Importância Prognóstica do Eletrocardiograma Pré-Operatório em Pacientes de Baixo Risco Submetidos à Intervenção Cirúrgica sob Anestesia Geral / Prognostic Value of Preoperative Electrocardiogram in Low-Risk Patients Undergoing Surgical Intervention and General Anesthesia

Resumo Fundamento Pacientes com idade superior a 50 anos requerem quatro vezes mais intervenções cirúrgicas que o grupo mais jovem. Muitas diretrizes recomendam a realização do eletrocardiograma pré-operatório nessa faixa etária. Objetivos Determinar a importância do ECG pré-operatório em pacientes com idade superior a 50 anos e com classificação de risco cirúrgico ASA I e II. Métodos Foram recrutados pacientes com idade superior a 50 anos, sem comorbidades, submetidos à intervenção cirúrgica sob anestesia geral. Os pacientes foram randomizados para a realização (grupo A n=214) ou não (grupo B n=213) do ECG pré-operatório. Foram analisadas as variáveis: sexo, idade, resultado do ECG, da radiografia do tórax e dos exames laboratoriais, risco cirúrgico, duração do procedimento, eventos adversos e mortalidade intra-hospitalar. O nível de significância estatística adotado foi de 5%. Resultados Houve ocorrência de desfechos adversos em 23 (5,4%) pacientes, com um número significante de eventos adversos nos pacientes do sexo masculino (OR=7,91, IC95% 3,3-18,90, p<0,001) e naqueles com intervenções de maior porte cirúrgico (OR=30,02, IC95% 4,01-224,92, p<0,001). Não houve diferença entre os grupos que realizaram ou não o ECG (OR=1,59, IC95% 0,67-3,75, p=0,289). As demais variáveis não mostraram diferenças significantes. Na regressão logística multivariada o sexo masculino (OR=6,49; IC95% 2,42-17,42, p<0,001) e o porte cirúrgico (OR=22,62; IC95% 2,95-173,41, p=0,002) foram preditores independentes de desfechos adversos, enquanto realizar ou não ECG (OR=1,09; IC95% 0,41-2,90, p=0,867) permaneceu sem significância estatística. Conclusões Os resultados sugerem que o ECG pré-operatório não foi capaz de predizer aumento do risco de desfechos adversos nos pacientes estudados, durante a fase hospitalar.

Abstract Background Patients aged over 50 years require four times more surgical interventions than younger groups. Many guidelines recommend the performance of preoperative electrocardiogram (ECG) in this population. Objectives To determine the value of preoperative ECG in patients aged over 50 years and classified as ASA I-II (surgical risk). Methods Patients older than 50 years, without comorbidities, who underwent surgical intervention and general anesthesia were included in the study. Patients were randomized to undergo ECG (group A, n=214) or not (group B, n=213) in the preoperative period. The following variables were analyzed: sex, age, ECG, chest x-ray and laboratory tests results, surgical risk, surgery duration, adverse events and in-hospital mortality. The level of significance was set at 5%. Results Adverse outcomes were reported in 23 (5.4%) patients, with a significant number of adverse events in male patients (OR=7.91 95%CI 3.3-18.90, p<0.001) and in those undergoing major surgeries (OR=30.02 95%CI 4.01-224.92, p<0.001). No differences were observed between patients who underwent ECG and those who did not (OR=1.59, 95%CI, 0.67-3.75, p=0.289). No significant differences were found in the other variables. In multivariate logistic regression, male sex (OR = 6.49; 95%CI 2.42-17.42, p<0.001) and major surgery (OR=22.62; 95%CI 2.95-173.41, p=0.002) were independent predictors of adverse outcomes, whereas undergoing (or not) ECG (OR=1.09; IC95% 0.41-2.90, p=0.867) remained without statistical significance. Conclusion Our findings suggest that preoperative ECG could not predict an increased risk of adverse outcomes in our study population during the hospital phase.

Dependência de cuidados pré-operatórios e qualidade de recuperação pós-operatória de pacientes cirúrgicos / Dependencia de cuidados preoperatorios y calidad de recuperación posoperatoria de pacientes quirúrgicos / Preoperative care dependency and postoperative quality of recovery of the surgical patients

Resumo Objetivo O objetivo do estudo foi determinar a relação entre a dependência de cuidados pré-operatórios e a qualidade de recuperação no pós-operatório de pacientes submetidos à cirurgia. Métodos A amostra do estudo descritivo, transversal e correlacional foi composta por 215 pacientes. Um formulário de informações do paciente, a Care Dependency Scale e o questionário Quality of Recovery-40 item foram aplicados aos pacientes usando a técnica de entrevista face a face para a coleta de dados entre junho e dezembro de 2018. A ferramenta Strengthening the Reporting of Observational Studies in Epidemiology foi utilizada neste estudo. Resultados Houve uma diferença estatisticamente significativa entre as pontuações médias da Care Dependency Scale e do Quality of Recovery-40 item Scale dos pacientes e seus domínios conforto físico, independência física e dor em termos de faixas etárias e sexo (p<0,05). Foi encontrada uma correlação positiva e moderada entre a dependência de cuidados dos pacientes e a independência física. Conclusão Quando o nível de dependência de cuidados diminuiu, os pacientes precisaram de menos assistência durante a recuperação no período pós-operatório, pois conseguiram realizar suas atividades diárias de forma independente.

Resumen Objetivo El objetivo del estudio fue determinar la relación entre la dependencia de cuidados preoperatorios y calidad de recuperación en el posoperatorio de pacientes sometidos a cirugía. Métodos La muestra del estudio descriptivo, transversal y correlacional estuvo compuesta por 215 pacientes. Se aplicó a los pacientes un formulario de información del paciente, la Care Dependency Scale y el cuestionario Quality of Recovery-40 item, mediante la técnica de entrevista cara a cara para la recopilación de datos, entre junio y diciembre de 2018. Se utilizó la herramienta Strengthening the Reporting of Observational Studies in Epidemiology en este estudio. Resultados Hubo una diferencia estadísticamente significativa entre el puntaje promedio de la Care Dependency Scale y del Quality of Recovery-40 item Scale de los pacientes y los dominios bienestar físico, independencia física y dolor en términos de grupos de edad y sexo (p<0,05). Se observó una correlación positiva y moderada entre la dependencia de cuidados de los pacientes y la independencia física. Conclusión Cuando el nivel de dependencia de cuidados disminuyó, los pacientes necesitaron menos atención durante la recuperación en el período posoperatorio, ya que pudieron realizar sus actividades diarias de forma independiente.

