title: New perioperative fluid and pharmacologic management protocol results in reduced blood loss, faster return of bowel function, and overall recovery.
abstract: Cystectomy and urinary diversion have high morbidity, and strategies to reduce complications are of utmost importance. Epidural analgesia and optimized fluid management are considered key factors contributing to successful enhanced recovery after surgery. In colorectal surgery, there is strong evidence that an intraoperative fluid management aiming for a postoperative zero fluid balance results in lower morbidity including a faster return of bowel function. Recently, a randomized clinical trial focusing on radical cystectomy demonstrated that a restrictive intraoperative hydration combined with a concomitant administration of norepinephrine reduced intraoperative blood loss, the need for blood transfusion and morbidity. The purpose of this review is to highlight specific anesthesiological aspects which have been shown to improve outcome after RC with urinary diversion.
authors.affiliation: Department of Anaesthesiology and Pain Medicine, Bern University Hospital, CH-3010, Berne, Switzerland, patrick.wuethrich@insel.ch.
authors.forename: Patrick Y
authors.initials: PY
authors.lastname: Wuethrich
authors.forename: Fiona C
authors.initials: FC
authors.lastname: Burkhard
mesh_terms: D015360:Analgesia, Epidural / Q000379:methods; D016063:Blood Loss, Surgical / Q000517:prevention & control*; D002985:Clinical Protocols; D015653:Cystectomy / Q000379:methods*; D005440:Fluid Therapy / Q000379:methods*; D006801:Humans; D009638:Norepinephrine / Q000627:therapeutic use*; D019990:Perioperative Care / Q000379:methods*; D020127:Recovery of Function; D013566:Sympathomimetics / Q000627:therapeutic use*; D014547:Urinary Diversion / Q000379:methods*
chemical_list: D013566:Sympathomimetics; D009638:Norepinephrine