Masui. The Japanese journal of anesthesiology
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In recent years, various perioperative patient management programs have been proposed as "Enhanced recovery after surgery program" in order to improve patient prognosis. These programs are an evidence-based approach which does not use novel drugs or novel therapeutic intervention, but uses conventional medical therapy and skill. ⋯ Specifically, early postoperative recovery will be carefully managed by evaluating clinical variables such as "postoperative pain, gut dysfunction, and immobility". These programs aim to keep the reduction of body functions as marginally as possible by minimizing surgical stress imposed on patients and then help shorten the recovery time after surgery.
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Recently, European countries and US have issued the practice guidelines for preoperative fasting, and there is a trend of shortening the fating time before surgery. In Japan, some institutions have just started to use an oral rehydration therapy by oral rehydration solutions, which is effective in the treatment of mild to moderate dehydration, and in the preoperative water and electrolyte management. Besides shortening the fasting time, water and electrolytes can be adequately given to the patients by oral rehydration therapy Currently, this therapy is gaining a widespread attention, because it can improve patients' satisfaction for preoperative care and is also a safe and efficient medical treatment.
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Oral rehydration therapy before surgery may be useful for elderly patients in perioperative management especially induction of general anesthesia, as they cannot preserve water in the body sufficiently. In elderly patients oral rehydration therapy is favorable to intravenous hydration as in younger patients. However, if swallowing is impaired or there are risks for aspiration, gastric emptying rate is decreased; gastroesophageal reflux disease is pointed out; cognitive function is disordered; or delirium has appeared, oral rehydration therapy should be carefully considered. It may be necessary to provide preoperative oral rehydration therapy to high risk elderly patients when they are hospitalized and they should be watched for taking oral rehydration solution soon by hospital nurses.
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Postoperative delirium increases the morbidity and mortality in elderly patients. The present study was carried out to evaluate whether the difference of anesthetics has influence on the incidence of postoperative delirium, retrospectively. ⋯ Propofol anesthesia decreases postoperative delirium in elderly patients compared with sevoflurane anesthesia.
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A morbidly obese patient, with a body mass index of 43 kg m(-2), was scheduled to undergo open reduction and internal fixation (ORIF) to his left fibular fracture under general anesthesia in the lateral position. Before the induction of general anesthesia the patient positioned himself comfortably in right lateral. General anesthesia was induced with intravenous propofol and remifentanil infusions. ⋯ As soon as he awoke, LMA was removed in the lateral position. The patient turned to the supine position himself and was discharged to general ward. We consider our method, the induction of general anesthesia and the LMA insertion in the lateral position, was a selectable option to a morbidly obese patient who underwent an operation in the lateral position.