Abstract Objective The purpose of the study was to determine the relationship between preoperative care dependency and postoperative quality of recovery in patients undergoing surgery. Methods The sample of the descriptive, cross-sectional and correlational study consisted of 215 patients. A Patient Information Form, the Care Dependency Scale and the Recovery Quality-40 Scale were applied to the patients through face-to-face interview technique in order to collect the data between June and December 2018. This study adhered to Strengthening the Reporting of Observational Studies in Epidemiology guidelines. Results There was a statistically significant difference between Care Dependency Scale and the Recovery Quality-40 Scale mean scores of the patients and their physical comfort, physical independence, and pain in terms of age groups and genders (p<.05). A positive and moderate correlation was found between the patients' care dependency and physical independence. Conclusion It was observed that when the care dependency level decreased, the patients needed less assistance throughout the postoperative recovery period, as they were able to carry out their daily activities independently.

Impact of preoperative body composition in patients with renal cell carcinoma submitted to surgical treatment / Impacto da composição corporal pré-operatória em pacientes com carcinoma de células renais submetidos a tratamento cirúrgico

Abstract Objective: To evaluate the impact of preoperative body composition in patients with renal cell carcinoma (RCC) undergoing surgical treatment. Materials and Methods: This was a retrospective study of 52 patients with RCC undergoing total or partial nephrectomy. Body composition assessment was performed using the body mass index, together with computed tomography analysis at the level of the third lumbar vertebra to measure the area of visceral adipose tissue, as well as the area and density of skeletal muscle mass. Results: Malnutrition, obesity and inadequate skeletal muscle gauge (SMG) were associated with higher hospital length of stay (p = 0.028, p = 0.02 and p = 0.012, respectively). Although the rates of postoperative symptoms and readmissions were low, survival was better among the patients with an adequate SMG than among those with an inadequate SMG (p = 0.003). Conclusion: Among patients with RCC undergoing surgical treatment, preoperative body composition does not seem to be associated with the rates of perioperative complications, although an inadequate SMG seems to be associated with worse overall survival.

Resumo Objetivo Avaliar o impacto da composição corporal pré-operatória em pacientes portadores de carcinoma de células renais (CCR) submetidos a tratamento cirúrgico. Materiais e Métodos: Foi realizado estudo retrospectivo de 52 pacientes portadores de CCR submetidos a tratamento cirúrgico. A avaliação da composição corporal foi realizada por meio do índice de massa corporal e análise da L3 obtida pela tomografia computadorizada para mensurar a área do tecido adiposo visceral, área e densidade da massa muscular esquelética. Resultados: Os pacientes desnutridos, obesos e que apresentaram produto muscular esquelético (PME) inadequado permaneceram mais tempo internados (p = 0,028, p = 0,02 e p = 0,012, respectivamente). As taxas de sintomas e reinternações no pósoperatório foram baixas em toda a amostra, no entanto, observou-se que pacientes com PME inadequado apresentaram uma pior sobrevida em relação aos pacientes com PME adequado (p = 0,003). Conclusão: A análise da composição corporal pré-operatória não mostrou associação com as taxas de complicações periope-ratórias em pacientes portadores de CCR submetidos a nefrectomia total ou parcial, no entanto, a inadequação do PME está associada a uma pior sobrevida.

Nursing evaluation of pediatric preoperative anxiety: a qualitative study / Avaliação de enfermagem da ansiedade pré-operatória pediátrica: um estudo qualitativo? / Evaluación enfermera de la ansiedad prequirúrgica pediátrica: estudio cualitativo

Abstract Objective: to explore and describe how perioperative nurses assess and interpret the child's behavior before entering the operating room, identifying the strategies they use to reduce anxiety and the proposals for improvements. Method: descriptive qualitative study using semi-structured interviews and participant observation of daily routines. Thematic analysis of data. This study follows the recommended criteria for publication of articles of the qualitative methodology Consolidated Criteria for Reporting Qualitative Research. Results: four topics emerged from the data: a) assessment of anxiety or close communication with the child and their family; b) evaluating what was observed; c) managing anxiety and d) improving the assessment or proposals for improvements in daily practice. Conclusion: nurses assess anxiety in their daily practice through observation using their clinical judgment. The nurse's experience is decisive for the appropriate assessment of the preoperative anxiety in child. Insufficient time between waiting and entering the operating room, lack of information from child and their parents about the surgical procedure, and parental anxiety make it difficult to assess and properly manage anxiety.

Resumo Objetivo: explorar e descrever como as enfermeiras perioperatórias avaliam e interpretam o comportamento da criança antes de entrar na sala de cirurgia, identificando as estratégias que utilizam para minimizar a ansiedade e as propostas de melhoria. Método: estudo qualitativo descritivo utilizando entrevistas semiestruturadas e observação participante das rotinas diárias. Análise temática dos dados. O estudo segue os critérios recomendados para publicação de artigos da metodologia qualitativa Consolidated Criteria for Reporting Qualitative Research. Resultados: quatro temas emergiram dos dados: a) avaliação da ansiedade ou comunicação próxima com a criança e sua família; b) analisando o que foi observado; c) controlando a ansiedade e d) melhorando a avaliação ou propostas de melhoria na prática diária. Conclusão: as enfermeiras avaliam a ansiedade em sua prática diária por meio da observação e usando julgamento clínico. A experiência da enfermeira é decisiva na avaliação adequada da ansiedade pré-operatória da criança. A falta de tempo entre a espera e o momento de entrar na sala de cirurgia, a escassez de informação que a criança e os pais têm sobre o processo cirúrgico e a ansiedade dos pais, dificultam a avaliação e o controle adequado da ansiedade.

Resumen Objetivo: explorar y describir cómo las enfermeras perioperatorias evalúan e interpretan el comportamiento del niño antes de entrar a quirófano, identificando las estrategias que utilizan para minimizar la ansiedad y las propuestas de mejora. Método: estudio cualitativo descriptivo mediante entrevistas semiestructuradas y observación participante de las rutinas diarias. Análisis temático de los datos. El estudio sigue las recomendaciones de criterios para la publicación de artículos de metodología cualitativa Consolidated Criteria for Reporting Qualitative Research. Resultados: cuatro temas surgieron de los datos: a) evaluación de la ansiedad o comunicación estrecha con el niño y su familia; b) valorando lo observado; c) manejando la ansiedad y d) mejorando la evaluación o propuestas de mejora para la práctica diaria. Conclusión: enfermeras evalúan la ansiedad en su práctica diaria de forma observacional utilizando el juicio clínico. La experiencia de la enfermera es determinante en la adecuada evaluación de la ansiedad prequirúrgica del niño. La falta de tiempo entre la espera y el momento de entrar a quirófano, la mala información que tiene el niño y los padres sobre el proceso quirúrgico y la ansiedad de los padres dificultan la evaluación y el manejo correcto de la ansiedad.

