Postoperative blood pressure changes associated with cervical block versus general anesthesia following carotid endarterectomy.

The purpose of this report was to determine if cervical block anesthesia (CBA) was associated with fewer hypertensive and hypotensive episodes and decreased need for ICU monitoring following carotid endarterectomy, compared with general anesthesia (GA). A retrospective review of carotid endarterectomies performed using GA (n = 118) versus CBA (n = 116) was carried out and perioperative blood pressure changes and morbidity and mortality rates were analyzed. With increasing emphasis in today's health care market concerning cost containment without sacrificing safety, our results suggest that CBA should be considered preferable to GA for patients undergoing carotid endarterectomy. Fewer significant postoperative hemodynamic changes occurred and costly intensive care monitoring may be avoided.

Early postoperative feeding after elective colorectal surgery.

BACKGROUND: Several investigators have demonstrated that routine nasogastric decompression after abdominal surgery is unnecessary and can be safely eliminated, and 1 recent study demonstrated the safety of early oral feedings. OBJECTIVE: To test the hypothesis that successful early feeding would lead to a shorter duration of hospitalization and, therefore, would be more cost-effective. PATIENTS: Fifty-eight patients with elective colorectal surgery. METHODS: Patients were prospectively randomized to 1 of 2 postoperative treatment arms: early feeding (EF group, n = 29) and traditional feeding (TF group, n = 29). All patients in the EF group began a liquid diet on the first postoperative day and were advanced to a regular diet when they consumed 1000 mL in 24 hours. All patients in the TF group began a liquid diet after resolution of the postoperative ileus and were advanced to a regular diet after consuming 1000 mL in 24 hours. Patients were dismissed after tolerating two thirds of the regular diet. Both groups had intraoperative orogastric tubes that were removed at the end of surgery. Nasogastric tubes were inserted for persistent postoperative vomiting. RESULTS: No significant differences were noted in age, types of procedures, or in prior abdominal surgery in either group. No significant differences were seen in rates of nausea (55% in EF vs 50% in TF group) or vomiting (48% in EF vs 33% in TF group). One patient in the EF group had aspiration pneumonia, and anastomotic leak resulted in sepsis and eventual death of 1 patient in the TF group. No significant difference was observed in length of hospital stay between the 2 groups (mean +/- SD, 7.2 +/- 3.3 days in EF vs 8.1 +/- 2.3 days in TF group). CONCLUSIONS: Early oral feeding after elective colorectal surgery is safe. Most of the patients tolerated EF; however, there was no significant difference in duration of hospitalization in these patients.