ABSTRACT
La prehabilitación tiene una concepción multimodal con tres pilares fundamentales: mejora en la condición física del paciente, optimización nutricional e intervención cognitiva para reducir el estrés y la ansiedad, además de otras medidas como la deshabituación tabáquica o la corrección de la anemia. El objetivo principal es la optimización del paciente durante el periodo de tiempo preoperatorio (diagnóstico-intervención) con la finalidad de mejorar la capacidad funcional y disminuir las complicaciones derivadas de la cirugía. Al igual que ocurre con los protocolos de rehabilitación multimodal, las acciones de los programas de prehabilitación tienen efectos sinérgicos, es decir, pequeños cambios que por sí solos no tienen transcendencia clínica pero que al sumarse producen una mejoría significativa en la evolución postoperatoria de los pacientes. Aunque se requieren más estudios que evalúen el impacto concreto de estos programas en poblaciones de pacientes con diversas patologías, intervenciones y distintos factores de riesgo, se hace necesaria su implementación progresiva en la práctica clínica habitual de nuestros pacientes. El objetivo de esta revisión narrativa es evaluar la literatura disponible sobre la prehabilitación en cirugía, haciendo especial hincapié en las estrategias actualmente establecidas, así como en las lagunas de conocimiento actuales y futuros focos de investigación
Prehabilitation has a multimodal conception based on three fundamental pillars: improvement of the patient's physical condition, nutritional optimization and cognitive intervention to reduce stress and anxiety, as well as other measures such as smoking cessation and correction of anemia. The aim of prehabilitation programs is to optimize the patient from the moment of diagnosis until the surgical intervention in order to reduce postoperative complications. As in the case of multimodal rehabilitation protocols, the actions of prehabilitation programs have synergistic effects, that is, small changes that, by themselves, do not have clinical significance but when added up, they produce a significant improvement in the postoperative evolution of patients. Although more studies are required to evaluate the impact of these programs on patients groups with different pathologies, interventions and risk factors, their progressive implementation is necessary in the daily clinical practice of our patients. The objective of this narrative review is to evaluate the available evidence about prehabilitation in surgery, focusing on current established strategies, knowledge gaps and future research
Subject(s)
Humans , Postoperative Complications/prevention & control , Anemia/therapy , Anxiety/prevention & control , Body Composition , Exercise , Medication Reconciliation , Mindfulness , Nutritional Status , Physical Conditioning, Human , Psychological Tests , Smoking Cessation , Stress, Physiological/physiologyABSTRACT
Prehabilitation has a multimodal conception based on three fundamental pillars: improvement of the patient's physical condition, nutritional optimization and cognitive intervention to reduce stress and anxiety, as well as other measures such as smoking cessation and correction of anemia. The aim of prehabilitation programs is to optimize the patient from the moment of diagnosis until the surgical intervention in order to reduce postoperative complications. As in the case of multimodal rehabilitation protocols, the actions of prehabilitation programs have synergistic effects, that is, small changes that, by themselves, do not have clinical significance but when added up, they produce a significant improvement in the postoperative evolution of patients. Although more studies are required to evaluate the impact of these programs on patients groups with different pathologies, interventions and risk factors, their progressive implementation is necessary in the daily clinical practice of our patients. The objective of this narrative review is to evaluate the available evidence about prehabilitation in surgery, focusing on current established strategies, knowledge gaps and future research.
Subject(s)
Enhanced Recovery After Surgery , Postoperative Complications/prevention & control , Preoperative Exercise/physiology , Anemia/therapy , Anxiety/prevention & control , Body Composition , Cardiorespiratory Fitness/physiology , Exercise , Humans , Medication Reconciliation , Mindfulness , Nutritional Status , Physical Conditioning, Human , Physical Functional Performance , Psychological Tests , Smoking Cessation , Stress, Physiological/physiology , Walk TestABSTRACT
In 1954, McKittrick and Wheelock described for the first time a syndrome presenting chronic lost of fluid and electrolytes secondary to chronic diarrhea, associated to large rectal villous adenomas. We report a case of a 75-year-old female who presented chronic diarrhea (3 to 4 depositions per day in the last year), accompanied by acute renal failure. In the rectal tact, we objective the presence of a mass of soft consistency with an irregular surface, occupying approximately two thirds of the circumference, at about 3 cm from the anal margin. It was confirmed by the colonoscopy and the patology was informed as villous adenoma, producing chronic diarrhea or McKittrick-Wheelock syndrome. We decide the surgical approach after the normalization of patient's general status and a proctectomy with coloanal anastomosis was performed. We conclude that we must think about this syndrome in aged patients with chronic diarrhea, alterations of the electrolyte balance and presence of renal failure. Surgery treatment after the replacement of water and electrolytes is the unique curative treatment. The absence of this can cause the death of these patients.
