Preoperative Oral Administration Research Articles

The Effect of Preoperative Oral Glucose Administration on Blood Glucose Levels in Diabetes Mellitus Patients in General Anesthesia Surgery

Background The administration of general anesthesia during surgery can trigger the body’s stress response causing changes in regular metabolic patterns that result in hyperglycemia and ketosis. The goal of this study is to investigate how preoperative oral glucose and non-glucose administration affect patients with diabetes mellitus with blood glucose levels during surgery under general anesthesia. Methods This is a single-blind, randomized controlled trial (RCT) being carried out by the Central Surgical Installation and postoperative recovery area at Haji Adam Malik General Hospital Medan. The study sample consists of 38 patients with diabetes mellitus who underwent electively scheduled laparotomies under general anesthesia and met inclusion/exclusion criteria. For treatment group participants, mineral water containing 50 grams of glucose was administered with 400 cc. Research hypotheses were assessed using the t-test, and significant findings had p-values equal to or less than 0.05 within a confidence interval of 95%. Results The study sample had a mean age of 50.1 ± 12.73 and showed a significant effect between glucose levels before (178.47) and after (163.78) administration of maltodextrin, with a P value (0.001). No side effects were observed during or after the post-operative evaluation process conducted in this study's participants. Conclusions Patients with diabetes mellitus experience a preoperative oral glucose-induced impact on blood glucose levels.

Effect of Preoperative Oral Carbohydrate Intake on Perioperative Hyperglycemia in Indian Patients Undergoing Hip Fracture Fixation.

Preoperative fasting leads to a catabolic state aggravated by surgical stress. This leads to poor patient outcomes. This study aimed to determine the effect of preoperative oral carbohydrate administration on perioperative hyperglycemia and patient comfort. This prospective, randomized study was conducted on 60 adult American Society of Anesthesiologist I/II patients undergoing hip fracture fixation after obtaining institutional ethical committee clearance. Patients were randomly kept conventionally fasted before surgery (group F, n = 30) or were given oral carbohydrate 2 h before surgery (group C, n = 30). Under all aseptic precautions, a combined spinal epidural block was administered, and surgery was allowed. The primary outcome was blood glucose, and secondary outcomes included incidence of postoperative hyperglycemia, insulin level, blood urea, hunger, thirst, and anxiety. Blood glucose levels were not statistically different between the two groups at baseline (T0; P=0.400), immediately after surgery (T1; P=0.399) and 24h after surgery (T2; P=0.619). The incidence of postoperative hyperglycemia was significantly higher in group F than in group C (P=0.045) at T2. Insulin levels, blood urea levels, and hunger scores were also not statistically different between the groups. The thirst and anxiety scores were lower at T0 and T1 in group C. Preoperative oral carbohydrate administration does not prevent perioperative increases in blood glucose levels. However, it reduces the incidence of perioperative hyperglycemia and decreases perioperative thirst and anxiety, thereby improving the quality of perioperative patient care.

Effect of preoperative oral medication of Diclofenac sodium, Ibuprofen and Etoricoxib on the effectiveness of maxillary infiltration anaesthesia in patients with irreversible pulpitis: A Randomized Clinical Study

Introduction Preoperative pain of endodontic origin, has its effect on the patient‘s attitude towards the endodontic treatment. Dental anxiety associated with the above may cause ineffective anaesthesia of the tissues of interest. To assess the efficacy of preoperative oral single-dose administration of three non-steroidal anti-inflammatory drugs namely, Diclofenac sodium 50 mg, Ibuprofen 200 mg and Etoricoxib 60 mg and on the effectiveness of infiltration anaesthesia in patients with irreversible pulpitis of maxillary first molars. Material and Methods Sixty (n=60) patients with a chief complaint of moderate to severe pain of endodontic origin participated in the study. Patients were asked to indicate their pain scores on a visual analog scale (VAS) and then they were divided into three groups of n=20. Then according to their groups, the patients received a single dose of Diclofenac sodium 50 mg, Ibuprofen 200 mg and Etoricoxib 60 mg one hour before administration of the infiltration anaesthesia with 2% lignocaine containing 1:80,000 epinephrine. The patients indicated their pain score on VAS after one hour of drug administration and again after completion of the access opening. Differences in the pain scores at these three intervals were noted. Data was collected and analyzed using SPSS v.20 software and subjected to descriptive statistics, one-sample t-test and one-way ANOVA test with the acceptance level of significance set at p<0.05. Results Diclofenac sodium 50 mg, Ibuprofen 200 mg and Etoricoxib 60 mg had shown a gradual decrease in mean pain scores after the completion of access opening, which was statistically significant (p<0.05). Etoricoxib 60 mg (p=0.01) showed lower mean pain scores compared to Diclofenac sodium 50 mg and Ibuprofen 200 mg. Conclusion Within the limitations of the present study, Etoricoxib significantly lower mean pain scores when compared with the other two groups. Key Words Drug efficacy, Non-steroidal anti-inflammatory drugs, Visual Analog

