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Patterns in current anaesthesiological peri-operative practice for colonic resections: a survey in five northern-European countries

Authors

  • P. Hannemann,

    1. 1Department of Surgery, University Hospital Maastricht and NUTRIM Institute, Maastricht, The Netherlands, 2Department of Gastrointestinal Surgery, University Hospital of Northern Norway, Tromsø, Norway, 3Centre for Surgical Sciences, Karolinska Institutet and Center of Gastrointestinal Disease, Ersta Hospital, Stockholm, Sweden, 4Department of Anaesthesiology and 5Department of Clinical and Surgical Sciences (Surgery), School of Clinical Sciences and Community Health, The University of Edinburgh, Edinburgh, UK , 6Department of Surgical Gastroenterology, Hvidovre, Denmark and 7Department of Anaesthesiology and Intensive Care Medicine, Campus Charité Mitte and Campus Virchow-Klinikum, Charité- University Medicine Berlin, Berlin, Germany
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  • 1 K. Lassen,

    1. 1Department of Surgery, University Hospital Maastricht and NUTRIM Institute, Maastricht, The Netherlands, 2Department of Gastrointestinal Surgery, University Hospital of Northern Norway, Tromsø, Norway, 3Centre for Surgical Sciences, Karolinska Institutet and Center of Gastrointestinal Disease, Ersta Hospital, Stockholm, Sweden, 4Department of Anaesthesiology and 5Department of Clinical and Surgical Sciences (Surgery), School of Clinical Sciences and Community Health, The University of Edinburgh, Edinburgh, UK , 6Department of Surgical Gastroenterology, Hvidovre, Denmark and 7Department of Anaesthesiology and Intensive Care Medicine, Campus Charité Mitte and Campus Virchow-Klinikum, Charité- University Medicine Berlin, Berlin, Germany
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  • 2 J. Hausel,

    1. 1Department of Surgery, University Hospital Maastricht and NUTRIM Institute, Maastricht, The Netherlands, 2Department of Gastrointestinal Surgery, University Hospital of Northern Norway, Tromsø, Norway, 3Centre for Surgical Sciences, Karolinska Institutet and Center of Gastrointestinal Disease, Ersta Hospital, Stockholm, Sweden, 4Department of Anaesthesiology and 5Department of Clinical and Surgical Sciences (Surgery), School of Clinical Sciences and Community Health, The University of Edinburgh, Edinburgh, UK , 6Department of Surgical Gastroenterology, Hvidovre, Denmark and 7Department of Anaesthesiology and Intensive Care Medicine, Campus Charité Mitte and Campus Virchow-Klinikum, Charité- University Medicine Berlin, Berlin, Germany
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  • 3 S. Nimmo,

    1. 1Department of Surgery, University Hospital Maastricht and NUTRIM Institute, Maastricht, The Netherlands, 2Department of Gastrointestinal Surgery, University Hospital of Northern Norway, Tromsø, Norway, 3Centre for Surgical Sciences, Karolinska Institutet and Center of Gastrointestinal Disease, Ersta Hospital, Stockholm, Sweden, 4Department of Anaesthesiology and 5Department of Clinical and Surgical Sciences (Surgery), School of Clinical Sciences and Community Health, The University of Edinburgh, Edinburgh, UK , 6Department of Surgical Gastroenterology, Hvidovre, Denmark and 7Department of Anaesthesiology and Intensive Care Medicine, Campus Charité Mitte and Campus Virchow-Klinikum, Charité- University Medicine Berlin, Berlin, Germany
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  • 4 O. Ljungqvist,

    1. 1Department of Surgery, University Hospital Maastricht and NUTRIM Institute, Maastricht, The Netherlands, 2Department of Gastrointestinal Surgery, University Hospital of Northern Norway, Tromsø, Norway, 3Centre for Surgical Sciences, Karolinska Institutet and Center of Gastrointestinal Disease, Ersta Hospital, Stockholm, Sweden, 4Department of Anaesthesiology and 5Department of Clinical and Surgical Sciences (Surgery), School of Clinical Sciences and Community Health, The University of Edinburgh, Edinburgh, UK , 6Department of Surgical Gastroenterology, Hvidovre, Denmark and 7Department of Anaesthesiology and Intensive Care Medicine, Campus Charité Mitte and Campus Virchow-Klinikum, Charité- University Medicine Berlin, Berlin, Germany
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  • 3 J. Nygren,

