ABSTRACT
Backgrounds/Aims: Optimal intravenous fluid management during the perioperative period for patients undergoing pancreaticoduodenectomy (PD) within the framework of enhanced recovery after surgery (ERAS) is unclear. Studies have indicated that excessive total body salt and water can contribute to the development of oedema, leading to increased morbidity and extended hospital stays. This study aimed to assess the effects of an intravenous therapy regimen during postoperative day (POD) 0 to 2 in PD patients within ERAS. Methods: A retrospective interventional cohort study was conducted, and it involved all PD patients before and after implementation of ERAS (2009-2017). In the ERAS group, a targeted maintenance fluid regimen of 20 mL/kg/day with a sodium requirement of 0.5 mmoL/kg/day was administered. Outcome measures included the mmol of sodium and chloride administered, length of stay, and morbidity (postoperative pancreatic fistula, POPF; acute kidney injury, AKI; ileus). Results: The study included 169 patients, with a mean age of 64 ± 11.3 years. Following implementation of the intravenous fluid therapy protocol, there was a significant reduction in chloride and sodium loading. However, in the multivariable analysis, chloride administered (mmoL/kg) did not independently influence the length of stay; or rates of POPF, ileus, or AKI (p > 0.05). Conclusions: The findings suggested that a postoperative intravenous fluid therapy regimen did not significantly impact morbidity. Notably, there was a trend towards reduced length of stay within an increasingly comorbid patient cohort. This targeted fluid regimen appears to be safe for PD patients within the ERAS program. Further prospective research is needed to explore this area.
ABSTRACT
BACKGROUND: Patient-controlled analgesia is used for both labor and postoperative analgesia. OBJECTIVES: This study aimed to assess user satisfaction and functionality of two ambulatory, electronic patient controlled analgesia devices, the GemStar pump Hospira Inc., Illinois, USA) and the ambIT Ambulatory Infusion Therapy pump (Sorenson Medical Products, Utah, USA). PATIENTS AND METHODS: It was a randomized clinical trial of laboring women and postoperative gynecology patients receiving patient-controlled epidural analgesia. Patients were randomized to use one of the pumps and both anesthesiologists and patients completed questionnaires about aspects of pump function, and rated their satisfaction with the equipment. Midwives and high-dependency unit nurses also evaluated the pumps in each clinical setting. RESULTS: Forty patients, 20 laboring women and 20 postoperative patients were randomized and completed the study. The pumps were compared by nine anesthesiologists. Patient and staff satisfaction with both devices was high. Patient satisfaction did not significantly differ between groups (median 10 [8, 10] for the GemStar and 10 [9, 10] for the ambIT, P = 0.525]. The median staff satisfaction score was 8 [6, 8] for the GemStar and 7 [5, 8] for the ambIT (P = 0.154). Both patient cohorts rated each pump highly for most aspects of clinical function. Staff rated the ambIT pump more favourably with respect to portability and storage at the bedside whilst the GemStar had better assessments with respect to its consumables and interactions involving the electronic interface. CONCLUSIONS: Both devices were well-rated by patients and staff, with no significant difference between them for overall satisfaction, and only minor differences with respect to their respective strengths and weaknesses.