Tumor Models for Training of Fluorescence-Guided Brain Tumor Resection

BACKGROUND AND OBJECTIVES: Neurosurgical resection of brain tumors is a technically demanding task with a steep initial learning curve. Experience has been shown to improve surgical performance and increase the rates of resection. High-grade gliomas (HGG) are responsible for 65% of all primary malignant central nervous system tumors and are the commonest surgically treated brain tumor worldwide. There is increasing evidence that maximal safe surgical resection of HGG impacts on overall survival. The delineation of tumor tissue (and hence the extent of resection) is improved by the use of intraoperative tumor fluorescence, which is achieved by preoperative oral administration of 5-aminolevulinic acid. This however relies on the surgeon developing a skillset of operating under different light conditions for which specific training and experience are required. METHODS: We propose a novel, affordable, and highly adaptable model for recreating these surgical conditions and thus simulate fluorescence-guided HGG resection outside the operating theater for trainee neuro-oncological surgeons. We present a model incorporating plant-based polysaccharides, doped with protoporphyrin IX (PpIX), into cadaveric brains of animals. RESULTS: We show that the concentrations of polymer and PpIX can be titrated (using previously published data) to produce mechanical and fluorescence properties that model tumor tissue. We validate the simulation in a neurosurgical skills laboratory. Furthermore, we used a mini spectrometer with handheld probe to collect fluorescence signals and validate the spectroscopic signal from the PpIX. CONCLUSION: It is hoped that this model system will be useful in neurosurgical teaching and training courses and to neurosurgeons who want to try out new techniques or equipment in anatomy laboratories.

Preoperative oral antibiotic administration in patients undergoing curative resection with stoma creation for colorectal cancer: effectiveness in preventing surgical site infection and the possibility of peristomal candidiasis induced by enterobacterial alteration.

There are many reports that preoperative oral antibiotics (OAs) are effective in preventing surgical site infections (SSIs) in colorectal surgery. However, there is no consensus on the optimal dose of OAs. In this study, we investigated the efficacy of OAs in preventing SSIs and the possibility that OAs induce enterobacterial alteration in the intestinal tract. We performed a retrospective cross-sectional analysis of 389 patients who underwent R0 resection and stoma creation for colorectal cancer in our department between 2009 and 2020. We focused on the incidence of peristomal candidiasis (PSC) as an indicator of enterobacterial alteration and used kanamycin (KM) and metronidazole (MNZ) as the OAs. A low-dose group received 1000 mg/day of both KM and MNZ, and a high-dose group received 2000 mg/day of both KM and MNZ. SSI occurred in 60 of the 389 cases (15.4%). Regardless of stoma type, SSI was significantly more common in the non-OA group, while PSC was significantly less common. When examined by OA dose, the incidence of SSI was not significantly different between the low-dose and high-dose groups. However, PSC was significantly more common in the high-dose group than in the non-OA and low-dose groups. Analysis of bacterial and fungal levels in stool samples showed that bacterial levels after OAs were significantly lower than before OAs, while fungal levels increased. OAs significantly reduce SSI in colorectal cancer surgery. However, excess OAs were significantly associated with the occurrence of PSC without contributing to further reduction in SSI.

The Effect of Computer Tablets on the Need for Medical Anxiolysis in Children in an Ambulatory Surgical Center.

