American Society for Enhanced Recovery (ASER) and Perioperative Quality Initiative (POQI) joint consensus statement on perioperative fluid management within an enhanced recovery pathway for colorectal surgery

BACKGROUND: Enhanced recovery may be viewed as a comprehensive approach to improving meaningful outcomes in patients undergoing major surgery. Evidence to support enhanced recovery pathways (ERPs) is strong in patients undergoing colorectal surgery. There is some controversy about the adoption of specific elements in enhanced recovery "bundles" because the relative importance of different components of ERPs is hard to discern (a consequence of multiple simultaneous changes in clinical practice when ERPs are initiated). There is evidence that specific approaches to fluid management are better than alternatives in patients undergoing colorectal surgery; however, several specific questions remain. METHODS: In the "Perioperative Quality Initiative (POQI) Fluids" workgroup, we developed a framework broadly applicable to the perioperative management of intravenous fluid therapy in patients undergoing elective colorectal surgery within an ERP. DISCUSSION: We discussed aspects of ERPs that impact fluid management and made recommendations or suggestions on topics such as bowel preparation; preoperative oral hydration; intraoperative fluid therapy with and without devices for goal-directed fluid therapy; and type of fluid

Enhanced anaerobic biodegradation of PCBs in contaminated sediments using periodic amendment of iron.

Enhanced anaerobic biodegradation of PCBs in contaminated sediments using periodic amendment of iron

Enhanced recovery after surgery (ERAS) strategies: possible advantages also for head and neck surgery patients?

Enhanced recovery after surgery (ERAS) programs have recently been developed in order to reduce morbidity, improve recovery, and shorten hospital stays of surgical patients. Since the 1990s, ERAS programs have been successfully applied in many centres, especially in northern Europe and America, to perioperative management for colorectal surgery, vascular surgery, thoracic surgery, and then also to urological and gynaecologic surgery. Purpose of this paper is to evaluate and discuss the very recent introduction of ERAS programs also in head and neck surgery. Embase and Pubmed database searches were performed for relevant published studies. There are still no reports concerning the results of the application of ERAS protocols in the head and neck field. ERAS programs, however, could offer also to head and neck surgery patients an advantage in terms of fastening recovery, reducing hospital stay, and favouring early return to daily activities after hospital discharge. Therefore, the investigation of specific ERAS protocol in head and neck surgery patients should be encouraged

Fluid management and its role in enhanced recovery

Enhanced recovery programs have repeatedly been shown to safely reduce perioperative morbidity and hospital length of stay for surgical patients, and they are being used across an increasing number of surgical specialties. For these programs to be successful, appropriate fluid management is essential throughout the whole perioperative period with the main aim being to maintain physiological normality for patients wherever possible. While excessive fluid administration increases the risk of harm through tissue edema and surgical ileus formation, insufficient fluid administration will result in end-organ failure. To minimize these risks and maintain a “zero-balanced” approach, patients should start surgery minimally dehydrated, be given fluids only to replace what is lost intraoperatively, and then converted to normal enteral intake again as soon as possible after the operation is finished. Good clinical assessment is essential throughout the perioperative period to evaluate how fluid-responsive the patient is at that time and whether they would benefit from further volume, or more inotropic support instead. Increasingly in mechanically ventilated patients, dynamic markers such as stroke volume variation have been shown to be the most effective way of doing this, although these measures do have a number of limitations that need careful consideration. Another approach is targeting fluid administration to a patient’s cardiac output-so-called “goal-directed therapy." Again, there is good evidence that like enhanced recovery pathways, goal-directed therapy can also reduce perioperative morbidity and surgical patient’s length of stay. National guidelines currently recommend that every surgical patient should have an individualized fluid plan as part of their enhanced recovery program and that goal-directed therapy should be considered as part of this approach-particularly in either high-risk patients and/or more major surgical procedures.</p