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https://www.readbyqxmd.com/read/30094811/orthostatic-intolerance-in-enhanced-recovery-laparoscopic-colorectal-resection
#1
Jens R Eriksen, Pia Munk-Madsen, Henrik Kehlet, Ismail Gögenur
BACKGROUND: Orthostatic hypotension (OH) and intolerance (OI) are common findings in the early postoperative period after major surgery and may delay early mobilization. The mechanism of impaired orthostatic competence and OI symptoms is not fully understood, and specific data after colorectal surgery with well-defined perioperative care regimens and mobilization protocols are lacking. The aim of this study was to investigate the prevalence, possible risk factors and the impact of OI in patients undergoing elective minimal invasive colorectal cancer resection...
August 10, 2018: Acta Anaesthesiologica Scandinavica
https://www.readbyqxmd.com/read/30039461/objectively-measured-early-physical-activity-after-total-hip-or-knee-arthroplasty
#2
Iben Engelund Luna, Henrik Kehlet, Heidi Raahauge Wede, Susanne Jung Hoevsgaard, Eske Kvanner Aasvang
Although reduced early physical function after total hip- and knee arthroplasty (THA/TKA) is well-described, the underlying reasons have not been clarified with detailed studies on pathophysiological mechanisms related to recovery, thereby prohibiting advances in rehabilitation. Thus, we aimed to describe early post-THA/TKA physical activity measured by actigraphy and potential underlying pathophysiological mechanisms related to recovery in a well-defined cohort of THA and TKA patients. Daytime-activity was measured from 2 days before until 13 (THA) or 20 (TKA) days after surgery...
July 23, 2018: Journal of Clinical Monitoring and Computing
https://www.readbyqxmd.com/read/29994994/a%C3%A2-and-not-c-fibers-mediate-thermal-hyperalgesia-to-short-laser-stimuli-after-burn-injury-in-man
#3
Hocine Slimani, Leon Plaghki, Paola Valenti, Mads U Werner, Henrik Kehlet, Ron Kupers
It remains unclear which nerve fibers are responsible for mediating hyperalgesia following skin injury. Here, we examined the role of A∂- and C-fibers in inflammatory hyperalgesia following a first-degree burn injury. A CO2-laser delivered ultrafast short constant-temperature heat pulses to the upper part of the lower leg, to stimulate selectively the relatively fast conducting thinly myelinated A∂ and the slowly conducting unmyelinated C-fibers. Participants were asked to respond as fast as possible whenever they detected a thermal stimulus...
July 9, 2018: Pain
https://www.readbyqxmd.com/read/29975197/is-an-extensive-eras-program-able-to-bring-a-better-outcome-in-contrast-with-standard-eras-program-for-laparoscopic-colorectal-cancer-surgery
#4
Li Yun, Jiang Zhiwei, Henrik Kehlet, Wang Gang, Liu Jiang, Li Jieshou
No abstract text is available yet for this article.
July 2, 2018: Annals of Surgery
https://www.readbyqxmd.com/read/29944516/preoperative-high-dose-methylprednisolone-and-glycemic-control-early-after-total-hip-and-knee-arthroplasty-a-randomized-double-blind-placebo-controlled-trial
#5
Viktoria Lindberg-Larsen, Henrik Kehlet, Jens Bagger, Sten Madsbad
BACKGROUND: To evaluate the effect of a single preoperative dose of 125 mg methylprednisolone (MP) on glycemic homeostasis early after fast-track total hip and knee arthroplasty. METHODS: One-hundred thirty-four patients undergoing elective unilateral total hip arthroplasty and total knee arthroplasty were randomized (1:1) to preoperative intravenous MP 125 mg (group MP) or isotonic saline intravenous (group C). All procedures were performed under spinal anesthesia, using a standardized multimodal analgesic regime...
June 25, 2018: Anesthesia and Analgesia
https://www.readbyqxmd.com/read/29913846/persistent-pain-sensory-disturbances-and-functional-impairment-after-adjuvant-chemotherapy-for-breast-cancer
#6
Kenneth Geving Andersen, Maj-Britt Jensen, Henrik Kehlet, Rune Gärtner, Lise Eckhoff, Niels Kroman
Background Persistent pain after breast cancer treatment (PPBCT) is a considerable clinical problem affecting between 25 and 60% of breast cancer survivors [1]. Several risk factors have been proposed, among them nerve damage caused by adjuvant treatment [2]. Taxanes used in adjuvant therapy for breast cancer are neurotoxic, and thereby being a potential risk factor for PPBCT and sensory disturbances. However, the long term influence of taxanes on PPBCT is not well documented. Thus, the aim of this study was therefore to compare a nationwide cohort treated with cyclophosphamide and epirubicin + docetaxel (CE + T) versus a nationwide cohort treated with cyclophosphamide, epirubicin and fluoruracil (CEF), in order to assess differences in reporting of PPBCT, sensory disturbances in surgical area, symmetric peripheral sensory disturbances, and functional impairment...