Background Preoperative anxiety is common in children undergoing surgery. When anxiety is identified or suspected, there are several strategies typically used to manage it. Perhaps the most common is anxiolytic premedication or parental presence at induction. Medications such as midazolam have been associated with adverse effects, such as a slower wakeup, and require timing of administration, while parental presence can be disturbing to the parent and divert the attention of the operating room team. A more recent option is distraction via electronic tablets. The purpose of this study was to retrospectively investigate and quantify any change in the use of midazolam, the most common anxiolytic approach at our institution, and any change in the length of time in the post-anesthesia care unit (PACU) following the introduction of tablet computers to a pediatric ambulatory surgical center. Methods We conducted an IRB-approved retrospective chart review of 13,790 pediatric patients ages one to 18 undergoing outpatient elective surgeries at the University of Florida (UF) Children's Surgical Center over a five-year period. A univariate analysis was conducted using the Fisher's Exact test and interrupted time series analysis to determine differences between midazolam administration and PACU times, with interruption occurring at tablet implementation. A multivariable analysis and sensitivity analyses were performed to confirm the findings of the univariate analysis. Results On univariate analysis, tablet availability was associated with both a decreased preoperative oral midazolam administration (odds ratio (OR) 0.158, 95% confidence interval (CI): 0.140 to 0.179, P-value <0.001) and a decreased PACU length of stay (-17.4 min, 95% CI: -19.6 to -15.3 min, P-value <0.001). The association with decreased preoperative midazolam administration held after multivariable analysis (adjusted OR 0.207, 95% CI: 0.154 to 0.278, P-value <0.001), but PACU length of stay was not statistically significant (-9.1 min, 95% CI: -20.6 to 2.4, P-value = 0.12). These results were confirmed on sensitivity analysis, with tablet availability continuing to be associated with decreased preoperative oral midazolam administration but not with reduced PACU length of stay. Conclusion Our results demonstrate that computer tablets were associated with a significant decrease in the frequency of midazolam administration and consequently may reduce preoperative pediatric anxiety.We did not find an associated change in PACU length of stay following the introduction of tablets. Tablets present a unique distraction alternative to chemical anxiolysis for institutions seeking to reduce medication use in pediatric patients.

Effects of single preoperative oral pregabalin administration on postoperative hyperalgesia and opioid consumption after total abdominal hysterectomy

Background The objective of this randomized double blind study was to evaluate the effect of preoperative single oral dose of pregabalin 150 mg on pain sensitivity, postoperative hyperalgsia and opioid consumption after total abdominal hysterectomy. Purpose The aim of this study was to evaluate the effect of preoperative single oral dose of pregabalin on pain sensitivity, postoperative hyperalgsia and opioid consumption after total abdominal hysterectomy. Patients and methods Sixty female patients were randomly categorized into two equal groups (30 patients each): group I, patients received pregabalin 150 mg orally, 1 h before induction of anaesthesia. Group II, patients received a matching placebo orally, 1 h before induction of anaesthesia, then evaluation of postoperative analgesia by visual analogue scale score, postoperative hyperalgesia using von Frey filaments and opioid consumption for 24 h was carried out. Conclusion From the primary endpoints assessed in this work, one can declare that usage of pregabalin in a dose of 150 mg, was more effective in reducing hemodynamic changes, postoperative pain intensity, hyperalgesia and analgesic consumption in comparison with a placebo as pre-emptive analgesia, when neither doses caused respiratory depression or sedation or PONV, but found also to significantly increase postoperative side effects including dizziness and somnolence as a secondary endpoint assessed.

Selective Decontamination of the Digestive Tract in Pancreatic Head Resections-A Propensity Score-Matched Analysis.

