Duration Of Oral Intake Research Articles

Administration of Intravenous Dexmedetomidine and Acetaminophen for Improved Postoperative Pain Management in Primary Palatoplasty.

Suboptimal pain management after primary palatoplasty (PP) may lead to complications such as hypoxemia, and increased hospital length of stay. Opioids are the first option for postoperative acute pain control after PP; however, adverse effects include excessive sedation, respiratory depression, and death, among others. Thus, optimizing postoperative pain control using opioid-sparing techniques is critically important. This paper aims to analyze efficacy and safety of combined intravenous (IV), dexmedetomidine, and IV acetaminophen during PP. Review of a cohort of patients who underwent PP from April 2009 to July 2018 at a large free-standing children's hospital was performed, comparing patients who received combined IV dexmedetomidine and acetaminophen with those who did not receive either of the 2 medications. Efficacy was measured through opioid and nonopioid analgesic dose and timing, pain scores, duration to oral intake, and length of stay. Safety was measured by 30-day complication rates including readmission for bleeding and need for supplementary oxygen. Total postoperative acetaminophen (P = 0.01) and recovery room fentanyl (P < 0.001) requirements were significantly lower in the study group compared with the control group. Length of stay, oral intake duration, pain scores, total postoperative opioid requirements, and complications rates trended favorably in the study group, though differences did not reach statistical significance. Intraoperative IV dexmedetomidine and acetaminophen during PP provides safe and effective perioperative pain control, resulting in statistically significant decreased need for postoperative acetaminophen and fentanyl. Larger studies are necessary to determine if other trends identified in this study may be significant.

A clinical comparison of laparoscopic versus open appendectomy for the treatment of complicated appendicitis: historical cohort study

BackgroundAppendectomy is one of the most common operations. Laparoscopic appendectomy (LA) is considered first-line treatment, but the use of LA for treatment of complicated appendicitis remains controversial. Here, we performed a retrospective analysis to compare clinical outcomes between patients treated with LA and those who underwent open appendectomy (OA).MethodsData for 179 patients who underwent an operation for the treatment of complicated appendicitis at our hospital between 2011 and 2017 were retrospectively analyzed. The selection included 89 patients who underwent a conventional appendectomy and 90 patients who were treated laparoscopically. Outcome measures such as mean operative time, blood loss, time until oral intake duration of hospital stay, and postoperative complications were analyzed. Logistic regression analysis was performed to determine the concurrent effects of the examined factors on the rate of postoperative complications.ResultsThe mean ages of patients in the OA and LA groups were 50.17 ± 22.77 and 50.13 ± 25.84 year. Mean operative times were longer in the LA group than OA (10.2.56 ± 44.4 versus 85.4 ± 43.11 min; p = 0.009). The duration of hospital stay was shorter for the LA group (9.61 ± 5.57 versus 12.19 ± 8.4; p = 0.016). There were no significant differences in return to consumption of oral intake between the LA and OA groups (2.03 ± 1.66 versus 2.48 ± 2.17; p = 0.123). Multivariable analysis found that the rate of postoperative complications was significantly reduced for the LA group, in comparison with the postoperative-complication rate of the OA group (16.7% versus 27%; odds ratio 0.376; 95% CI 0.153–0.923; p = 0.0327).ConclusionsThese results suggest that LA is a safe and efficient operative procedure that provides clinically beneficial advantages in comparison with OA. Thus, when possible, appendectomy for complicated appendicitis should be attempted using a laparoscopic approach.Trial registrationRetrospectively registered.

Comparison of results of laparoscopic and open surgical techniques in adrenal masses larger than 6 cm

Aim: In this study, we aimed to compare the results of conventional and laparoscopic adrenalectomy in patients with adrenal masses greater than 6 cm.Material and Methods: Thirty-six patients with tumor size greater than 6 cm who underwent adrenalectomy between January 2011 and January 2018 were included in the study. Patients were divided into two groups as Group 1 conventional and Group 2 Laparoscopic surgery. The two groups were retrospectively compared in terms of age, sex, mass localization, mass size, duration of operation, amount of bleeding, duration of hospitalization, duration of onset of food intake, perioperative mortality, early period complications and re-admission to the hospital within 90 days. P0.05 was considered statistically significant.Results: There were 13 patients in Group 1 and 23 patients in Group 2. There was no statistically significant difference between the groups in terms of age, sex, tumor localization, tumor size, indications for operation, postoperative complications, perioperative mortality and readmission within 90 days. Duration of operation (min), amount of bleeding (ml), duration of oral intake (day) and duration of hospitalization (day) were higher in Group 1 and statistically significant.Conclusion: Laparoscopic adrenalectomy has demonstrated advantages in patients with a mass greater than 6 cm compared to conventional surgery, such as short operation duration, less blood loss, early onset of oral food intake and shorter hospital stay. It can be safely used in patients with a mass larger than 6 cm.

