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 .
Restrictive Deferred Hydration Combined with Preemptive Norepinephrine Infusion during Radical Cystectomy Reduces Postoperative Complications and Hospitalization Time: A Randomized Clinical Trial
Background : Anesthetics and neuraxial anesthesia commonly result in vasodilation/hypotension . Norepinephrine counteracts this effect and thus allows for decreased intraoperative hydration . The authors investigated whether this approach could result in reduced postoperative complication rate . Methods : In this single-center , double-blind , r and omized , superiority trial , 166 patients undergoing radical cystectomy and urinary diversion were equally allocated to receive 1 ml·kg−1·h−1 of balanced Ringer ’s solution until the end of cystectomy and then 3 ml·kg−1·h−1 until the end of surgery combined with preemptive norepinephrine infusion at an initial rate of 2 µg·kg−1·h−1 ( low-volume group ; n = 83 ) or 6 ml·kg−1·h−1 of balanced Ringer ’s solution throughout surgery ( control group ; n = 83 ) . Primary outcome was the in-hospital complication rate . Secondary outcomes were hospitalization time , and 90-day mortality . Results : In-hospital complications occurred in 43 of 83 patients ( 52 % ) in the low-volume group and in 61 of 83 ( 73 % ) in the control group ( relative risk , 0.70 ; 95 % CI , 0.55–0.88 ; P = 0.006 ) . The rates of gastrointestinal and cardiac complications were lower in the low-volume group than in the control group ( 5 [ 6 % ] vs. 31 [ 37 % ] ; relative risk , 0.16 ; 95 % CI , 0.07–0.39 ; P < 0.0001 and 17 [ 20 % ] vs. 39 [ 48 % ] , relative risk , 0.43 ; 95 % CI , 0.26–0.60 ; P = 0.0003 , respectively ) . The median hospitalization time was 15 days [ range , 11 , 27d ] in the low-volume group and 17 days [ 11 , 95d ] in the control group ( P = 0.02 ) . The 90-day mortality was 0 % in the low-volume group and 4.8 % in the control group ( P = 0.12 ) . Conclusion : A restrictive-deferred hydration combined with preemptive norepinephrine infusion during radical cystectomy and urinary diversion significantly reduced the postoperative complication rate and hospitalization time
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 .