(1) Background: The postoperative morbidity rate after pancreatic head resection remains high, partly due to infectious complications. The primary aim of this study was to analyze the influence of selective decontamination of the digestive tract (SDD) on the postoperative infection rate after pancreatic surgery. (2) Methods: From January 2019, the standard of care for patients undergoing pancreatic head resections at the Department for Visceral, Thoracic, and Vascular Surgery, University Hospital Dresden was the preoperative oral administration of SDD. The influence of SDD was evaluated for patients operated on between January 2019 and June 2020 in comparison to a propensity score-matched cohort, extracted from an existing database including all pancreatic resections from 2012 to 2018. The primary endpoint of the study was the shift of the bacterial load on the intraoperative bile swab test. The secondary endpoint was the association of SDD with postoperative complications. (3) Results: In total, 200 patients either with SDD (n = 100; 50%) or without SDD (non-SDD, n = 100; 50%) were analyzed. In the patient group without a preoperative biliary stent, 44% (n = 11) of the non-SDD group displayed positive bacterial results, whereas that was the case for only 21.7% (n = 10) in the SDD group (p = 0.05). Particularly, Enterobacter species (spp.) were reduced from 41.2% (n = 14) (non-SDD group) to 23.5% (n = 12) (SDD group) (p = 0.08), and Citrobacter spp. were reduced by 13.7% (p = 0.09) from the non-SDD to the SDD cohort. In patients with a preoperative biliary stent, the Gram-negative Enterobacter spp. were significantly reduced from 52.2% (n = 12) in the non-SDD group to 26.8% (n = 11) in the SDD group (p = 0.04). Similarly, Citrobacter spp. decreased by 20.6% from 30.4% (n = 7) to 9.8% (n = 4) in the non-SDD compared to the SDD group (p = 0.04). In general, deep fluid collection and abscesses occurred more frequently in the non-SDD group (36%; n = 36 vs. 27%; n = 27; p = 0.17). (4) Conclusions: Adoption of SDD before pancreatic head surgery may reduce the bacterial load in bile fluid. SDD administration does not significantly affect the postoperative infectious complication rate after pancreatic head resections.

Analgesic Efficacy of Pre-Operative Oral Pregabalin in Dacryocystorhinostomy Surgery

Background: External dacryocystorhinostomy (DCR) is still considered the golden standard for lacrimal surgery. It is a painful procedure that involves intra- and extra-ocular dissection with a high prevalence post-operative nausea and vomiting (PONV). Aims: This study was designed to evaluate the effects of preoperative oral pregabalin on postoperative pain and analgesic requirements in patients undergoing DCR surgery. Design: A prospective randomized double-blind clinical trial. Patients and methods: 100 American Society of Anesthesiologists (ASA) physical classes I and II patients in an age ranging from 18 to 65 years of either sex, had DCR surgery. Patients were divided randomly into two equal groups (each = 50). In pregabalin group, they received two capsules of pregabalin (one at the night of the surgery, the other at 2 hours before the surgery), while patients in control group received two identical placebo capsules. Hemodynamics were monitored, postoperative VAS scores, the time of first analgesic request, total pethidine requirements, and the incidence of PONV were recorded as well. Statistical analysis: A prospective analysis of the collected data was performed using the SPSS program for Windows (version 22). Results: The pregabalin group exhibited a significant lower incidence of postoperative pain, pethidine consumption and nausea, without any statistically significant differences regarding hemodynamic parameters in comparison to control group. Conclusion: Preoperative oral administration of pregabalin can be a promising modality for alleviation of postoperative pain and reduction in postoperative opioid consumption.

Efficacy of Preoperative Oral Glucose on Blood Glucose Response and Neutrophil–Lymphocyte Ratio in Patient Undergoing Brain Tumor Resection

Abstract Background: Hyperglycemia and inflammatory conditions due to surgical stress response in conventional brain tumor resection can increase the morbidity and mortality of neurosurgery patients. Enhanced recovery after surgery (ERAS) protocol has been widely used in various types of surgery, but data on the neurosurgery are still limited. The aim of this study was to analyze the role of preoperative oral glucose administration in attenuating surgical stress response in patients undergoing brain tumor resection. Materials and Methods: Thirty-four elective craniotomy brain tumor resection patients underwent a double-blind, randomized controlled trial. Patients were divided into two groups: one group that received oral carbohydrate (CHO; maltodextrin 12.5% 50 g in 400 ml water) 2 h preoperatively and a control group that only received water. Blood glucose level and neutrophil–lymphocyte ratio (NLR) were obtained preoperatively, before induction, and 6 h and 24 h postoperatively. Results: Blood glucose was better in the CHO group at 6 h (117.18 ± 16.25 mg/dl vs. 154.88 ± 28.22 mg/dl, P &lt; .001) and 24 h (118.05 ± 13.89 mg/dl vs. 153.76 ± 34.81 mg/dl, P &lt; .001) postoperatively compared to that in the control group. NLR in the CHO group showed a lower value compared to that in the control group at 6 h (8.21 ± 6.20 vs. 15.47 ± 6.76, P &lt; .001) and 24 h (9.43 ± 7.35 vs. 20.04 ± 10.99, P &lt; .001) postoperatively. Conclusion: Preoperative oral glucose administration can help reduce the stress response in brain tumor resection by maintaining blood glucose level and attenuating the increase of NLR postoperatively better than in routine preoperative fasting.

