstract
Objective Preoperative fasting leads to a catabolic state aggravated by surgical stress. This leads to poor patient outcomes. This study aimed to determine the effect of preoperative oral carbohydrate administration on perioperative hyperglycemia and patient comfort. Methods This prospective, randomized study was conducted on 60 adult American Society of Anesthesiologist I/II patients undergoing hip fracture fixation after obtaining institutional ethical committee clearance. Patients were randomly kept conventionally fasted before surgery (group F, n = 30) or were given oral carbohydrate 2 h before surgery (group C, n = 30). Under all aseptic precautions, a combined spinal epidural block was administered, and surgery was allowed. The primary outcome was blood glucose, and secondary outcomes included incidence of postoperative hyperglycemia, insulin level, blood urea, hunger, thirst, and anxiety. Results Blood glucose levels were not statistically different between the two groups at baseline (T0; P=0.400), immediately after surgery (T1; P=0.399) and 24h after surgery (T2; P=0.619). The incidence of postoperative hyperglycemia was significantly higher in group F than in group C (P=0.045) at T2. Insulin levels, blood urea levels, and hunger scores were also not statistically different between the groups. The thirst and anxiety scores were lower at T0 and T1 in group C. Conclusion Preoperative oral carbohydrate administration does not prevent perioperative increases in blood glucose levels. However, it reduces the incidence of perioperative hyperglycemia and decreases perioperative thirst and anxiety, thereby improving the quality of perioperative patient care.
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Affiliation(s)
- Evelyn Eliza Minz
- Vardhman Mahavir Medical College & Safdarjung Hospital, Department of Anaesthesiology, New Delhi, India
| | - Rashmi Salhotra
- University College of Medical Sciences & GTB Hospital, Department of Anaesthesiology, New Delhi, India
| | - Asha Tyagi
- University College of Medical Sciences & GTB Hospital, Department of Anaesthesiology, New Delhi, India
| | - Aditya N Aggarwal
- University College of Medical Sciences & GTB Hospital, Department of Orthopaedics, New Delhi, India
| | - Mohit Mehndiratta
- University College of Medical Sciences & GTB Hospital, Department of Biochemistry, New Delhi, India
| | - S V Madhu
- University College of Medical Sciences & GTB Hospital, Department of Endocrinology, New Delhi, India
| | - Venu George Toppo
- Vardhman Mahavir Medical College & Safdarjung Hospital, Department of Community Medicine, New Delhi, India
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Coppens S, Somville A, Hoogma DF, Dewinter G, Neyrinck A, Desmet M, Vandebroek A, D'Hoore A, Wolthuis A, Bislenghi G, Fieuws S, Rex S. The effect of anterior quadratus lumborum block on morphine consumption in minimally invasive colorectal surgery: a multicentre, double-blind, prospective randomised placebo-controlled trial. Anaesthesia 2024; 79:54-62. [PMID: 37970976 DOI: 10.1111/anae.16177] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/13/2023] [Indexed: 11/19/2023]
Abstract
We investigated the efficacy and safety of a bilateral anterior quadratus lumborum block in patients undergoing minimally invasive colorectal surgery. This was a two-centre, double-blind, prospective, randomised, placebo-controlled trial including 150 patients undergoing laparoscopic colorectal surgery (left- or right hemicolectomy, sigmoidectomy) who were enrolled in the institutional abdominal enhanced recovery programme. Before induction of anaesthesia, patients received a bilateral anterior quadratus lumborum block in the left and right lateral decubitus position under ultrasound guidance and were allocated randomly to receive 30 ml of ropivacaine 0.375% (n = 75) or placebo (saline 0.9%) (n = 75) bilaterally. Postoperatively, all patients received multimodal intravenous analgesia including paracetamol, ketorolac and patient-controlled analgesia with morphine. The primary outcome was morphine consumption during the first 24 h after tracheal extubation. Secondary outcomes included severity of pain; presence and extent of sensory block; incidence of postoperative nausea and vomiting; and hospital duration of stay. We also investigated the need for, and dose of, rescue analgesia. Safety outcomes included the incidence of adverse events. Mean (SD) 24-hour morphine consumption was no different between patients allocated to ropivacaine and placebo (28.6 (22.3) mg vs. 28.4 (22.5) mg, p = 0.966, respectively). While a sensory block could be detected in significantly more patients allocated to the ropivacaine group, no differences were detected in pain scores or other secondary or safety endpoints. Patient satisfaction scores were high in both groups. In laparoscopic colorectal surgery, adding a bilateral anterior quadratus lumborum block to a standard multimodal analgesia regimen did not reduce opioid consumption or improve pain scores.