December 29, 2017: Scandinavian Journal of Pain
https://www.readbyqxmd.com/read/29913809/the-variability-in-thermal-threshold-assessments-in-post-thoracotomy-pain-syndrome
#7
Kim Wildgaard, Thomas K Ringsted, Henrik Kehlet, Mads U Werner
Background/aims Quantitative sensory testing (QST) is a reference method in characterization of neuropathic pain components. Variability data on thermal thresholds have been presented for a number of diseases, but not for patients with persistent post-surgical pain. Thus, the objectives of the present study were to assess the day-to-day variation, but also topographic variability in thermal threshold assessments in post-thoracotomy pain syndrome (PTPS) patients. The variability in thermal thresholds between pre-specified sites, on the surgical and the non-surgical side were compared to each other and to the area of maximum pain...
December 29, 2017: Scandinavian Journal of Pain
https://www.readbyqxmd.com/read/29913791/mirror-image-sensory-dysfunction-in-the-post-thoracotomy-pain-syndrome
#8
Mads U Werner, Thomas K Ringsted, Henrik Kehlet, Kim Wildgaard
Background/aims Mirror-image sensory dysfunction (MISD) has been described in various medical conditions, but has not been systematically characterized following major surgery. Methods The presence of MISD was evaluated with standardized thermal and mechanical stimuli, in a group of preoperative patients scheduled for thoracotomy (n = 14) and in patients with post-thoracotomy pain syndrome (PTPS = 14). The primary outcome was areas with sensory dysfunction evaluated by dynamic sensory mapping with metal-rollers and a brush...
December 29, 2017: Scandinavian Journal of Pain
https://www.readbyqxmd.com/read/29886883/a-nationwide-study-of-the-quality-of-surgical-guidelines-and-written-patient-information
#9
Lotte Linnemann Rønfeldt, Dorthe Hjort Jakobsen, Henrik Kehlet, Henriette Lipczak, Kasper Wennervaldt
INTRODUCTION: Clinical practice guidelines (CPGs) support enhanced post-operative recovery and decrease morbidity. In addition, patient information leaflets (PILs) are associated with enhanced overall outcomes and improved patient satisfaction. The aim of this study was to provide an overview of the quality of CPGs and PILs in cancer surgery departments undertaking pulmonary lobectomy, nephrectomy, cystectomy, whipples, colorectal and ovarian surgery. METHODS: We conducted a cross-sectional descriptive study within 44 surgical departments in six cancer subspecialties: lung (n = 4), kidney (n = 9), bladder (n = 5), pancreas (n = 4), colorectal (n = 18) and ovarian (n = 4)...
June 2018: Danish Medical Journal
https://www.readbyqxmd.com/read/29794296/the-influence-of-pre-and-perioperative-administration-of-gabapentin-on-pain-3-4-years-after-total-knee-arthroplasty
#10
Kristian Kjær Petersen, Troels Haxholdt Lunn, Henrik Husted, Lars Tambour Hansen, Ole Simonsen, Mogens Berg Laursen, Henrik Kehlet, Lars Arendt-Nielsen
BACKGROUND AND AIMS: Approximately 20% of patients having total knee arthroplasty (TKA) will experience chronic postoperative pain. Recently, preoperative pain facilitation has been associated with chronic pain after TKA, and gabapentin has been shown to decrease pain facilitation. The current study is a secondary follow-up of a primary RCT investigating the effect of gabapentin on acute postoperative pain after TKA and exploring the effect of pre- and perioperative administration of gabapentin on chronic postoperative pain and psychological state 3-4 years after TKA...
April 25, 2018: Scandinavian Journal of Pain
https://www.readbyqxmd.com/read/29781366/high-dose-glucocorticoid-before-hip-and-knee-arthroplasty-to-use-or-not-to-use-that-s-the-question
#11
Henrik Kehlet, Viktoria Linberg-Larsen
No abstract text is available yet for this article.
May 21, 2018: Acta Orthopaedica
https://www.readbyqxmd.com/read/29741427/time-course-of-subacute-pain-after-transoral-robotic-surgery-tors-for-oropharyngeal-squamous-cell-carcinoma-versus-traditional-bilateral-tonsillectomy-in-adults-a-case-control-study
#12
Susanne Irene Scott, Anne Kathrine Østergaard Madsen, Niclas Rubek, Hani Ibrahim Channir, Henrik Kehlet, Christian von Buchwald
OBJECTIVE: To examine pain after Transoral Robotic Surgery (TORS) for oropharyngeal squamous cell carcinoma (OPSCC) versus traditional bilateral tonsillectomy in adults. METHODS: Pain evolvement was assessed in a prospective case-control design of 16 consecutive patients treated with TORS for early stage OPSCC versus 12 patients, who underwent bilateral tonsillectomy on suspicion of malignant disease. The TORS group received an optimized analgesia regime of preoperative oral celecoxib and gabapentin, intra- and postoperative high-dose intravenous dexamethasone, and regular postoperative oral contalgin, gabapentin, celecoxib, paracetamol and rescue morphine...