Cross‐sectional study of propofol dose during intravenous sedation for dental surgery in patients with long‐term oral benzodiazepine therapy: A secondary publication

ObjectivesThe amount of propofol required for intravenous sedation (IVS) in patients on long‐term oral benzodiazepine (BZD) therapy may be affected by drug interactions and central changes in sensitivity. However, there is no research on the effect of long‐term oral BZD use on the amount of propofol required for IVS. We aimed to clarify the difference between the total propofol dose required for IVS in patients with or without long‐term oral BZD therapy.Material and methodsAmong patients treated for 4 years, the total administered dose required for IVS with propofol alone and local anesthesia for the extraction of bilateral impacted mandibular wisdom teeth, was retrospectively compared between patients with continuous oral BZD use for ≥6 months (BZD group; n = 24) and those without such use (control group; n = 307). The aimed sedation level was the Ramsay sedation scale 3–4.ResultsThe amount of propofol required for IVS was significantly lower in the BZD group compared to the control group (4.83 ± 1.30 vs. 5.91 ± 1.25 mg/kg/h, p < .001; 95% confidence interval, −1.22 to −0.94 mg/kg/h; Cohen's d, 0.84). The required propofol dose was not influenced by preoperative oral BZD administration on the day of extraction (presence [n = 13] vs. absence [n = 11]: 4.9 ± 1.3 vs. 4.8 ± 1.7 mg/kg/h, p = .83). Long‐term oral BZD therapy remained a significant factor for a lower required propofol dose after adjusting for age with multiple linear regression analysis. The underlying mechanism cannot be an additive action process but might pertain to competitive inhibition via an enzyme involved in glucuronate conjugation or competitive albumin binding.ConclusionsClinicians should understand that patients on long‐term oral BZDs therapy might require less propofol for IVS than those not on BZDs, irrespective of whether BZDs were taken preoperatively on the day of surgery.

Effects of tizanidine premedication on the duration of perioperative maintenance dose of vecuronium bromide

Aim. The aim of this study was to evaluate the effects of preoperative administration of tizanidine on the maintenance dose duration of the nondepolarizing muscle relaxant, i.e. vecuronium bromide.Material and Methods. This prospective clinical study was conducted in 30 adult male patients scheduled for elective inguinal hernia surgery. Patients were categorised into two randomised groups based on the premedication use. Group 1 included patients (n = 15) who received oral diazepam (Diazem) in the evening prior to the surgery, as well as meperidine (Dolantin) 1 mg/kg-1 (max. 50 mg) i.m. with 50 ml water by mouth 1 hour before the procedure. Group 2 comprised patients (n = 15) who were given oral tizanidine 4 mg in the evening before the surgery, as well as oral tizanidine 4 mg with 50 ml water 1 hour prior to the operation. The following parameters were recorded in both groups: pre-operative and perioperative diastolic arterial blood pressure, systolic arterial blood pressure, mean arterial blood pressure, heart rate, respiratory rate, pre-operative vecuronium bromide maintenance doses, procedure time and postoperative score according to the Ramsay scale in 1st, 2nd and 3rd hour.Results. No significant difference was observed between the two groups with regard to the pre-operative and perioperative haemodynamic variables and the respiratory rate (P &gt; 0.05), although it was found that vecuronium maintenance dose duration was significantly higher in the tizanidine premedicated group (P = 0.015). In addition, the operative time (P = 0.128) and the postoperative patients’ Ramsay scores did not differ statistically between the two groups (P &gt; 0.05). Conclusions. The prolonged duration of vecuronium maintenance dose, the increased nondepolarizing block time, as well as haemodynamic stability preservation in patients undergoing inguinal hernia surgery following preoperative oral administration of tizanidine support the view that tizanidine can be used as an effective and safe myotonolytic premedication agent.

