ABSTRACT
BACKGROUND: The need to preserve operating room (OR) scheduling flexibility can challenge adherence to the 2-h pre-operative fasting period recommendation before elective surgery. Our primary objective was to assess the feasibility of a pre-operative carbohydrate (CHO) drink delivery strategy preserving OR scheduling flexibility. METHODS: During the 1st study phase, patients admitted for elective surgery fasted overnight (Control group); during the 2nd phase, patients fasted overnight and received a pre-operative CHO drink (CHO group). CHO delivery time was set to allow any patient to be ready for surgery 30 min ahead of the scheduled time and any patient with an operation scheduled in the afternoon to be ready at 13:00 hours; patients admitted the morning of an early morning operation would not be allowed to take a CHO drink. RESULTS: We included 194 patients in the Control group and 199 in the CHO group. In the CHO group, the morning CHO dose was delivered to 66.3% of the patients (95% CI 59.3-72.9%), with a median pre-operative fasting time period of 4 h 57 min. After excluding patients admitted the morning of an operation scheduled before 10:00 hours, the delivery rate was 77.2% (70.2-83.3%). Patients in the CHO group experienced significantly less pre-operative thirst (median 2 vs. 5 on a 0-10 scale, P < 0.0001) and hunger (0 vs. 2, P < 0.0001) than those in the Control group. CONCLUSION: Although preservation of OR scheduling flexibility resulted in a longer fasting time than recommended, CHO drink can be made available to a large proportion of patients with significantly reduced perioperative discomfort.
Subject(s)
Elective Surgical Procedures , Fasting , Operating Rooms , Preoperative Care , Adult , Aged , Drinking , Female , Humans , Male , Middle Aged , Personnel Staffing and Scheduling , Time FactorsABSTRACT
We report a case of entire of small bowel necrosis due to internal herniation through a mesenteric rent around the Roux-en-Y anastomosis. For prevention of internal herniation around the Roux-en-Y limb, secure closing of the mesenteric is recommended. Nevertheless, the consequences of a mesenteric closing defect are rarely reported. Necrosis of the entire small has never been described yet.
Subject(s)
Hernia/etiology , Mesentery/pathology , Mesentery/surgery , Postoperative Complications , Anastomosis, Roux-en-Y/adverse effects , Humans , Intestine, Small/pathology , Male , Middle Aged , Necrosis/etiologyABSTRACT
We report a case of colonic perforation revealing Ehlers -Danlos syndrome type IV in a male adult. This syndrome is a heritable disorder of collagen synthesis. Its prognosis is severe resulting in vascular rupture or bowel perforation. In his surgical strategy, the surgeon has to cope with the recurrent feature of the colonic perforation. In order to prevent other perforations, a therapeutic scheme has been set up according to literature.