ABSTRACT
INTRODUCTION: The implementation of enhanced recovery programmes (ERPs) in colorectal surgery has seen improvements in the length of inpatient stay with no increase in complications. We investigated the role of ERP in radical cystectomy at our institution. METHODS: Prospective data were collected from 26 consecutive patients prior to the introduction of the ERP and 51 patients who underwent open radical cystectomy within an ERP. Individuals in the ERP cohort did not receive bowel preparation or nasogastric drainage but received preoperative carbohydrate drinks, perioperative epidural analgesia and immediate mobilisation on day 1. Primary outcome measures included duration of intensive care unit (ICU) stay and length of hospital stay. Secondary outcome measures included the time to the passage of flatus and faeces, and time to mobilisation. Other measures that were analysed included operation time and complications. RESULTS: Baseline characteristics for both groups were similar. The median length of hospital stay fell from 11.5 days to 10.4 days and the mean ICU stay dropped from 2.4 days to 1.0 days (p=0.01). Time to removal of nasogastric tube, and time to passage of flatus and faeces were significantly shorter in the ERP group, as was the time to full oral diet. Clavien complication rates and 30-day mortality rates were similar in both groups. There were no readmissions. CONCLUSIONS: ERP in radical cystectomy is safe and not associated with any increase in complications or readmissions. It is associated with reductions in ICU stay, and could also reduce length of hospital stay and duration of postoperative ileus.
Subject(s)
Cystectomy/rehabilitation , Urinary Bladder Neoplasms/surgery , Adult , Aged , Aged, 80 and over , Critical Care , Early Ambulation , Female , Humans , Length of Stay , Male , Middle Aged , Neoplasm Recurrence, Local/etiology , Postoperative Complications/etiology , Prospective Studies , Urinary Bladder Neoplasms/rehabilitationSubject(s)
Coronary Artery Bypass/methods , Heart Arrest, Induced/methods , Insulin/administration & dosage , Cardioplegic Solutions/administration & dosage , Coronary Disease/surgery , Elective Surgical Procedures , Hemodynamics/drug effects , Humans , Sensitivity and Specificity , Treatment OutcomeABSTRACT
A series of N6,2-disubstituted adenosine analogues have been synthesized and their functional activity measured against A2a and A1 receptors. Examples of compounds with both a lipophilic N6-substituent and amino-functionalized 2-position were highly active at the A2a receptor on the human neutrophil.
Subject(s)
Adenosine/chemistry , Adenosine/pharmacology , Purinergic P1 Receptor Agonists , Adenosine/analogs & derivatives , Anti-Inflammatory Agents/chemistry , GTP-Binding Proteins , Solubility , Structure-Activity RelationshipSubject(s)
Anesthetics , Steroids , Animals , Dose-Response Relationship, Drug , Male , Mice , Sleep/drug effects , Steroids/pharmacology , Structure-Activity RelationshipABSTRACT
3alpha-Hydroxy-5alpha-pregnane-11,20-dione-[21-14C] and 3alpha,21-dihydroxy-5alpha-pregnane-11,20-dione-[21-14C] 21-acetate were prepared from a common radio-labelled intermediate, 21-diazo-3alpha-hydroxy-5alpha-pregnane-11,20-dione-[21-14C] 3-nitrate, obtained by the reaction of 17beta-chlorocarbonyl-3alpha-hydroxy-5alpha-androstan-11-one 3-nitrate with diazomethane-[14C].