The effect of oral glucose administration before surgery based on Enhanced Recovery After Surgery (ERAS) protocol on preventing insulin resistance and patient's quality of life

Introduction Preoperative oral glucose administration is part of the ERAS protocol, which is still not implemented worldwide. This study aims to determine the effect of preoperative oral glucose administration based on the ERAS protocol on the patient's quality of life and insulin resistance. Method This study is a quantitative quasi-experimental study (post-test with control group) involving patients undergoing surgery using general anesthesia at dr. Zainoel Abidin Banda Aceh from January 2021 to April 2021. The intervention was carried out on patients who were about to undergo surgery divided into two groups: the group receiving and the group not receiving 50 grams of oral glucose 2 hours before surgery according to the ERAS protocol. The data obtained were processed using Chi Square statistical test, Mann- Whitney, and unpaired T-test to assess patients' quality of life and insulin resistance. Result A total of 48 patients (24 treatment group and 24 control group patients) were involved in the study. There were significant mean differences in all quality of life indicators between the group receiving and the group not receiving oral glucose with a significance value of p&lt;0.05. There is a relationship between oral glucose administration and prevention of insulin resistance with a significance value of p&lt;0.05. Conclusion: There is a relationship between preoperative oral glucose administration on quality of life and postoperative insulin resistance according to the ERAS protocol.

ANALGESIC EFFECT OF PRE-EMPTIVE ORAL NSAIDS ON POST-ENDODONTIC PAIN LEVELS IN SINGLE VISIT ENDODONTICS -A SYSTEMATIC REVIEW

Background: Pre-emptive analgesia is an anti-nociceptive treatment which reduces the postoperative pain by preventing the processing of altered afferent input. As most of the patients present with pain preoperatively have higher levels of released local inflammatory mediators. Thus, pretreatment analgesia decreases the establishment of central sensitization, a mechanism by which spinal neurons increase their response to peripheral nociceptive impulse. Objective: This systematic review aims to compare and evaluate the postoperative pain levels and analgesic intake on preoperative oral administration of NSAIDs in single visit root canal treatment. Data Sources: The present review was done according to PRISMA guidelines and was registered in the PROSPERO (Centre for Reviews and Dissemination University of York; http://www.crd.york.ac.uk/PROSPERO). Registration number - CRD42020195775. The research question was formulated based on the PICO strategy. A comprehensive electronic literature search was conducted across PubMed/Medline, Scopus and Cochrane Database independently by two reviewers. Study Eligibility Criteria: Articles published from January 1990 to May 2019 that focused on preemptive strategies in single visit root canal treatment were included in the present review. Based on specified inclusion and exclusion criteria’s, the selected articles were subjected to quality assessment, and the risk of bias was evaluated. Methods: A total of 6 articles were included, out of which three were hand searched. The overall risk of bias of included studies was moderate, and the study limitations were high. Results: Among the studies included, Ibuprofen was considered as the best drug of choice in single visit endodontics. Limitations: The present review was assessing only the effectiveness of NSAIDs in single visit root canal treatment. But ideally comprehensive literature should search on effectiveness in both single and multiple visit root canal treatments. Conclusion: The present systematic review concluded that ibuprofen was considered to be an effective drug in single visit root canal treatment.

Effects of preoperative oral carbohydrate administration combined with postoperative early oral intake in elderly patients undergoing hepatectomy with acute-phase inflammation and subjective symptom burden: A prospective randomized controlled study

BackgroundEnhanced recovery after surgery (ERAS) has received increasing attention. Preoperative oral carbohydrate and postoperative early oral feeding (POC-PEOF) as the basic nutrition administration in the ERAS program suffers from low adherence. The role and benefits of administering POC-PEOF in elderly patients with hepatocellular carcinoma (HCC) are unclear. Therefore, the randomized controlled trial evaluated the effects of POC-PEOF in elderly patients with HCC undergoing hepatectomy with inflammation and patient self-reported symptom burden compared with the corresponding outcomes of traditional fasting protocols. MethodsElderly patients with HCC (n = 126) were randomly assigned to two groups using the sealed envelope technique. Sixty-three patients were included in the intervention (POC-PEOF) group and received POC-PEOF administration, whereas the 63 patients in the control (FAST) group underwent conventional fasting. Acute-phase inflammation markers, patient self-reported symptom burdens, and postoperative outcomes were compared between the two groups. ResultsThe average age was 69.60 ± 5.00 years in the POC-PEOF group and 70.44 ± 6.15 years in the FAST group. Compared to prolonged fasting, POC-PEOF achieved significant positive results, including lower overall levels of inflammatory response mediators (CRP, IL-6) on postoperative day (POD) 1, POD 3, and POD 5 (P < 0.05), lower patient self-reported symptom burdens of thirst, hunger, anxiety and nausea (P < 0.05), faster gastrointestinal function return with shortened times to first flatus and first defecation (48.31 ± 13.24 h vs. 96.26 ± 23.12 h and 72.87 ± 21.12 h vs. 144.34 ± 23.31 h, and P = 0.034 and P = 0.013, respectively). Furthermore, the average postoperative hospitalization duration in the POC-PEOF group was shorter than that in the FAST group (6.93 ± 0.98 d vs. 8.12 ± 1.15 d, P = 0.042). There was no significant difference of total complications between the groups (25.39 % vs 36.51 %, RR 0.696, 95 % CI 0.408–0.187, P = 0.177). ConclusionPOC-PEOF helps lessen acute-phase inflammation and relieves the subjective symptom burden, which can ensure better positive postoperative outcomes in elderly HCC patients undergoing hepatectomy.