May 9, 2018: Acta Oto-laryngologica
https://www.readbyqxmd.com/read/29668658/anesthesia-and-analgesia-for-total-knee-arthroplasty-where-is-the-evidence
#13
Henrik Kehlet
No abstract text is available yet for this article.
May 2018: Regional Anesthesia and Pain Medicine
https://www.readbyqxmd.com/read/29552522/enhanced-recovery-after-surgery-a-patient-centered-process
#14
REVIEW
Marco Taurchini, Carlo Del Naja, Antonio Tancredi
The Enhanced Recovery After Surgery (ERAS) is a model of care introduced in 1997 by a group of general surgeons from Northern Europe led by Henrik Kehlet. The core of this approach is to produce improvements in surgical patient outcomes, especially in the reduction of hospital stay, complications rate, early recovery and reduction of economic burdens. Simply elaborating and establishing a protocol is not enough and much more efforts and changes are needed to achieve the aim to offer a sustainable improvement in the overall quality of patient care, therefore, ERAS is not a single and rigid protocol but is a method, a "modus operandi", a new way of multidisciplinary teamwork with readiness to make changes as knowledge evolves, i...
2018: Journal of Visualized Surgery
https://www.readbyqxmd.com/read/29510807/feasibility-and-safety-of-outpatient-breast-cancer-surgery
#15
Helle Molter Duriaud, Niels Kroman, Henrik Kehlet
INTRODUCTION: Improvement in perioperative care programmes has facilitated post-operative recovery and use of short-term or outpatient procedures. The aim of this study was to assess the feasibility and safety of an outpatient breast cancer programme in patients referred to a large breast cancer unit. METHODS: After an introduction period involving 554 consecutive patients, all patients operated from 1 November 2015 to 30 June 2016 (a total 483 patients) were treated with multimodal oral analgesia, preoperative high-dose glucocorticoids and no routine use of drains...
March 2018: Danish Medical Journal
https://www.readbyqxmd.com/read/29462010/eras-implementation-time-to-move-forward
#16
Henrik Kehlet
No abstract text is available yet for this article.
June 2018: Annals of Surgery
https://www.readbyqxmd.com/read/29302723/second-generation-of-a-fast-track-liver-resection-programme
#17
Nicolai A Schultz, Peter N Larsen, B Klarskov, L M Plum, Hans-Jørgen Frederiksen, Henrik Kehlet, Jens G Hillingsø
BACKGROUND: Recent developments in perioperative pathophysiology and care have documented evidence-based, multimodal rehabilitation (fast-track) to hasten recovery and decrease morbidity and hospital stay in several major surgical procedures. The aim of this study was to investigate the effect over time of a modified previously published fast-track programme in unselected patients undergoing open or laparoscopic liver resection. METHODS: A prospective study includes the first 121 consecutive patients following an updated fast-track programme for liver resection...
June 2018: World Journal of Surgery
https://www.readbyqxmd.com/read/29260691/-fast-track-hip-arthroplasty
#18
Torben Bæk Hansen, Kirill Gromov, Billy B Kristensen, Henrik Husted, Henrik Kehlet
Fast-track surgery implies a coordinated perioperative approach aimed at reducing surgical stress and facilitating post-operative recovery. The fast-track programme has reduced post-operative length of stay and has led to shorter convalescence with more rapid functional recovery and decreased morbidity and mortality in total hip arthroplasty. It should now be a standard total hip arthroplasty patient pathway, but fine tuning of the multiple factors in the fast-track pathway is still needed in patients with special needs or high comorbidity burden...
December 18, 2017: Ugeskrift for Laeger
https://www.readbyqxmd.com/read/29202644/outpatient-total-hip-and-knee-arthroplasty
#19
Stephan B W Vehmeijer, Henrik Husted, Henrik Kehlet
As a result of the introduction of fast-track programs, the length of hospital stay after arthroplasty has decreased to a point where some patients meet the discharge criteria on the day of surgery. In several studies, well-established fast-track centers have demonstrated the feasibility of outpatient procedures in selected patients. However, in literature the term "outpatient" is sometimes also used for patients who spend one or more nights in hospital. We therefore propose to use "outpatient" solely for patients who are discharged to their own home on the day of surgery and do not have an overnight stay at either the hospital or another non-home facility...
April 2018: Acta Orthopaedica
https://www.readbyqxmd.com/read/29190219/enhanced-recovery-after-surgery-current-controversies-and-concerns
#20
Henrik Kehlet, Girish P Joshi
No abstract text is available yet for this article.
December 2017: Anesthesia and Analgesia
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