Abnormalities in preoperative examinations of plastic surgery patients / Anormalidades em exames pré-operatórios de pacientes de cirurgia plástica

Introduction: Preoperative tests (EPO) aim to detect abnormalities and give greater safety to the procedure. However, the request for these tests is still controversial, either because they do not bring about changes in conduct for the procedure or result in some harm to the patient. The objective is to assess the frequency of EPO requests and abnormalities in aesthetic plastic surgery patients, to verify what these abnormalities are, what preoperative management should be done based on the finding, and to associate the data obtained with the patient's profile and the planned surgery. Method: Retrospective study evaluating medical records of aesthetic plastic surgery patients who underwent routine EPO in a plastic surgery hospital in 2019. Results: 978 patients were studied, and 51% had some abnormality in EPO. 93.7% were women, with a mean age of 46.5 years. 12.3 exams were performed per patient, and abnormality was observed in 6.1% of EPO. The exams that had the most abnormalities were the lipidogram (23.8%) and the cardiac evaluation (14.1%). Hypothyroidism was the most common comorbidity (18.4% of patients); 70% of diabetics had a glycemic level above the recommended level. Only 3.4% of the patients suffered a change in preoperative management due to EPO abnormality, and in 57.9% of these cases, the surgery was postponed. Test alterations were more frequent in male patients (p<0.0001). Conclusion: The performance of routine EPO showed a low frequency of altered exams (3.4%) and implied changes in the preoperative conduct of plastic surgery patients.

Introdução: Os exames pré-operatórios (EPO) visam detectar anormalidades e dar maior segurança ao procedimento. No entanto, a solicitação desses exames ainda é controversa, seja por não trazerem mudanças de conduta para o procedimento ou resultar em alguns malefícios para o paciente. O objetivo é avaliar a frequência de solicitações e de anormalidades dos EPO em pacientes de cirurgia plástica estética, verificar quais são estas anormalidades, qual conduta pré-operatória mediante o achado e associar os dados obtidos com o perfil do paciente e cirurgia prevista. Método: Estudo retrospectivo avaliando prontuários de pacientes de cirurgia plástica estética que realizaram EPO de rotina em um hospital de cirurgia plástica durante o ano de 2019. Resultados: Foram estudados 978 pacientes e 51% desses apresentaram alguma anormalidade nos EPO. 93,7% eram mulheres, com média de idade 46,5 anos. Foram realizados 12,3 exames por paciente e observada anormalidade em 6,1% dos EPO. Os exames que mais tiveram anormalidades foram o lipidograma (23,8%) e os da avaliação cardíaca (14,1%). Hipotireoidismo foi a comorbidade mais achada (18,4% dos pacientes); 70% dos diabéticos estavam com o nível glicêmico acima do recomendado. Apenas 3,4% dos pacientes sofreram alteração da conduta pré-operatória devido anormalidade dos EPO e em 57,9% desses casos houve adiamento da cirurgia. Alterações de exames foram mais frequentes em pacientes do sexo masculino (p<0,0001). Conclusão: A realização de EPO de rotina mostrou baixa frequência de exames alterados (3,4%) e implicou em mudanças na conduta pré-operatória em pacientes de cirurgia plástica.

PERIOPERATIVE ANXIETY IN CHILDREN: NARRATIVE REVIEW

Preoperative anxiety in children is common and can have negative effects on their overall surgical experience. Several factors, such as age, personality traits, and past medical experiences, can contribute to increased preoperative anxiety. Behavioral interventions, such as distraction techniques, parental presence at induction of anesthesia, and preoperative preparation programs, can be effective in reducing anxiety. Behavioral family preparation programs have been found to reduce the number of children requiring preoperative sedation, but they may not be practical for all centers. Anesthesiologists and child life specialists can play an essential role in reducing anxiety in children by interacting with them in an age-appropriate way, providing therapeutic play experiences, and offering developmentally appropriate language. Distraction techniques, such as non-procedural distracting talk, electronic devices, music, stories, and guided imagery, can also help children cope with anxiety. Pharmacological interventions, such as sedative premedication, should be used with caution, especially for children with neurodevelopmental disorders, due to potential drug interactions and increased risks of upper airway obstruction.

Preoperative clinical management of patients who are candidates for facial transplantation / Manejo clínico pré-operatório de pacientes candidatos ao transplante facial

Introduction: Face transplantation has gained recognition, changing the clinicalsurgical scenario for restoring complex facial defects, as it attributes functional and aesthetic recovery to patients who have suffered serious accidents. At the time of writing this article, in official publications, 43 patients had already undergone facial transplantation worldwide. Face transplantation has numerous pieces of evidence that can irrefutably provide improvements to the patient. For this, preoperative care for the patient must be carefully established so that there is good surgical performance. Case Report: Male patient, 46 years old, reports that, at the age of 6, he had burns due to exposure to gasoline, with 72% of his body surface burned, showing sequelae of burns and surgical reconstructions on the face, with redundant and ptotic skin flap on the left cheek, absence of upper and lower lip and exposure of lower teeth. Conclusion: It is important to publicize this innovative procedure in different medical specialties and preoperative care through a thorough investigation, which attributes better surgical effectiveness, allowing the rescue of their facial identity, once stigmatized.

Introdução: O transplante de face adquiriu reconhecimento, alterando o panorama clínico-cirúrgico para a restauração de defeitos faciais complexos, visto que atribui recuperação funcional e estética a pacientes que sofreram acidentes graves. Até o momento da redação deste artigo, em publicações oficiais, 43 pacientes já haviam realizado o transplante facial em todo mundo. O transplante de face possui inúmeras evidências que podem fornecer melhorias ao paciente de forma irrefutável. Para isso, cuidados pré-operatórios ao paciente devem ser cuidadosamente estabelecidos para que haja um bom desempenho cirúrgico. Relato de Caso: Paciente sexo masculino, 46 anos, relata que, aos 6 anos de idade, teve queimadura por exposição à gasolina, com 72% de superfície corporal queimada, apresentando sequelas de queimaduras e reconstruções cirúrgicas na face, com retalho cutâneo redundante e ptótico em bochecha esquerda, ausência de lábio superior e inferior e exposição dos dentes inferiores. Conclusão: Ressalta-se a importância da divulgação desse procedimento inovador em diferentes especialidades médicas e dos cuidados pré-operatórios através de uma investigação minuciosa, que atribuem uma melhor eficácia cirúrgica, possibilitando o resgate de sua identidade facial, uma vez estigmatizada.

