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 .
Effects of immediate postoperative enteral nutrition on body composition, muscle function, and wound healing.
Thirty-two patients undergoing bowel resection were r and omized to receive either immediate postoperative nasojejunal feeding with full strength Osmolite solution for 56 hours ( n = 16 ) or routine postoperative hypocaloric fluids and gradual re introduction of diet  ( n = 16 ) . Body composition changes were measured at 14 days after operation with in vivo neutron activation analysis , the wound healing response by subcutaneous implantation of Gortex tubes , and muscle function by grip strength , maximum ventilatory volume , and stimulation of the ulnar nerve at the wrist . Postoperative fatigue up to 3 months after operation was assessed using a 10-point analogue . Successful immediate enteral nutrition was established in 12 of the 16 patients . Enterally fed patients had a mean daily caloric intake of 1179 + /- 388 kcal/d ( mean + /- SD ) over the first 4 postoperative days compared with 382 + /- 71 kcal/d for the controls ( p less than 0.0001 ) . The amount of hydroxyproline accumulating in the Gortex tubes was also significantly greater ( 2.5 + /- 1.1 nmol/g tube vs 1.5 + /- 0.8 nmol/g tube ; p less than 0.02 ) . However , the amount and composition of the weight lost was not significantly different . Muscle function was not preserved , and postoperative fatigue occurred to an equal extent in both groups . Complications were similar in both groups , except for a preponderance of bowel obstructions in the controls . The time to passage of first flatus and first bowel motion , although shorter in the fed group , did not reach significance ( p = 0.07 ) . We conclude that immediate enteral nutrition is feasible and results in an improved wound healing response . ( ABSTRACT TRUNCATED AT 250 WORDS
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 .