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Affiliation(s)
- S Coppens
- Department of Anesthesiology, University Hospitals of Leuven, Leuven, Belgium
- Biomedical Sciences Group, Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium
| | - A Somville
- Department of Anesthesiology, University Hospitals of Leuven, Leuven, Belgium
| | - D F Hoogma
- Department of Anesthesiology, University Hospitals of Leuven, Leuven, Belgium
- Biomedical Sciences Group, Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium
| | - G Dewinter
- Department of Anesthesiology, University Hospitals of Leuven, Leuven, Belgium
- Biomedical Sciences Group, Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium
| | - A Neyrinck
- Department of Anesthesiology, University Hospitals of Leuven, Leuven, Belgium
- Biomedical Sciences Group, Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium
| | - M Desmet
- Department of Anesthesiology, AZ Groeninge Kortrijk, Kortrijk, Belgium
| | - A Vandebroek
- Department of Anesthesiology, AZ Groeninge Kortrijk, Kortrijk, Belgium
| | - A D'Hoore
- Department of Anesthesiology, University Hospitals of Leuven, Leuven, Belgium
- Department of Abdominal Surgery, University Hospitals of Leuven, Leuven, Belgium
| | - A Wolthuis
- Department of Anesthesiology, University Hospitals of Leuven, Leuven, Belgium
- Department of Abdominal Surgery, University Hospitals of Leuven, Leuven, Belgium
| | - G Bislenghi
- Department of Anesthesiology, University Hospitals of Leuven, Leuven, Belgium
- Department of Abdominal Surgery, University Hospitals of Leuven, Leuven, Belgium
| | - S Fieuws
- Biomedical Sciences Group, Leuven Biostatistics and Statistical Bioinformatics Centre, University of Leuven, Leuven, Belgium
| | - S Rex
- Department of Anesthesiology, University Hospitals of Leuven, Leuven, Belgium
- Biomedical Sciences Group, Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium
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Montagne F, Guisier F, Venissac N, Baste JM. The Role of Surgery in Lung Cancer Treatment: Present Indications and Future Perspectives-State of the Art. Cancers (Basel) 2021; 13:3711. [PMID: 34359612 PMCID: PMC8345199 DOI: 10.3390/cancers13153711] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2021] [Revised: 07/14/2021] [Accepted: 07/20/2021] [Indexed: 12/25/2022] Open
Abstract
Non-small cell lung cancers (NSCLC) are different today, due to the increased use of screening programs and of innovative systemic therapies, leading to the diagnosis of earlier and pre-invasive tumors, and of more advanced and controlled metastatic tumors. Surgery for NSCLC remains the cornerstone treatment when it can be performed. The role of surgery and surgeons has also evolved because surgeons not only perform the initial curative lung cancer resection but they also accompany and follow-up patients from pre-operative rehabilitation, to treatment for recurrences. Surgery is personalized, according to cancer characteristics, including cancer extensions, from pre-invasive and local tumors to locally advanced, metastatic disease, or residual disease after medical treatment, anticipating recurrences, and patients' characteristics. Surgical management is constantly evolving to offer the best oncologic resection adapted to each NSCLC stage. Today, NSCLC can be considered as a chronic disease and surgery is a valuable tool for the diagnosis and treatment of recurrences, and in palliative conditions to relieve dyspnea and improve patients' comfort.
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Affiliation(s)
- François Montagne
- Department of Thoracic Surgery, Calmette Hospital, University Hospital of Lille, Boulevard du Pr. J Leclercq, F-59000 Lille, France; (F.M.); (N.V.)
| | - Florian Guisier
- Department of Pneumology, Rouen University Hospital, 1 rue de Germont, F-76000 Rouen, France;
- Clinical Investigation Center, Rouen University Hospital, CIC INSERM 1404, 1 rue de Germont, F-76000 Rouen, France
- Faculty of Medicine and Pharmacy of Rouen, Normandie University, LITIS QuantIF EA4108, 22 Boulevard Gambetta, F-76183 Rouen, France
| | - Nicolas Venissac
- Department of Thoracic Surgery, Calmette Hospital, University Hospital of Lille, Boulevard du Pr. J Leclercq, F-59000 Lille, France; (F.M.); (N.V.)
| | - Jean-Marc Baste
- Department of General and Thoracic Surgery, Rouen University Hospital, 1 rue de Germont, F-76000 Rouen, France
- Faculty of Medicine and Pharmacy of Rouen (UNIROUEN), Normandie University, INSERM U1096, 22 Boulevard Gambetta, F-76000 Rouen, France
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