Preoperative evaluation of sarcopenia in patients with colorectal cancer: a prospective study

SUMMARY OBJECTIVE: Colorectal cancer is the third most diagnosed malignant neoplasm in the world and the fourth leading cause of cancer mortality. The loss of muscle mass in oncological patients is the main aspect of cancer-related malnutrition. Associations between sarcopenia and poor outcomes, such as high postoperative mortality, chemotherapy toxicity, and reduced survival, have been recently described. The aim of this study was to prospectively assess the prevalence of preoperative sarcopenia in patients with colorectal cancer using validated methods to evaluate muscle strength, muscle mass, and physical performance. METHODOLOGY: This study included patients with colorectal cancer undergoing oncological staging at a Cancer Center in Brazil from May 2019 to March 2020 who had images from abdominal computed tomography available for analysis of body composition. The muscle strength test, physical performance, referred fatigue, and clinical and nutritional data were evaluated. RESULTS: A total of 31 patients were included, and most were diagnosed with colon cancer (77.4%) and clinical stage II in 41.9% of cases. The prevalence of probable sarcopenia was 22.6%; of these patients, sarcopenia was confirmed in 19.4%, and ultimately, 9.7% of the sample was classified as severe sarcopenia. We did not find a significant association between the presence of sarcopenia in our sample and age, sex, tumor staging, nutritional characteristics, referred patient fatigue, or postoperative complications. CONCLUSION: Considering the criteria established by the EWGSOP, the prevalence of preoperative sarcopenia in colorectal cancer patients was 19.4%.

Effectiveness of an Educational Intervention with Guidelines from the Total Acceleration of Postoperative Recovery Project (ACERTO) in Gynecology / Efetividade de uma intervenção educativa com diretrizes do projeto Aceleração da Recuperação Total Pós-operatória (ACERTO) na ginecologia

Abstract Objective To evaluate the effectiveness of an educational intervention among gynecologists about recommendations of the Total Acceleration of Postoperative Recovery (ACERTO, in the Portuguese acronym) project derived from the solid foundations of Enhanced Recovery After Surgery (ERAS) guidelines to optimize hospital care for surgical-gynecological patients. Methods Educational intervention through monthly 1-hour long meetings (3 months), with the application of an objective questionnaire about specific knowledge of the ACERTO project between before and after educational intervention phases, for gynecologists, after approval by the ethics committee and signature of informed consent by participants, in a federal university hospital. Results Among the 25 gynecologists who agreed to participate, the educational intervention could be effective with a statistically significant difference between the phases before and after the intervention for the main recommendations of the ACERTO project, such as abbreviation of preoperative fasting (p = 0.006), venous thromboembolism prophylaxis (p = 0.024), knowledge and replication of ACERTO (p = 0.034), and multimodal analgesia (p = 0.021). Conclusion An educational intervention, through clinical meetings with exposition and discussion of the recommendations of the ACERTO project based on the ERAS protocol can be effective for the knowledge and possibility of practical application of the main measures, such as abbreviation of preoperative fasting, multimodal analgesia, and prophylaxis of thrombosis among gynecologists.

Resumo Objetivo Avaliar a efetividade de uma intervenção educativa entre ginecologistas de um hospital universitário a fim de capacitar o conhecimento científico das recomendações do projeto Aceleração da Recuperação Total Pós-operatória ACERTO, derivado das bases sólidas do protocolo Enhanced Recovery After Surgery (ERAS) para otimizar a assistência hospitalar de pacientes cirúrgico-ginecológicas. Métodos Intervenção educativa por meio de reuniões mensais por 3 meses, com duração de 1 hora, com aplicação de questionário objetivo com questões de conhecimentos específicos do projeto ACERTO com fases antes e depois da intervenção, para profissionais ginecologistas, após aprovação do comitê de ética em pesquisas (CEP) e assinatura do termo de consentimento livre e esclarecido (TCLE) pelos participantes. Resultados Dentre os 25 ginecologistas que aceitaram participar, a intervenção educativa se mostrou eficaz com diferença estatisticamente significante entre as fases antes e depois da intervenção para as principais recomendações do projeto ACERTO, como abreviação de jejum pré-operatório (p = 0.006), profilaxia de tromboembolismo venoso (p = 0.024), conhecimento e replicação do conhecimento do ACERTO (p = 0.006) e analgesia multimodal (p = 0.006). Conclusão Uma intervenção educativa, por meio de reuniões clínicas com exposição e discussão das recomendações do projeto ACERTO baseadas em evidências e derivadas do ERAS é eficaz para o conhecimento e possibilidade de aplicação prática de medidas como abreviação de jejum pré-operatório, analgesia multimodal e profilaxia de trombose entre ginecologistas.

Efectividad de intervención de Enfermería para disminuir la depresión de personas en el preoperatorio cardiovascular / Effectiveness of a Nursing Intervention to Reduce Depression in Individuals during the Preoperative Period of Cardiovascular Surgery

Introducción: Durante el preoperatorio cardiovascular, las personas presentan con frecuencia niveles altos de depresión, los que se asocian a resultados quirúrgicos poco favorables y, por ende, a la necesidad de una intervención de Enfermería para disminuir estos niveles. Objetivo: Evaluar la efectividad de una intervención de Enfermería para disminuir la depresión de personas en el preoperatorio cardiovascular. Métodos: Estudio preexperimental con pretest y protest, en una población de 88 personas en el Servicio de Cirugía Cardiovascular en el Centro de Investigaciones Médico Quirúrgicas, La Habana, Cuba, desde marzo de 2019 a junio de 2020. La depresión fue medida con el test de Inventario de Depresión Rasgo-Estado. Se realizó una intervención de Enfermería sustentada en el Modelo de Adaptación de Sor Callista Roy, el Proceso de Atención de Enfermería y las taxonomías NANDA, NOC, NIC, para disminuir la depresión de personas en el preoperatorio cardiovascular. Los resultados se confrontaron y expresaron en porcentajes, media y números absolutos. Se utilizó la prueba de Chi cuadrado y probabilidad exacta de Fisher. La asociación de variables se obtuvo con la prueba no paramétrica de Wilcoxon, con regla de disociación: si p≤ 0,05 se rechaza HO. Resultados: El sexo masculino constituyó el 57,92 por ciento de los casos y la edad media fue de 57 años. Luego de la intervención se redujo la depresión en un 27,27 por ciento (p= 0,000). Conclusiones: La implementación de una intervención de Enfermería para disminuir la depresión de personas en el preoperatorio cardiovascular, sustentada en el Modelo de Adaptación de Sor Callista Roy, el PAE y las Taxonomías NANDA, NOC, NIC mostró efectividad, ya que se logró modificar de forma positiva y significativa la depresión, en tanto, optimizó los resultados posoperatorios(AU)