Preoperative Oral Administration of Yunnan Baiyao and Its Effect on Coagulation Parameters in Tick-Borne Disease and/or Heartworm Seropositive Dogs: A Pilot Study

The overall goal of this clinically focused pilot study was to investigate the preoperative benefit of oral administration of Yunnan Baiyao (YB) to Ehrlichia. canis, Anaplasma platys and/or heartworm seropositive canines. A total of 12 clinically normal dogs undergoing sterilization procedures were randomly subdivided into Control/Placebo Group (n=6) or Treatment Group (n=6). Each patient received three oral doses of YB (0.5g/5kg) or placebo every twelve hours with the last dose given the evening before surgery. Citrated blood measurements for prothrombin time (PT), activated partial thromboplastin time (aPTT), and fibrinogen were obtained before the first YB dose and after the third dose. Intraoperative blood loss was estimated by blood-soaked gauze sponge counts. The study found the Control Group’s mean aPTT increased by 3.8% while the Treatment Group’s decreased by 0.42%. PT values were slightly decreased in both groups. Fibrinogen decreased in controls (9.7%) but had a modest increase in treated dogs (12.4%). Intraoperative blood loss was increased in controls (3%) compared to the Treatment Group (mean±SD: 6.6±6.8 vs. 6.4±3.6, respectively). Findings from the study which suggest preoperative benefits from YB administration to seropositive dogs include stabilizing aPTT and fibrinogen values along with reduced intraoperative blood loss in YB treated dogs. Although these modest findings were not statistically significant in this small study, the biological trends suggest potential benefits of preoperative administration of YB before routine elective surgeries in seropositive patients and support a clinical trial with larger sample size.

Effect of Preoperative Oral Carbohydrate Administration on Patients Undergoing Cesarean Section with Epidural Anesthesia: A Pilot Study

PurposeThe aim of this study was to evaluate the effect of preoperative oral carbohydrate administration on patients undergoing Cesarean section with epidural anesthesia. DesignRandomized controlled clinical study. MethodsA total of 75 patients undergoing Cesarean section (American Society of Anesthesiologists physical status grade I-II) were randomized to preparation with a carbohydrate drink (CHO group), flavored water (placebo group), or to the fasting group. The CHO and placebo groups were double-blinded and given 300 mL of the drink 2 hours before surgery. Visual analog scores of the patient were assessed to evaluate thirst, hunger, and anxiety level, and the gastric antral cross-sectional areas were recorded by ultrasonography during the operative period. Insulin resistance was calculated on the basis of the blood glucose and insulin levels assessed before administration and after surgery. FindingsThe CHO and placebo groups did not show an increase in gastric fluid volumes in terms of gastric antral cross-sectional area, and there were no adverse events. The visual analog scale scores at preoperative baseline were not different between groups . During the preoperative waiting period, preparation with CHO reduced not only thirst and anxiety more efficiently than water (placebo) but also hunger (P < .05), whereas water did not. No difference was observed in insulin resistance between groups before intake of the drink. Compared with the preoperative levels, insulin resistance showed a statistically significant increase in all groups (P < .05); however, the increase was significantly higher in the fasting and placebo groups than in the CHO group (P < .05). ConclusionsPreoperative administration of CHO decreases postoperative insulin resistance and enhances pregnant women's comfort, leading to a reduced sense of thirst, hunger, and anxiety during the preoperative period for Cesarean section.

