Enhanced recovery after surgery (ERAS) protocols: Time to change practice?
TLDR
Enhanced recovery after surgery (ERAS) protocols are multimodal perioperative care pathways designed to achieve early recovery after surgical procedures by maintaining preoperative organ function and reducing the profound stress response following surgery as discussed by the authors.Abstract:
Radical cystectomy with pelvic lymph node dissection remains the standard treatment for patients with muscle invasive bladder cancer. Despite improvements in surgical technique, anesthesia and perioperative care, radical cystectomy is still associated with greater morbidity and prolonged in-patient stay after surgery than other urological procedures. Enhanced recovery after surgery (ERAS) protocols are multimodal perioperative care pathways designed to achieve early recovery after surgical procedures by maintaining preoperative organ function and reducing the profound stress response following surgery. The key elements of ERAS protocols include preoperative counselling, optimization of nutrition, standardized analgesic and anesthetic regimens and early mobilization. Despite the significant body of evidence indicating that ERAS protocols lead to improved outcomes, they challenge traditional surgical doctrine, and as a result their implementation has been slow. The present article discusses particular aspects of ERAS protocols which represent fundamental shifts in surgical practice, including perioperative nutrition, management of postoperative ileus and the use of mechanical bowel preparation.read more
Citations
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COVID-19 and resuming elective surgery. How do we get back to normal?
TL;DR: In order to resume elective surgeries safely the effective participation of anesthesia services in management committees is indispensable, aimed at making all resources available to face the pandemic, to manage possible lack of supplies, and also aimed at developing and adapting care protocols.
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Effects of general anesthesia with and without thoracic epidural block on length of stay after open spine surgery: A single-blinded randomized controlled trial.
Marvin Thepsoparn,Porranee Punyawattanakit,Nara Jaruwangsanti,Weerasak Singhatanadgige,Pornpan Chalermkitpanit +4 more
TL;DR: In this article , the authors compared the length of hospital stay after open complete laminectomy with fusion between general anesthesia and combined general anesthesia involving a single thoracic epidural injection.
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Accelerating Post-Surgical Best Practices Using Enhanced Recovery After Surgery
TL;DR: The goal of Enhanced Recovery Canada is to support the uptake of best practices in the areas of nutrition, activity, opioid-sparing analgesia, hydration and overall best practices across Canada, improving patient outcomes and experiences.
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The impact of breast cancer surgery on functional status in older women – A systematic review of the literature
TL;DR: In this paper, a systematic review was performed to examine the evidence for impact of breast cancer surgery on functional status in older women, finding that physical activity level was negatively impacted by breast cancer, and this was compounded by the extent of surgery.
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Enhanced Recovery Program (ERP) versus Traditional care after Elective Left Side Colorectal Cancer Surgery
Ahmad Aboelkassem Ibrahim,Reda M. Moustafa,Ashraf Abdulmoghni Moustafa,Saleem El-Rabaa,Yahya Salama +4 more
TL;DR: ERAS didn’t affect complications rate significantly following left side colorectal surgery, however, it reduced LOS as it improved tolerating oral intake and bowel movement, and should be encouraged for all patients.
References
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Intensive Insulin Therapy in Critically Ill Patients
Greet Van den Berghe,Pieter Wouters,Frank Weekers,Charles Verwaest,Frans Bruyninckx,Miet Schetz,Dirk Vlasselaers,Patrick Ferdinande,Peter Lauwers,Roger Bouillon +9 more
TL;DR: Intensive insulin therapy to maintain blood glucose at or below 110 mg per deciliter reduces morbidity and mortality among critically ill patients in the surgical intensive care unit.
Journal ArticleDOI
Multimodal approach to control postoperative pathophysiology and rehabilitation.
TL;DR: While no single technique or drug regimen has been shown to eliminate postoperative morbidity and mortality, multimodal interventions may lead to a major reduction in the undesirable sequelae of surgical injury with improved recovery and reduction in postoperative mortality and overall costs.
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Multimodal strategies to improve surgical outcome.
Henrik Kehlet,Douglas W. Wilmore +1 more
TL;DR: Understanding perioperative pathophysiology and implementation of care regimes to reduce the stress of an operation, will continue to accelerate rehabilitation associated with decreased hospitalization and increased satisfaction and safety after discharge.
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Enhanced recovery after surgery
TL;DR: A protocol is presented which is in current use by the ERAS Group and may provide a standard of care against which either current or future novel elements of an enhanced recovery approach can be tested for their effect on outcome.