Introduction: During the preoperative period of cardiovascular surgery, people frequently present high levels of depression, associated with little favorable surgical outcomes and, therefore, with the need for a nursing intervention to reduce such levels. Objective: To evaluate the effectiveness of a nursing intervention to reduce depression in preoperative cardiovascular patients. Methods: A preexperimental study with pretest and protest was carried out in a population of 88 people in the cardiovascular surgery service at Centro de Investigaciones Médico-Quirúrgicas, in Havana, Cuba, from March 2019 to June 2020. Depression was measured using the State/Trait Depression Inventory test. A nursing intervention was performed, based on the Adaptation Model of Sister Callista Roy, the Nursing Care Process, as well as the NANDA, NOC and NIC taxonomies, in order to reduce depression in preoperative cardiovascular patients. The results were compared and expressed as percentages, mean and absolute numbers. The chi-square and Fisher's exact probability tests were used. The association of variables was obtained with the nonparametric Wilcoxon test, with the dissociation rule if p ≤ 0.05, H O is rejected. Results: The male sex accounted for 57.92 percent of the cases and the mean age was 57-years. After the intervention, depression was reduced by 27.27 percent (p= 0.000). Conclusions: The implementation of a nursing intervention to reduce depression in preoperative cardiovascular patients, based on the Adaptation Model of Sister Callista Roy, the Nursing Care Process, as well as NANDA, NOC and NIC taxonomies, showed effectiveness, since it was possible to modify depression in a positive and significant way, while optimizing postoperative outcomes(AU)

Efficacy of goal-directed analgesia/sedation for improvement in preoperative management of patients with aortic dissection / 中华麻醉学杂志

Objective:To evaluate the efficacy of goal-directed analgesia/sedation for improvement in the preoperative management of the patients with aortic dissection.Methods:One hundred and ten patients of either sex, aged≥18 yr, diagnosed with arterial dissection by aortic CTA in our hospital, were divided into 2 groups ( n=55 each) using a random number table method: conventional group and goal-directed analgesia/sedation group. Routine preoperative management was performed in both groups. Fentanyl 0.13 μg/min was intravenously infused, and the infusion rate of fentanyl was adjusted to maintain the numerical rating scale (NRS) score at 0-3 at rest in conventional group. Midazolam 0.02 mg·kg -1·h -1 and fentanyl 0.13 μg/min were intravenously infused, and the infusion rates of midazolam and fentanyl were adjusted to maintain Richmond agitation-sedation score at -2 to 0 and NRS score at rest 0-3 in goal-directed analgesia/sedation group. Nicardipine was intravenously injected and the administration rate was adjusted to maintain systolic blood pressure at 100-120 mmHg, and metoprolol was taken orally to maintain the heart rate 60-70 beats/min. The time to reach the target blood pressure and consumption of fentanyl and nicardipine within 24 h were recorded, and the occurrence of drug-related adverse reactions during analgesia and sedation and perioperative death were recorded. Results:Compared with conventional group, the time to reach the target blood pressure was significantly shortened, and the consumption of fentanyl and nicardipine within 24 h was decreased in goal-directed analgesia/sedation group ( P<0.05). No adverse reactions or perioperative death was observed in two groups. Conclusions:Goal-directed analgesia/sedation (Richmond Agitation-Sedation Scale score -2-0, NRS score at rest 0-3) is helpful in controlling blood pressure and heart rate, thus improving the quality of preoperative management of patients with aortic dissection.

Avaliação do Conhecimento e Aplicação de Critérios Abordados em Protocolos de Condutas Perioperatórias para Recuperação Acelerada por Médicos Cirurgiões / Assesment of the Surgeons' Knowledge and Application of Enhanced Recovery after Surgery Protocols

Introdução: Pacientes submetidos a procedimentos cirúrgicos estão sujeitos a complicações cirúrgicas e decorrentes de longos períodos de internação. Programas que visam melhorar os desfechos cirúrgicos e abreviar o tempo de permanência hospitalar foram criados e otimizados com intuito de reduzir essas complicações e custos relacionados. Devido à complexidade do tema, da implantação dos protocolos e das alterações de práticas já consolidadas, esses protocolos ainda não são totalmente colocados em prática pelos profissionais da área. Objetivo: Avaliar o conhecimento e a aplicabilidade dos médicos cirurgiões, acerca de aspectos abordados em programas de recuperação pós-operatória acelerada. Materiais: Estudo observacional descritivo, transversal, com coleta de dados primários. Resultados: Dos entrevistados, 82,9% eram homens, com idade média de 43,07 anos. Destes, 81,1% não utilizam fórmulas para calcular individualmente a reposição de volume perioperatório. Em relação ao uso de drenos no sítio operatório, 55,7% dos participantes relataram fazer uso rotineiro, e 91,7% referiram orientar a retirada do mesmo após pelo menos 3 dias. Quanto ao jejum pré-operatório para sólidos, 40,4% e 34,2% dos cirurgiões consideram 6 e 8 horas como o tempo mínimo adequado, respectivamente, sendo que 62,7% dos entrevistados disseram reintroduzir a dieta por via oral de acordo com protocolos predeterminados. Conclusão: Os protocolos de recuperação acelerada são amplamente embasados em evidências e comprovados através de estudos científicos, e alguns dos aspectos por eles defendidos já são colocados em prática por boa parte dos cirurgiões em atuação. Porém, é possível perceber que alguns aspectos ainda precisam de maior aceitação por parte dos médicos.

Introduction: Patients undergoing surgical procedures are subject to surgical complications and resulting from long hospital stays. Programs aimed at improving surgical outcomes and shortening hospital stay were created and optimized in order to reduce these complications and related costs. Due to the complexity of the topic, of the implementation of protocols and changes in practices that have already been consolidated, these protocols are still not fully put into practice by professionals in the field. Objective: To evaluate surgeons' knowledge and applicability of aspects addressed in accelerated postoperative recovery programs. Materials and methods: A descriptive, cross-sectional observational study with primary data collection. Results: Of the respondents, 82.9% were men, with a mean age of 43.07 years. Of these, 81.1% do not use formulas to individually calculate perioperative volume replacement. Regarding the use of drains in the operative site, 55.7% of the participants reported using it routinely, and 91.7% reported advising to remove it after at least 3 days. As for preoperative fasting for solids, 40.4% and 34.2% of surgeons consider 6 and 8 hours as the minimum adequate time, respectively, and 62.7% of respondents reported reintroducing the diet orally according to predetermined protocols. Conclusion: Accelerated recovery protocols are largely based on evidence and proven through scientific studies and some of the aspects defended by them are already put into practice by most practicing surgeons. However, it is possible to see that some aspects still need greater acceptance by doctors.

