Langenbeck's archives of surgery
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Langenbecks Arch Surg · Aug 2004
ReviewEffect of postoperative pain treatment on outcome-current status and future strategies.
The effect of postoperative pain relief on morbidity and hospital stay is reviewed. ⋯ The effects of pain relief on outcome remains debatable, despite beneficial effects of pathophysiological responses. Future outcome studies are required where optimised dynamic pain relief is integrated with a multimodal rehabilitation programme.
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Langenbecks Arch Surg · Jun 2004
How long do we need teaching in the operating room? The true costs of achieving surgical routine.
Our aim was to quantify the incremental costs of longer operating times of residents and less-experienced junior consultants when compared with senior consultants on the basis of two surgical routine procedures. ⋯ Owing to longer operating times for junior consultants the costs of achieving surgical routine are considerably higher than previously estimated. These higher costs derive from junior consultants performing operations without proper supervision from senior consultants. We conclude that prolonged supervision in the operating room is highly cost-effective regardless of higher costs for personal resources per operating-minute.
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Perioperative and intensive therapy unit (ITU) morbidity and mortality has remained unchanged during the past several decades, and this at an unacceptably high level. It is most likely, in the EU countries annually, that more than 1 million people suffer severe sepsis and some 300,000 die. Pharmaceutical attempts at prevention and treatment have, despite extensive efforts, hitherto failed to improve outcome more significantly. Much supports the fact that sepsis and its severe consequences are results of a malfunctioning innate immune system, impaired by both lifestyle and disease. A series of mostly simple measures to prevent further deterioration of the immune system, and to boost it, is recommended. Among the measures recommended are some modifications of surgical and postoperative management: restricted use of antibiotics, attempts made to maintain salivation and GI secretions, omission of prophylactic gastric decompression, postoperative drainage and preoperative bowel preparation, restricted use of stored blood, avoidance of overload with nutrients, uninterrupted enteral nutrition but also tight blood glucose control, supply of antioxidants, administration of prebiotic fibre and probiotic lactic acid bacteria. Nutritional control of postoperative morbidity includes use of so-called synbiotics, e.g. a combination of bioactive lactic acid bacteria (LAB) and bioactive plant fibres. ⋯ Dramatic reduction in (in reality, almost abolishment of) septic morbidity is reported following supplementation of specific bioactive lactic bacteria in combination with prebiotic plant fibres, as tried in controlled studies in connection with extensive abdominal operations, liver transplantation and severe acute pancreatitis.
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Langenbecks Arch Surg · Apr 2004
ReviewProcalcitonin: improved biochemical severity stratification and postoperative monitoring in severe abdominal inflammation and sepsis.
Infections and sepsis are among the most devastating complications in abdominal surgery and significantly contribute to morbidity and mortality. Early and reliable diagnosis of septic complications is notoriously difficult, and the search for novel approaches to overcome this problem is still a compelling issue for clinicians. Among a large array of inflammatory parameters, procalcitonin (PCT), the 116-amino-acid pro-peptide of calcitonin, has gained considerable importance in identifying patients at risk of developing infection and sepsis in clinical practice. ⋯ Compared with established biochemical routine variables, PCT significantly contributes to earlier and better stratification of patients at risk of developing septic complications and provides excellent prognostic assessment in severe abdominal inflammation. The currently available test systems render PCT an applicable and readily available parameter under clinical routine and emergency conditions.