    1. 1Department of Surgery, University Hospital Maastricht and NUTRIM Institute, Maastricht, The Netherlands, 2Department of Gastrointestinal Surgery, University Hospital of Northern Norway, Tromsø, Norway, 3Centre for Surgical Sciences, Karolinska Institutet and Center of Gastrointestinal Disease, Ersta Hospital, Stockholm, Sweden, 4Department of Anaesthesiology and 5Department of Clinical and Surgical Sciences (Surgery), School of Clinical Sciences and Community Health, The University of Edinburgh, Edinburgh, UK , 6Department of Surgical Gastroenterology, Hvidovre, Denmark and 7Department of Anaesthesiology and Intensive Care Medicine, Campus Charité Mitte and Campus Virchow-Klinikum, Charité- University Medicine Berlin, Berlin, Germany
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  • 3 M. Soop,

    1. 1Department of Surgery, University Hospital Maastricht and NUTRIM Institute, Maastricht, The Netherlands, 2Department of Gastrointestinal Surgery, University Hospital of Northern Norway, Tromsø, Norway, 3Centre for Surgical Sciences, Karolinska Institutet and Center of Gastrointestinal Disease, Ersta Hospital, Stockholm, Sweden, 4Department of Anaesthesiology and 5Department of Clinical and Surgical Sciences (Surgery), School of Clinical Sciences and Community Health, The University of Edinburgh, Edinburgh, UK , 6Department of Surgical Gastroenterology, Hvidovre, Denmark and 7Department of Anaesthesiology and Intensive Care Medicine, Campus Charité Mitte and Campus Virchow-Klinikum, Charité- University Medicine Berlin, Berlin, Germany
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  • 3 K. Fearon,

    1. 1Department of Surgery, University Hospital Maastricht and NUTRIM Institute, Maastricht, The Netherlands, 2Department of Gastrointestinal Surgery, University Hospital of Northern Norway, Tromsø, Norway, 3Centre for Surgical Sciences, Karolinska Institutet and Center of Gastrointestinal Disease, Ersta Hospital, Stockholm, Sweden, 4Department of Anaesthesiology and 5Department of Clinical and Surgical Sciences (Surgery), School of Clinical Sciences and Community Health, The University of Edinburgh, Edinburgh, UK , 6Department of Surgical Gastroenterology, Hvidovre, Denmark and 7Department of Anaesthesiology and Intensive Care Medicine, Campus Charité Mitte and Campus Virchow-Klinikum, Charité- University Medicine Berlin, Berlin, Germany
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  • 5 J. Andersen,

    1. 1Department of Surgery, University Hospital Maastricht and NUTRIM Institute, Maastricht, The Netherlands, 2Department of Gastrointestinal Surgery, University Hospital of Northern Norway, Tromsø, Norway, 3Centre for Surgical Sciences, Karolinska Institutet and Center of Gastrointestinal Disease, Ersta Hospital, Stockholm, Sweden, 4Department of Anaesthesiology and 5Department of Clinical and Surgical Sciences (Surgery), School of Clinical Sciences and Community Health, The University of Edinburgh, Edinburgh, UK , 6Department of Surgical Gastroenterology, Hvidovre, Denmark and 7Department of Anaesthesiology and Intensive Care Medicine, Campus Charité Mitte and Campus Virchow-Klinikum, Charité- University Medicine Berlin, Berlin, Germany
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  • 6 A. Revhaug,

    1. 1Department of Surgery, University Hospital Maastricht and NUTRIM Institute, Maastricht, The Netherlands, 2Department of Gastrointestinal Surgery, University Hospital of Northern Norway, Tromsø, Norway, 3Centre for Surgical Sciences, Karolinska Institutet and Center of Gastrointestinal Disease, Ersta Hospital, Stockholm, Sweden, 4Department of Anaesthesiology and 5Department of Clinical and Surgical Sciences (Surgery), School of Clinical Sciences and Community Health, The University of Edinburgh, Edinburgh, UK , 6Department of Surgical Gastroenterology, Hvidovre, Denmark and 7Department of Anaesthesiology and Intensive Care Medicine, Campus Charité Mitte and Campus Virchow-Klinikum, Charité- University Medicine Berlin, Berlin, Germany
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  • 2 M. F. Von Meyenfeldt,