Effect of preoperative oral administration of steroids in comparison to an anti-inflammatory drug on postoperative pain following single-visit root canal treatment - a double-blind, randomized clinical trial.

This randomized, double-blinded, clinical trial evaluated the effect of oral premedication of piroxicam, prednisolone, dexamethasone or placebo on postoperative pain after single-visit root canal treatment in teeth with symptomatic irreversible pulpitis and symptomatic apical periodontitis. The trial is reported according to the Preferred Reporting Items for RAndomized Trials in Endodontics (PRIRATE) 2020 guidelines. The protocol was registered at the clinical trial registry (India) (CTRI/2019/06/019818). In total, 160 patients, assigned to four groups, received orally either 20mg piroxicam, 20mg prednisolone, 4mg dexamethasone or a placebo 60min before root canal treatment. Patients recorded their postoperative pain intensity at 6, 12, 24, 48 and 72h using a 10-cm visual analogue scale. Intergroup comparison was performed using Kruskal-Wallis tests with post hoc analysis using Dunns test. Incidence of pain was analysed using chi-square tests. A P value<0.05 was considered to be statistically significant. Binary logistic regression was used to determine the odds of postoperative pain, with incidence of pain as the dependent variable and intervention groups, gender, age and type of tooth as independent variables. In total, 156 patients were analysed in the trial, since four patients dropped out during follow-up. All drugs were associated with a significantly lower incidence of postoperative pain compared to the placebo at 6h (P=0.009), 12h (P=0.003) and 24h (P=0.008). Mean intensity of pain was significantly more intense at 6, 12 and 24h with the use of placebo in comparison to the other three intervention groups (P<0.05). Intensity of pain was not significantly different between the premedications used (P>0.05). One patient in the piroxicam group reported gastritis, whereas no adverse effects were recorded in other groups. Preoperative oral administration of a single dose of 4mg dexamethasone, 20mg piroxicam or 20mg prednisolone reduced the incidence and severity of postoperative pain following single-visit root canal treatment compared to a placebo in patients with symptomatic irreversible pulpitis and symptomatic apical periodontitis up to 24h. The odds of postoperative pain at 24h for patients premedicated with 4mg dexamethasone or 20mg piroxicam or 20mg prednisolone were 5.3 times, 3.4 times and 2.5 times less compared to the placebo, respectively.

Science, Medicine, and the Anesthesiologist

Science, Medicine, and the Anesthesiologist

Outcome of Preoperative Administration of Oral Ambrisentan on Pulmonary Hypertension After Cardiac Surgery for VSD

Background: There is significant difference between the survival of patient with and without post-operative pulmonary arterial hypertension (PAH). This study was designed to see the early post-operative outcomes of PAH after preoperative oral administration of ambrisentan.&#x0D; Objective: Evaluation of role of preoperative oral ambrisentan for the management of PAH following cardiac surgery for ventricular septal defect (VSD) with moderate to severe PAH.&#x0D; Materials and Methods: A total of 54 patients were stratified into two equal groups (n=27) depeding upon receiving of orala mbisentan. Ambrisentan group received dose of 2.5mg and 5mg in two divided doses for weight &lt;20kg and &gt; 20 kg respectively at least two weeks before surgery.&#x0D; Results: PASP was measured peroperatively before establishment of CPB, immediately after VSD closure and after weaning from CPB which were 59.55±11.16 mm of Hg, 45.49±9.46 mm of Hg and 40.49 ±10.33 mm of Hg respectively in the ambrisentan group (Group-A) and was 71.92 ±10.62 mm of Hg, 66.34±10.22 mm of Hg and 62.14 ±9.46 mm of Hg respectively in the control group (Group-B) with a p value of 0.002, 0.001 and 0.001 respectively. Considering PASP on echocardiogram at 7th post-operative day was 33.55 ± 1.23 in ambrisentan group and 41.70 ± 5.60 in control group. At one month PASP on echocardiogram was 30.55±2.26 in ambrisentan group and 39.11 ±3.28 in control group.&#x0D; Conclusion: Preoperative oral administration of ambrisentan is more effective in control of postoperative PAH and may be advised in every patients with VSD with moderate to severe PAH.&#x0D; KYAMC Journal Vol. 11, No.-1, April 2020, Page 36-41