Intervención de enfermería para disminuir la ansiedad en el perioperatorio en cirugía cardiovascular / Nursing intervention to reduce anxiety in the perioperative period in cardiovascular surgery

Introducción: La adecuada intervención de enfermería puede mejorar los resultados posoperatorios, al disminuir la ansiedad. Objetivo: Desarrollar una intervención personalizada de enfermería para disminuir la ansiedad durante el preoperatorio de personas que requieren cirugía cardiovascular en el Centro de Investigaciones Médico Quirúrgicas. Métodos: Se hizo un estudio longitudinal y preexperimental, que incluyó a 88 personas que acudieron al Servicio de Cirugía Cardiovascular en el Centro de Investigaciones Médico Quirúrgicas desde marzo de 2019 hasta junio de 2020. Se aplicó el test Inventario de Ansiedad Rasgo-Estado para medir la ansiedad. Se realizó una intervención de enfermería personalizada. Los resultados iniciales y finales se compararon y se expresaron en números absolutos, porcentajes y media. Se aplicó la prueba de Chi cuadrado a las variables cualitativas y el test de Student para medias independientes a las variables cuantitativas. Resultados: Predominaron los hombres (57,9 por ciento) con edad media de 57,73 ± 11,9 años. Luego de la intervención de enfermería, se redujo la ansiedad en un 36,6 por ciento (p = 0,000). No se encontró asociación entre la ansiedad posintervención y la estadía, aunque sí se redujeron de forma significativa las complicaciones posoperatorias (p = 0,008). Conclusiones: La intervención de enfermería disminuyó la ansiedad y se asoció de forma significativa a menos complicaciones(AU)

Introduction: Adequate nursing intervention can improve postoperative outcomes by reducing anxiety. Objective: To develop a personalized nursing intervention to reduce anxiety during the preoperative period of people requiring cardiovascular surgery at the Medical and Surgical Research Center. Methods: A longitudinal and pre-experimental study was conducted, which included 88 people who attended the Cardiovascular Surgery Service at the Center for Medical and Surgical Research from March 2019 to June 2020. The Trait-State Anxiety Inventory test was applied to measure anxiety. A personalized nursing intervention was performed. Initial and final results were compared and expressed in absolute numbers, percentages and average. The Chi square test was applied to the qualitative variables and the Student test for independent means to the quantitative variables. Results: Men (57.9 percent) with a mean age of 57.73 ± 11.9 years predominated. After the nursing intervention, anxiety was reduced by 36.6 percent (p = 0.000). No association was found between post-intervention anxiety and stay, although postoperative complications were significantly reduced (p = 0.008). Conclusions: The nursing intervention decreased anxiety and was significantly associated with fewer complications(AU)

Desarrollo de las habilidades profesionales del cirujano general en la atención preoperatoria mediata / Development of the general surgeon professional skills in the mediate preoperative care

Introducción: El avance en los disímiles tratamientos y habilidades profesionales en torno a la intervención quirúrgica en el continente americano va aparejado al desarrollo que existe en Europa, y Cuba no queda exenta de los progresos alcanzados hasta la actualidad. Objetivo: Diagnosticar las insuficiencias en el desarrollo de las habilidades profesionales de los cirujanos generales, en la atención preoperatoria mediata. Métodos: Se realizó una investigación cuasi - experimental de 60 médicos especialistas y residentes, encargados de la atención preoperatoria mediata en el Hospital General Docente Dr. Juan Bruno Zayas Alfonso de Santiago de Cuba, desde diciembre de 2019 hasta mayo de 2021, para lo cual se conformaron 2 grupos: A (de estudio) y B (de control), con 30 integrantes cada uno. Se analizaron las variables seleccionadas y se definieron las dimensiones para demostrar la correspondencia con los indicadores de dichas variables. Resultados: Existió un predominio del sexo masculino en ambos grupos y de las edades entre 15 - 44 años (83,3 % en el grupo A y 90,0 % en el B). Las dimensiones más afectadas en orden decreciente fueron: superación, cognitiva, científico - investigativa y axiológica. La triangulación de los instrumentos arrojó que la variable desempeño profesional se encontraba con un nivel de afectación alto. Conclusiones: Las indagaciones teóricas y empíricas para la caracterización del estado actual de los cirujanos generales permitieron determinar, que existían insuficiencias en todas las dimensiones exploradas, lo cual dificultó el desarrollo de las habilidades profesionales relacionadas con la atención preoperatoria mediata.

Introduction: The advance in the dissimilar treatments and professional skills around the surgical intervention in the American continent goes together with the development that exists in Europe, and Cuba is not exempt of the progresses reached until the present time. Objective: To diagnose the inadequacies in the development of the general surgeons professional skills, in the mediate preoperative care. Methods: A quasi-experimental investigation of 60 specialist doctors and residents, in charge of the mediate preoperative care was carried out in Dr. Juan Bruno Zayas Alfonso Teaching General Hospital from Santiago de Cuba, from December, 2019 to May, 2021, for which 2 groups were conformed: A (study group) and B (control group), with 30 members each one. The selected variables were analyzed and the dimensions to demonstrate the correspondence with the indicators of these variables were defined. Results: There was prevalence of the male sex in both groups and the 15 - 44 age group (83.3 % in group A and 90.0 % in group B). The most affected dimensions in decreasing order were: training, cognitive, scientific - investigative and axiological. The triangulation of the instruments showed that the variable professional performance was in a high level of affectation. Conclusion: The theoretical and empiric investigations for the characterization of the current state of the general surgeons allowed to determine that inadequacies existed in all the explored dimensions, which made difficult the development of the professional skills related to the mediate preoperative care.

Role of preoperative erythropoietin in the optimization of preoperative anemia among surgical patients — A systematic review and meta-analysis

Abstract Preoperative anemia is a common finding. Preoperative allogeneic transfusion, iron therapy, vitamin supplementation and erythropoietin therapy are the current management strategies for preoperative anemia. Previous reviews regarding erythropoietin were limited to specialties, provided little evidence regarding the benefits and risks of erythropoietin in managing preoperative anemia and included non-anemic patients. The purpose of our systematic review was to determine the role of erythropoietin solely in preoperatively anemic patients and to investigate the complications of this treatment modality to produce a guideline for preoperative management of anemic patients for all surgical specialties. The PubMed/Medline, Google Scholar, and Cochrane Library were searched for randomized trials evaluating the efficacy of erythropoietin in preoperative anemia. The risk ratio (RR) and standardized mean difference (SMD) was used to pool the estimates of categorical and continuous outcomes, respectively. Allogeneic transfusion and complications and the 90-day mortality were the primary outcomes, while the postoperative change in hemoglobin, bleeding in milliliters and the number of red blood cell (RBC) packs transfused were the secondary outcomes. Results: Eight studies were included, comprising 734 and 716 patients in the erythropoietin group and non-erythropoietin group, respectively. The pooled estimate by RR for allogeneic transfusion was 0.829 (p = 0.049), while complications and the 90-day mortality were among the 1,318 (p = 0.18) patients. Conclusion: Preoperative erythropoietin provides better outcomes, considering the optimization of preoperative anemia for elective surgical procedures. The benefits of erythropoietin are significantly higher, compared to the control group, while the risks remain equivocal in both groups. We recommend preoperative erythropoietin in anemic patients.

