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  • 1.
    Gupta, Anil
    Örebro University, School of Health and Medical Sciences.
    Evidence-based medicine in day surgery2007In: Current Opinion in Anaesthesiology, ISSN 0952-7907, E-ISSN 1473-6500, Vol. 20, no 6, p. 520-525Article in journal (Refereed)
    Abstract [en]

    PURPOSE OF REVIEW: To present the evidence available for the management of pain, for the prevention of nausea and vomiting, and for the best anaesthetic technique during ambulatory surgery.

    RECENT FINDINGS: Paracetamol and nonsteroidal anti-inflammatory drugs are effective analgesics with a low number needed to treat, and are recommended when not contraindicated. Droperidol, dexamethasone and ondansetron are equally effective in the prevention of postoperative nausea and vomiting during ambulatory surgery. The choice of the anaesthetic technique appears to play a minor role in recovery from anaesthesia or in the occurrence of minor postoperative complications or home discharge, except for the use of total intravenous anaesthesia for the prevention of postoperative nausea and vomiting.

    SUMMARY: Pain should be prevented adequately and treated vigorously. Postoperative nausea and vomiting is common and should be prevented in the at-risk patient. The choice of inhalation agents during ambulatory surgery is of minor importance in recovery from anaesthesia.

  • 2.
    Larsson, Jan
    et al.
    Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden; Department of Anaesthesia and Intensive Care, Uppsala University, Uppsala, Sweden.
    Holmström, Inger
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden.
    Understanding anesthesia training and trainees2012In: Current Opinion in Anaesthesiology, ISSN 0952-7907, E-ISSN 1473-6500, Vol. 25, no 6, p. 681-685Article in journal (Refereed)
    Abstract [en]

    Purpose of review: Patient safety is topical today. Competent professionals are necessary to keep anesthesia care safe, and teaching trainees is an important element in safety work. The purpose of this review is to present the latest research on anesthesia training and trainees.

    Recent findings: Most trainees of today aim for excellence, for which personal qualities are as important as knowledge and skills. The definition of excellence is the first subject covered here. Trainees of today can train many procedural skills in a simulators setting, a step forward for patient safety. Several studies about simulator training are reported. A dimension of competence that has received much attention during the last years is anesthesiologists' nontechnical skills. Studies on anesthesiologists' nontechnical skills as a valuable tool for assessing trainees' progress in nontechnical skills are presented.

    Summary: Much research about anesthesia training concerns simulator training and assessment of trainees' competence. More research is needed to understand the process of learning anesthesia.

  • 3.
    Nygren, Jonas
    et al.
    Ersta Hospital, Karolinska Institutet, Karolinska University Hospital Huddinge, Stockholm; Centre of GastroIntestinal Disease, Ersta Hospital, Stockholm.
    Thorell, Anders
    Ersta Hospital, Karolinska Institutet, Karolinska University Hospital Huddinge, Stockholm.
    Ljungqvist, Olle
    Ersta Hospital, Karolinska Institutet, Karolinska University Hospital Huddinge, Stockholm.
    Are there any benefits from minimizing fasting and optimization of nutrition and fluid management for patients undergoing day surgery?2007In: Current Opinion in Anaesthesiology, ISSN 0952-7907, E-ISSN 1473-6500, Vol. 20, no 6, p. 540-4Article, review/survey (Refereed)
    Abstract [en]

    Purpose of review: As a result of advances in anaesthesia and surgery, an increasing number of surgical procedures are currently possible in the ambulatory setting. Nausea/vomiting and sedation/drowsiness are often associated with delayed discharge and readmission. These symptoms are also related to pharmacological treatment as well as dehydration and fasting. The evidence that preoperative fasting and dehydration not only reduces preoperative well being, but may also affect postoperative recovery is currently being reviewed.

    Recent findings: In association with minor surgical procedures, rehydration with approximately 1 l fluid, and in cases with a moderate degree of surgery, such as laparoscopic surgery, 1-3 l fluid, given perioperatively will improve postoperative well being and recovery. Administration of a carbohydrate-rich beverage not only provides fluid but also counteracts the negative effects of preoperative fasting, which in turn reduces preoperative hunger and improves well being. Postoperatively, this treatment reduces insulin resistance, which may be relevant in surgery with significant postoperative stress response. Two studies on laparoscopic cholecystectomy demonstrate different results regarding effects on postoperative outcome and nausea/vomiting and further evaluation is required.

    Summary: When preoperative dehydration is corrected, postoperative well being and clinical outcome improves. Avoiding preoperative fasting by administration of carbohydrate-rich beverages improves preoperative well being while effects on postoperative recovery in patients undergoing ambulatory surgery need to be further evaluated.

  • 4.
    Nygren, Jonas
    et al.
    Danderyds Hosp, Dept Clin Sci, Karolinska Inst, Stockholm, Sweden; Dept Surg, Ersta Hosp, Stockholm, Sweden.
    Thorell, Anders
    Danderyds Hosp, Dept Clin Sci, Karolinska Inst, Stockholm, Sweden; Dept Surg, Ersta Hosp, Stockholm, Sweden.
    Ljungqvist, Olle
    Örebro University, School of Medicine, Örebro University, Sweden.
    Preoperative oral carbohydrate therapy2015In: Current Opinion in Anaesthesiology, ISSN 0952-7907, E-ISSN 1473-6500, Vol. 28, no 3, p. 364-369Article, review/survey (Refereed)
    Abstract [en]

    Purpose of review: Management of the postoperative response to surgical stress is an important issue in major surgery. Avoiding preoperative fasting using preoperative oral carbohydrates (POC) has been suggested as a measure to prevent and reduce the extent to which such derangements occur. This review summarizes the current evidence and rationale for this treatment.

    Recent findings: A recent review from the Cochrane Collaboration reports enhanced gastrointestinal recovery and shorter hospital stay with the use of POC with no effect on postoperative complication rates. Multiple randomized controlled trials demonstrate improved postoperative metabolic response after POC administration, including reduced insulin resistance, protein sparing, improved muscle function and preserved immune response. Cohort studies in patients undergoing major abdominal surgery have shown that the use of POC as part of an enhanced recovery after surgery protocol is a significant predictor for improved clinical outcomes.

    Summary: Avoiding preoperative fasting with POC is associated with attenuated postoperative insulin resistance, improved metabolic response, enhanced perioperative well-being, and better clinical outcomes. The impact is greatest for patients undergoing major surgeries.

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