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 .
Maintaining perioperative normothermia
Perioperative hypothermia can have a wide range of underappreciated , detrimental effects . These include increased rates of wound infection , morbid cardiac events , blood loss , and length of stay in both recovery and hospital . Maintaining core temperature at or above 36 ° C can be beneficial for the patient and cost effective . Frank et al studied high risk cardiac patients undergoing thoracic , abdominal , and vascular surgery.1 Patients r and omised to routine thermal care were , on average , 1.3 ° C cooler than patients warmed more aggressively . Despite this small difference the incidence of perioperative morbid cardiac events , assessed in a double blind fashion , was 300 % higher in the cooler group . Frank et al thought that this may be the a consequence of the dramatic increase in noradrenaline release seen in even mild hypothermia . It has also been said that the increase in noradrenaline may contribute to the higher number of wound infections seen in hypothermic patients . A r and omised study of patients undergoing colorectal surgery showed that 1.9 ° C hypothermia result ed in an infection rate of 19 % compared with 6 % in the normothermic
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 .