Recomendações para o preparo do paciente em pré-operatório de cirurgias cardíacas: revisão de escopo / Recommendations for patient preparation in the preoperative period of cardiac surgeries: a scoping review / Recomendaciones para la preparación del paciente en el preoperatorio de cirugías cardíacas: revisión del alcanc

OBJETIVO: Mapear a produção de conhecimento a respeito das recomendações para o preparo pré-operatório de qualquer tipo de cirurgia cardíaca, eletiva ou de urgência, de pacientes com idade superior a 18 anos em unidades de internação hospitalar. MÉTODO: Revisão de escopo realizada em dezembro de 2020, em 11 fontes de dados, seguindo as recomendações do Instituto Joanna Briggs, com análise de dados descritiva. RESULTADOS: Foram selecionados e caracterizados 27 estudos, identificando-se como principais recomendações pré-operatórias de cirurgia cardíaca: a educação pré-operatória, medicações, escalas para estratificação de risco pós-operatório, treinamento muscular inspiratório e realização de exames. CONCLUSÃO: As recomendações apresentaram eficácia na estabilidade hemodinâmica, atenuação do medo e ansiedade do paciente quanto à cirurgia, de arritmias, internação hospitalar, taxa de mortalidade e complicações pós-operatórias.

OBJECTIVE: To map the production of knowledge regarding the recommendations for the preoperative preparation of any type of cardiac surgery, whether elective or urgent, of patients over 18 years old in hospitalization units. METHOD: A scoping review carried out in December 2020 in 11 data sources, following the Joanna Briggs Institute recommendations, with descriptive data analysis. RESULTS: A total of 27 studies were selected and characterized, identifying the following as the main preoperative recommendations for cardiac surgeries: preoperative education, medications, scales for postoperative risk stratification, inspiratory muscle training and tests. CONCLUSION: The recommendations presented efficacy in hemodynamic stability, attenuation of the patient's fear and anxiety regarding the surgery, of the number of arrhythmias and hospitalizations, of the mortality rate and of postoperative complications.

OBJETIVO: Mapear la producción de conocimiento sobre las recomendaciones para la preparación preoperatoria de cualquier tipo de cirugía cardiaca, electiva o urgente, de pacientes mayores de 18 años en unidades de hospitalización. MÉTODO: Revisión de alcance realizada en diciembre de 2020, en 11 fuentes de datos, siguiendo las recomendaciones del Instituto Joanna Briggs, con análisis descriptivo de datos. RESULTADOS: Se seleccionaron y caracterizaron 27 estudios, las principales recomendaciones preoperatorias para cirugía cardiaca que se identificaron son: educación preoperatoria, medicamentos, escalas para estratificación de riesgo postoperatorio, entrenamiento de músculos inspiratorios y exámenes. CONCLUSIÓN: Las recomendaciones fueron efectivas para mejorar la estabilidad hemodinámica, disminuir el miedo y la ansiedad del paciente por la cirugía, las arritmias, el tiempo de estancia hospitalaria, la tasa de mortalidad y las complicaciones postoperatorias.

Audiovisual aids in preoperative cardiac surgery education: a scoping review / Recurso audiovisual en la educación durante el período preoperatorio de cirugías cardíacas: revisión de alcance / Recurso audiovisual na educação em pré-operatório de cirurgia cardíaca: revisão de escopo

ABSTRACT Objective: to map, in the scientific literature, the use of audiovisual aids as an educational strategy during the preoperative period of cardiac surgery. Method: a scoping review following the Joanna Briggs Institute methodology. Two independent reviewers analyzed the studies, applying the exclusion and inclusion criteria in the search by the audiovisual aid, cardiac surgery and preoperative care variables, including those that answered the research question. Results: final sample of nine studies, where the most used audiovisual aids were videos followed by apps, used because they are easily accessible and democratic. Such tools in health education optimize the team's time and promote patient education, improving the postoperative period, in addition to reducing risks and improving adherence to the treatment. Conclusion: it was possible to map the audiovisual aids used in the health education of surgical patients, such as videos, apps and information systems. These tools facilitate Nursing guidelines in the preoperative period of cardiac surgeries, increasing the patient's knowledge about the surgery.

RESUMEN Objetivo: mapear en la literatura científica el uso de recursos audiovisuales como estrategia educativa durante el período preoperatorio de cirugías cardíacas. Método: revisión de alcance que siguió la metodología del Instituto Joanna Briggs. Dos revisores independientes analizaron los estados, aplicando los criterios de exclusión e inclusión en la búsqueda por medio de las siguientes variables: recurso audiovisual, cirugía cardíaca y cuidados preoperatorios, incluyéndose los que respondían a la pregunta de la investigación. Resultados: la muestra final estuvo compuesta por nueve estudios, en los que los recursos audiovisuales más utilizados fueron los vídeos seguidos de aplicaciones, usados por ser de fácil acceso y democráticos. Estas herramientas de educación en salud optimizan el tiempo del equipo y promueven la educación del paciente, mejorando así el período postoperatorio, además de reducir riesgos y mejorar la adhesión al tratamiento. Conclusión: fue posible mapear los recursos audiovisuales utilizados en la educación en salud de los pacientes quirúrgicos, como ser vídeos, aplicaciones y sistemas de información. Estas herramientas facilitan las pautas orientadoras de la Enfermería en el período preoperatorio de cirugías cardíacas, incrementando así el conocimiento de los pacientes sobre las cirugías.

RESUMO Objetivo: mapear na literatura científica a utilização de recurso audiovisual como estratégia educativa durante o pré-operatório de cirurgia cardíaca. Método: revisão de escopo seguindo a metodologia do Instituto Joanna Briggs. Dois revisores independentes analisaram os estudos, aplicando os critérios de exclusão e inclusão na busca pelas variáveis recurso audiovisual, cirurgia cardíaca e cuidados pré-operatórios, tendo sido incluídos aqueles que respondiam à questão de pesquisa. Resultados: amostra final de nove estudos, nos quais os recursos audiovisuais mais utilizados foram os vídeos seguidos de aplicativos, usados por serem de fácil acesso e democráticos. Essas ferramentas na educação em saúde otimizam o tempo da equipe e promovem a educação do paciente, melhorando o pós-operatório. Além de reduzir riscos e melhorar a adesão ao tratamento. Conclusão: foi possível mapear os recursos audiovisuais utilizados na educação em saúde dos pacientes cirúrgicos, como vídeos, aplicativos e sistemas de informações. Essas ferramentas são facilitadoras das orientações de enfermagem no pré-operatório de cirurgia cardíaca, aumentando o conhecimento do paciente sobre a cirurgia.