PS02.226: PREDICTIVE FACTORS FOR EARLY RECOVERY OF ORAL INTAKE IN PATIENTS WHO UNDERWENT CURATIVE ESOPHAGECTOMY FOR ESOPHAGEAL CANCER

Abstract Background Evaluating swallowing function by Videoendoscopic evaluation of swallowing (VE) and Videofluorography (VF) is vital in reintroducing oral diet to patients who underwent esophagectomy. However, performing VE and VF requires specific facility and experts. So, the aim of this study is to evaluate predictive factors for early recovery of oral intake. Methods One-hundred and thirty-six patients who underwent minimally invasive esophagectomy for thoracic esophageal cancer with three-field-lymph node dissection were enrolled. Patients’ characteristics, surgical and pathological factors, postoperative complications, duration from surgery to reintroducing oral intake, results of repetitive saliva swallowing test (RSST) and maximum phonation time (MPT) on seventh postoperative day (7POD) were analyzed. We classified patients that duration of reintroducing oral intake is shorter than 10 days into Normal-intake (N) group and patients that duration of oral intake is longer than 11 days into Delayed-intake (D) group. Results The average age of all patients was 64 ± 9 years old and average hospital stay of them was 30 ± 15 days. Three-field-lymph node dissection was performed in 96% of the cases and all patients have been performed cervical esophagogastrostomy. N group had significantly many patients who completed neoadjuvant chemo(radio)therapy (neo-C(R)Tx)) compared to D group (74% vs. 51%, P = 0.01). Also, patients in N group had significantly low level of preoperative indocyanine green test (ICG test; determined by colorimetric method at 15 minutes after injection of indocyanine green solution) and maximum postoperative serum C-reactive protein level until 7POD (max-CRP) compared to D group (P = 0.047, P = 0.001, respectively). Moreover, average time of MPT on 7POD was long in N group compared to D group (P = 0.05). In multivariate analysis, completion of neo-C(R)Tx, ICG ≤ 9, max-CRP ≤ 14.5 mg/dL was independent predictive factor of early recovery of oral intake (OR: 2.6 P = 0.023, OR: 4.6 P = 0.003, OR: 1.7 P = 0.008, respectively). Conclusion Preoperative good liver function, completion of neoadjuvant treatment and relatively low postoperative inflammation were considered to be predictive factors for early recovery of oral intake in patients who underwent curative esophagectomy for esophageal cancer. Disclosure All authors have declared no conflicts of interest.

Prognostic Factors of Oral Intake After Endoscopic Gastroduodenal Stent Placement for Advanced Gastric Cancer.

Gastroduodenal stents are effective for gastric outlet obstruction (GOO) due to gastric cancer. However, some patients are unable to eat again soon. We retrospectively analyzed the cause of short-feeding periods. Between 2011 and 2015, we performed stent placement in 22 patients who could not eat solids. The effects of clinical characteristics on duration of oral intake were analyzed using Cox proportional hazards models. Univariate analyses revealed that the degree of GOO [no oral intake/liquids only; hazard ratio (HR), 10.9; 95% confidence interval (CI), 2.5-48.1; P=0.003], performance status score (2 or 3/0 or 1; HR, 5.7; 95% CI, 1.8-16.9; P=0.004), and poststenting chemotherapy (no/yes; HR, 5.7; 95% CI, 1.9-18.9; P=0.002) were significant factors for cessation of oral intake. Multivariate analysis showed that GOO and chemotherapy were significant factors. Gastroduodenal stents were less effective for patients with severe stenosis or without poststenting chemotherapy.

Preoperative administration of dexamethasone reduces post-tonsillectomy morbidities in adults

AimTo investigate the efficacy of dexamethasone on the quality of life in adult tonsillectomy patients in terms of postoperative nausea, vomiting, and pain. Materials and methodsIn this study, 106 adult patients of control and study groups were injected with 2ml intravenous normal saline and dexamethasone in a dose of 0.3mg/kg (maximal dose 8mg), respectively, during the induction of anesthesia, prior to cold dissection tonsillectomy. Post-operative pain scores, incidences of nausea and vomiting, and the duration of oral intake were compared in both groups. ResultsThe overall post-operative incidences of nausea and vomiting and pain scores of 74 patients were significantly less in the study group (n=43) as compared to the control group (n=31). The study group could intake liquid and solid foods earlier than patients of the control group. ConclusionPre-operative administration of dexamethasone significantly reduces post-tonsillectomy morbidities such as nausea, vomiting, and pain with early resumption of oral intake.

Palliation of patients with malignant gastric outlet obstruction with the enteral Wallstent: outcomes from a multicenter study

Endoscopic placement of self-expandable metallic stents for palliation of patients with malignant gastric outlet obstruction is safe and feasible. Patients with malignant gastric outlet obstruction undergoing enteral stent insertion were identified from endoscopy databases. Duration of oral intake after stent insertion was calculated by using the log-rank test. Factors associated with duration of oral intake were assessed by using Cox multivariable regression analysis. A total of 176 patients (mean age 65 [14] years) treated at 4 centers from 1996 to 2003 were identified. Obstruction was caused by cancer of the pancreas in 84, the stomach in 20, the bile duct in 15, the major duodenal papilla in 8, another primary site in 16, and metastases in 33. The site of obstruction was the duodenum in 125, the distal stomach in 17, the stomach and the duodenum in 18, and surgical anastomosis in 16 patients. Stent deployment was technically successful in 173. Complications occurred in 14 patients. Seventeen patients were lost to follow-up. Of the remaining 159 patients, 133 resumed oral intake for a median time of 146 days: 95% CI [65, 202]. On regression analysis, chemotherapy after stent placement was associated with prolonged duration of oral intake (hazard ratio 0.41: 95% CI [0.23, 0.72]). After enteral stent insertion for malignant gastric outlet obstruction, 84% of patients resumed oral intake for a median time of 146 days. Chemotherapy after enteral stent insertion was independently associated with prolongation of oral intake.