Wiener klinische Wochenschrift
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Wien. Klin. Wochenschr. · Jan 2010
Randomized Controlled TrialThe impact and safety of preoperative oral or intravenous carbohydrate administration versus fasting in colorectal surgery--a randomized controlled trial.
Increasing evidence suggests that preoperative fasting, as was the clinical practice for many decades, might be associated with untoward consequences and that a standardized preoperative intake of nutrients might be advantageous; this is a component of the enhanced recovery after surgery (ERAS) concept. Thus, in a randomized controlled trial we compared preoperative fasting with preoperative preparation with either oral or intravenous intake of carbohydrates, minerals and water. Biochemical, psychosomatic, echocardiographic and muscle-power parameters were assessed in surgical patients with colorectal diseases during the short-term perioperative period. We also assessed the safety of peroral intake shortly before surgery. ⋯ Preoperative fasting does not confer any benefit or advantage for surgical patients. In contrast, consumption of an appropriate potion composed of water, minerals and carbohydrates offers some protection against surgical trauma in terms of metabolic status, cardiac function and psychosomatic status. Peroral intake shortly before surgery did not increase gastric residual volume and was not associated with any risk.
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Wien. Klin. Wochenschr. · Jan 2010
Randomized Controlled TrialEffect of preoperative feeding on gastric emptying following spinal anesthesia: a randomized controlled trial.
Preoperative fasting is associated with various untoward postoperative health problems. Previous studies have stressed the advantages of preoperative feeding with a carbohydrate-rich drink 2 hours before surgery; this protocol does not increase the risk of gastric-content aspiration but reduces the level of anxiety and thirstiness during the perioperative period. Spinal anesthesia with the local anesthetic bupivacaine can decrease gastric emptying in the early postoperative period. However, the effect of spinal anesthesia on the gastric emptying rate following preoperative feeding is unknown. The aim of this study was to determine the impact of preoperative feeding with a clear carbohydrate-rich drink on gastric emptying early after orthopedic surgery under spinal anesthesia. ⋯ In patients undergoing spinal anesthesia, preoperative feeding 2 hours before surgery had no influence on the gastric emptying rate, indicating that preoperative feeding does not increase the risk of gastric-content aspiration and can be given safely.
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Wien. Klin. Wochenschr. · Jan 2010
The association between body-mass index and patient outcome in septic shock: a retrospective cohort study.
It is unknown whether body-mass index (BMI) and commonly defined BMI categories are associated with mortality in patients with septic shock. ⋯ BMI up to 50 does not appear to be associated with worse ICU and hospital mortality in patients with septic shock. In contrast, a high BMI may reduce the risk of death from septic shock.
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Wien. Klin. Wochenschr. · Jan 2010
Tako-Tsubo syndrome: an important differential diagnosis in patients with acute chest pain.
The syndrome of Tako-Tsubo cardiomyopathy (TTC) is characterized by the occurrence of acute chest pain, electrocardiographic signs of ischemia, and transient balloon-like abnormalities in cardiac wall motion mostly involving the left ventricular apex. Significant obstructive coronary artery disease is absent. Owing to its clinical and imaging characteristics, TTC is frequently misdiagnosed as an acute coronary syndrome. Tako-Tsubo syndrome was first described in the 1990s in Japan, but meanwhile has been increasingly identified in other parts of the world also. TTC predominantly affects postmenopausal women, and may involve up to 2% of all patients with acute ST-segment elevation myocardial infarction (STEMI). Apart from single case reports, no systematic data from Austria are currently available. ⋯ Patients with TTC display clinical symptoms and electrocardiographic findings that mimic acute myocardial infarction. A history of a preceding stressful event in elderly women, typical echocardiographic findings of TTC, and only a mild elevation of cardiac markers will be informative. Acute-coronary angiography should be performed in order to rule out acute coronary occlusion and to avoid inadequate treatment such as thrombolysis.