    1. 1Department of Surgery, University Hospital Maastricht and NUTRIM Institute, Maastricht, The Netherlands, 2Department of Gastrointestinal Surgery, University Hospital of Northern Norway, Tromsø, Norway, 3Centre for Surgical Sciences, Karolinska Institutet and Center of Gastrointestinal Disease, Ersta Hospital, Stockholm, Sweden, 4Department of Anaesthesiology and 5Department of Clinical and Surgical Sciences (Surgery), School of Clinical Sciences and Community Health, The University of Edinburgh, Edinburgh, UK , 6Department of Surgical Gastroenterology, Hvidovre, Denmark and 7Department of Anaesthesiology and Intensive Care Medicine, Campus Charité Mitte and Campus Virchow-Klinikum, Charité- University Medicine Berlin, Berlin, Germany
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  • 1 C. H. C. Dejong,

    Corresponding author
    1. 1Department of Surgery, University Hospital Maastricht and NUTRIM Institute, Maastricht, The Netherlands, 2Department of Gastrointestinal Surgery, University Hospital of Northern Norway, Tromsø, Norway, 3Centre for Surgical Sciences, Karolinska Institutet and Center of Gastrointestinal Disease, Ersta Hospital, Stockholm, Sweden, 4Department of Anaesthesiology and 5Department of Clinical and Surgical Sciences (Surgery), School of Clinical Sciences and Community Health, The University of Edinburgh, Edinburgh, UK , 6Department of Surgical Gastroenterology, Hvidovre, Denmark and 7Department of Anaesthesiology and Intensive Care Medicine, Campus Charité Mitte and Campus Virchow-Klinikum, Charité- University Medicine Berlin, Berlin, Germany
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  • and 1 C. Spies 7

    1. 1Department of Surgery, University Hospital Maastricht and NUTRIM Institute, Maastricht, The Netherlands, 2Department of Gastrointestinal Surgery, University Hospital of Northern Norway, Tromsø, Norway, 3Centre for Surgical Sciences, Karolinska Institutet and Center of Gastrointestinal Disease, Ersta Hospital, Stockholm, Sweden, 4Department of Anaesthesiology and 5Department of Clinical and Surgical Sciences (Surgery), School of Clinical Sciences and Community Health, The University of Edinburgh, Edinburgh, UK , 6Department of Surgical Gastroenterology, Hvidovre, Denmark and 7Department of Anaesthesiology and Intensive Care Medicine, Campus Charité Mitte and Campus Virchow-Klinikum, Charité- University Medicine Berlin, Berlin, Germany
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Cornelis H. C. Dejong
Department of Surgery
University Hospital Maastricht
PO Box 5800
6202 AZ Maastricht
The Netherlands
e-mail: c.dejong@surgery.azm.nl

Abstract

Background:  For colorectal surgery, evidence suggests that optimal management includes: no pre-operative fasting, a thoracic epidural analgesia continued for 2 days post-operatively, and avoidance of fluid overload. In addition, no long-acting benzodiazepines on the day of surgery and use of short-acting anaesthetic medication may be beneficial. We examined whether these strategies have been adopted in five northern-European countries.

Methods:  In 2003, a questionnaire concerning peri-operative anaesthetic routines in elective, open colonic cancer resection was sent to the chief anaesthesiologist in 258 digestive surgical centres in Scotland, the Netherlands, Denmark, Sweden and Norway.

Results:  The response rate was 74% (n = 191). Although periods of pre-operative fasting up to 48 h were reported, most (> 85%) responders in all countries declared to adhere to guidelines for pre-operative fasting and oral clear liquids were permitted until 2–3 h before anaesthesia. Solid food was permitted up to 6–8 h prior to anaesthesia. In all countries more than 85% of the responders indicated that epidural anaesthesia was routinely used. Except for Denmark, long-acting benzodiazepines were still widely used. Short-acting anaesthetics were used in all countries except Scotland where isoflurane is the anaesthetic of choice. With the exception of Denmark, intravenous fluids were used unrestrictedly.

Conclusion:  In northern Europe, most anaesthesiologists adhere to evidence-based optimal management strategies on pre-operative fasting, thoracic epidurals and short-acting anaesthetics. However, premedication with longer-acting agents is still common. Avoidance of fluid overload has not yet found its way into daily practice. This may leave patients undergoing elective colonic surgery at risk of oversedation and excessive fluid administration with potential adverse effects on surgical outcome.

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