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19 - Anaesthesia for major abdominal and urological surgery

Published online by Cambridge University Press:  05 September 2009

Paul Myles
Affiliation:
Department of Anaesthesia and Perioperative Medicine, Alfred Hospital and Monash University, Melbourne, Australia
Kate Leslie
Affiliation:
Department of Anaesthesia and Pain Management, Royal Melbourne Hospital and Department of Pharmacology, University of Melbourne, Melbourne, Australia
Ann Møller
Affiliation:
KAS Herlev, Copenhagen
Tom Pedersen
Affiliation:
Rigshospitalet, Copenhagen
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Summary

Abstract

There is good evidence that epidural analgesia provides slightly better analgesia when compared with intravenous (IV) opioid regimens; incisional local anaesthetic infiltration has minimal analgesic effectiveness; supplemental IV fluids improve patient comfort, but a restrictive fluid regimen promotes return of gastrointestinal (GI) function; normothermia prevents shivering and wound infection, prophylactic antibiotics prevent infections; heparin and graduated compression stockings reduce thromboembolism; nasogastric drainage has no benefit, but early enteral feeding reduces postoperative infection and hospital stay, and may have other benefits after abdominal surgery. There is inconclusive evidence that supplemental IV fluids improve postoperative nausea and vomiting (PONV), headache and pain; a restrictive fluid regimen reduces postoperative complications and hospital stay; choice of IV fluid has any clinically important effects; optimisation of tissue oxygen delivery with inotrope therapy improves outcome; supplemental oxygen reduces serious complications; nitrous oxide reduces wound infection and pneumonia; and whether or not beta-blockers reduce cardiac mortality.

Major abdominal surgery includes many types of GI, as well as hepatobiliary, aortic, renal, and prostatic surgery. Naturally there are specific anaesthetic considerations inherent in each of these procedures, and some institutions will have unique issues for the anaesthetist to consider, such as innovative surgical techniques or the extent of hospital resources available for the perioperative care of the patient.

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Chapter
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Publisher: Cambridge University Press
Print publication year: 2006

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  • Anaesthesia for major abdominal and urological surgery
    • By Paul Myles, Department of Anaesthesia and Perioperative Medicine, Alfred Hospital and Monash University, Melbourne, Australia, Kate Leslie, Department of Anaesthesia and Pain Management, Royal Melbourne Hospital and Department of Pharmacology, University of Melbourne, Melbourne, Australia
  • Edited by Ann Møller, KAS Herlev, Copenhagen, Tom Pedersen, Rigshospitalet, Copenhagen
  • Book: Evidence-based Anaesthesia and Intensive Care
  • Online publication: 05 September 2009
  • Chapter DOI: https://doi.org/10.1017/CBO9780511544613.020
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  • Anaesthesia for major abdominal and urological surgery
    • By Paul Myles, Department of Anaesthesia and Perioperative Medicine, Alfred Hospital and Monash University, Melbourne, Australia, Kate Leslie, Department of Anaesthesia and Pain Management, Royal Melbourne Hospital and Department of Pharmacology, University of Melbourne, Melbourne, Australia
  • Edited by Ann Møller, KAS Herlev, Copenhagen, Tom Pedersen, Rigshospitalet, Copenhagen
  • Book: Evidence-based Anaesthesia and Intensive Care
  • Online publication: 05 September 2009
  • Chapter DOI: https://doi.org/10.1017/CBO9780511544613.020
Available formats
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Save book to Google Drive

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Google Drive.

  • Anaesthesia for major abdominal and urological surgery
    • By Paul Myles, Department of Anaesthesia and Perioperative Medicine, Alfred Hospital and Monash University, Melbourne, Australia, Kate Leslie, Department of Anaesthesia and Pain Management, Royal Melbourne Hospital and Department of Pharmacology, University of Melbourne, Melbourne, Australia
  • Edited by Ann Møller, KAS Herlev, Copenhagen, Tom Pedersen, Rigshospitalet, Copenhagen
  • Book: Evidence-based Anaesthesia and Intensive Care
  • Online publication: 05 September 2009
  • Chapter DOI: https://doi.org/10.1017/CBO9780511544613.020
Available formats
×