Median effective dose of esketamine for preoperative sedation in pediatric patients of different ages / 中华麻醉学杂志

Objective:To determine the median effective dose (ED 50) of esketamine for preoperative sedation in different aged pediatric patients. Methods:Pediatric patients, aged 1-6 yr, of American Society of Anaesthesiologists physical status Ⅰ, with the preoperative parental Separation Anxiety Scale (PSAS) score ≥3, undergoing elective surgery under general anesthesia, were selected.According to the age, the children were divided into 1 yr≤age<4 yr low-age group (group L) and 4 yr≤age< 6 yr high-age group (group H). Esketamine 0.5 mg/kg was intravenously injected in the first child in each group.The dose in the next child was determined according to PSAS scores, and the two consecutive dose gradient was 0.1 mg/kg; when the PSAS score in the previous child was ≥3, the dose in the next child was increased; when the PSAS score in the previous child was< 3, the dose in the next child was decreased until appearance of 7 turning points, and then the experiment was terminated.The ED 50 and 95% confidence interval of esketamine for preoperative sedation were calculated by probit analysis. Results:A total of 54 children were enrolled in this study, including 26 cases in group L and 28 cases in group H. The ED 50 and 95% confidence interval of esketamine were 0.413 (0.314-0.530) mg/kg and 0.282 (0.252-0.318) mg/kg in group L and group H, respectively.Compared with group L, ED 50 of esketamine was significantly decreased in group H ( P<0.05). Conclusions:The ED 50 of esketamine for preoperative sedation is 0.413 mg/kg in pediatric patients of 1 yr≤age<4 yr old and 0.282 mg/kg in those of 4 yr≤age<6 yr old, and the efficacy of esketamine for preoperative sedation increases with age.

Effects of electroacupuncture on gastric emptying in patients undergoing hepatobiliary surgery with preoperative fasting and drinking under enhanced recovery after surgery protocol / 中华麻醉学杂志

Objective:To evaluate the effect of electroacupuncture (EA) on gastric emptying in patients undergoing hepatobiliary surgery with preoperative fasting and drinking under the enhanced recover after surgery (ERAS) protocol.Methods:Seventy-six patients of both sexes, aged 18-75 yr, with body mass index of 18-25 kg/m 2, of American Society of Anesthesiologists physical status Ⅰ or Ⅱ, who underwent elective laparoscopic hepatectomy or cholecystectomy from January 2019 to December 2020, were divided into 2 groups ( n=38 each) using a random number table method: control group (group C) and EA group.Both groups used the ERAS strategy of fasting and drinking before operation.Solid food was forbidden after 20: 00 the night before surgery, and 12.5% preoperative oral carbohydrate drinks 800 ml was taken orally from 20: 00 to 22: 00, and preoperative oral carbohydrate drinks 400 ml was taken orally from 5: 30 to 6: 00 on the morning of surgery.The bilateral Zusanli, Zhongwan, Neiguan, and Taichong were stimulated at 7: 30 in group EA, while sham acupoints were stimulated in group C. All the patients underwent ultrasonography of the gastric antrum at 8: 00 for measurement of the cross-sectional area (CSA) in the supine and right lateral decubitus positions (right-lat CSA), gastric volume (GV), ratio of gastric volume to weight (GV/W), and ratio of right-lat CSA to weight (CSA/W) were measured, and Perlas A semi-quantitative grating was performed.After induction of anesthesia, the level of mucous pepsin at the esophageal entrance was quantitatively determined by enzyme-linked immunosorbent assay, and positive expression was recorded.The adverse reactions such as nausea, vomiting and aspiration during induction of anesthesia were recorded. Results:Compared with group C, the supine CSA, right-lat CSA, GV, right-lat CSA/W, GV/W, Perlas A semi-quantitative grading, positive rate of pepsin and incidence of nausea were significantly decreased in group EA ( P<0.05). Conclusions:EA can promote gastric emptying in the patients undergoing hepatobiliary surgery with preoperative fasting and drinking under ERAS protocol.

Effect of preoperative oral carbohydrate on gastric emptying in patients undergoing laparoscopic cholecystectomy / 中华麻醉学杂志

Objective:To evaluate the effect of preoperative oral carbohydrate on gastric emptying in the patients undergoing laparoscopic cholecystectomy.Methods:One hundred patients of both sexes, aged 18-64 yr, with body mass index of 18-30 kg/m 2, of American Society of Anesthesiologists physical status Ⅰ or Ⅱ, were divided into 2 groups ( n=50 each) using the random number table method: control group (group C) and preoperative oral carbohydrate group (group P). Patients underwent solid food fasting after 20: 00 on the night before surgery in both groups and drinking fasting after 21: 30 on the night before surgery in group C. Group P received 800 ml of 12.5% oral carbohydrate at 21: 30 on the night before surgery and 400 ml of oral similar carbohydrate from 5: 00 to 5: 30 in the morning before surgery.All the patients underwent ultrasound examination of the gastric sinus at 7: 30 on the operation day (2 h after oral carbohydrate, T 1) to determine the nature of gastric contents according to the qualitative analysis of images, and Perlas grade was performed, and the cross-sectional area (CSA) of the gastric sinus in a semi-sitting position and right lateral decubitus position was calculated, and gastric volume (GV) and gastric volume to weight ratio (GV/W) were calculated.For solids in the stomach or GV > 1.5 ml/kg was defined as a full stomach.Patients assessed as a full stomach at T 1 underwent antrum ultrasonography again before induction of anesthesia (at 3 h after oral carbohydrate, T 2). The occurrence of satiety at T 1 and T 2 in each group was recorded.The patient′s hunger score, thirst score, and satisfaction score during fasting were recorded at T 2.The reflux aspiration, occurrence of nausea and vomiting at 24 h after operation, postoperative time to first flatus and postoperative total length of hospital stay were recorded. Results:Compared with group C, the CSA in a semi-sitting position, CSA, GV and GV/W ratio in a right lateral decubitus position, incidence of satiety, and Perlas grade were significantly increased at T 1 ( P<0.05), no significant change was found in the incidence of satiety at T 2 ( P>0.05), preoperative hunger and thirst scores were significantly decreased, satisfaction scores were increased, the incidence of nausea and vomiting was decreased at 24 h after surgery, and the postoperative time to first flatus was shortened ( P<0.05), and no significant change in the postoperative total length of hospital stay was found in group P ( P>0.05). Conclusions:Oral carbohydrates before laparoscopic cholecystectomy may result in delayed gastric emptying in the patients with cholelithiasis, and the time window for oral carbohydrates can be appropriately shifted forward (3 h before surgery).