Intraoperatively , a fluid and opioid sparing protocol may reduce fluid shifts and avoid complications from paralytic ileus .
Finally , enhanced recovery protocol s including novel medications , early feeding , and multi-modal analgesia approaches are associated with earlier postoperative convalescence .
CONCLUSION RC is a complex and morbid procedure that may benefit from care re design .
OBJECTIVE To present an evidence -based review of the perioperative management of the radical cystectomy ( RC ) patient in the context of a care re design initiative .
Intraoperative continuous norepinephrine infusion combined with restrictive deferred hydration significantly reduces the need for blood transfusion in patients undergoing open radical cystectomy: results of a prospective randomised trial.
BACKGROUND Open radical cystectomy ( ORC ) is associated with substantial blood loss and a high incidence of perioperative blood transfusions . Strategies to reduce blood loss and blood transfusion are warranted . OBJECTIVE To determine whether continuous norepinephrine administration combined with intraoperative restrictive hydration with Ringer 's maleate solution can reduce blood loss and the need for blood transfusion . DESIGN , SETTING , AND PARTICIPANTS This was a double-blind , r and omised , parallel-group , single-centre trial including 166 consecutive patients undergoing ORC with urinary diversion ( UD ) . Exclusion criteria were severe hepatic or renal dysfunction , congestive heart failure , and contraindications to epidural analgesia . INTERVENTION Patients were r and omly allocated to continuous norepinephrine administration starting with 2 μg/kg per hour combined with 1 ml/kg per hour until the bladder was removed , then to 3 ml/kg per hour of Ringer 's maleate solution ( norepinephrine/low-volume group ) or 6 ml/kg per hour of Ringer 's maleate solution throughout surgery ( control group ) . OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS Intraoperative blood loss and the percentage of patients requiring blood transfusions perioperatively were assessed . Data were analysed using nonparametric statistical models . RESULTS AND LIMITATIONS Total median blood loss was 800 ml ( range : 300 - 1700 ) in the norepinephrine/low-volume group versus 1200 ml ( range : 400 - 2800 ) in the control group ( p<0.0001 ) . In the norepinephrine/low-volume group , 27 of 83 patients ( 33 % ) required an average of 1.8 U ( ±0.8 ) of packed red blood cells ( PRBCs ) . In the control group , 50 of 83 patients ( 60 % ) required an average of 2.9 U ( ±2.1 ) of PRBCs during hospitalisation ( relative risk : 0.54 ; 95 % confidence interval [ CI ] , 0.38 - 0.77 ; p=0.0006 ) . The absolute reduction in transfusion rate throughout hospitalisation was 28 % ( 95 % CI , 12 - 45 ) . In this study , surgery was performed by three high-volume surgeons using a st and ardised technique , so whether these significant results are reproducible in other centres needs to be shown . CONCLUSIONS Continuous norepinephrine administration combined with restrictive hydration significantly reduces intraoperative blood loss , the rate of blood transfusions , and the number of PRBC units required per patient undergoing ORC with UD
Intraoperatively , a fluid and opioid sparing protocol may reduce fluid shifts and avoid complications from paralytic ileus .
Finally , enhanced recovery protocol s including novel medications , early feeding , and multi-modal analgesia approaches are associated with earlier postoperative convalescence .
CONCLUSION RC is a complex and morbid procedure that may benefit from care re design .
OBJECTIVE To present an evidence -based review of the perioperative management of the radical cystectomy ( RC ) patient in the context of a care re design initiative .