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
More filters
Journal ArticleDOI
Effects of preoperative carbohydrates drinks on immediate postoperative outcome after day care laparoscopic cholecystectomy.
Basant Narayan Singh,Divya Dahiya,Dinesh Bagaria,Vikas Saini,Lileswar Kaman,Vivek Kaje,Ankur Vagadiya,Shawashat Sarin,Roger Edwards,Vishal Attri,Kajal Jain +10 more
TL;DR: Perioperative consumption of a carbohydrate-rich drink can minimize postoperative nausea, vomiting and pain in patients undergoing outpatient cholecystectomy.
Journal ArticleDOI
Effect of Epidural Analgesia on Postoperative Insulin Resistance as Evaluated by Insulin Clamp Technique
TL;DR: The results indicate that insulin resistance after elective abdominal surgery is due to a postreceptor deficit in glucose utilization, as indicated by the downward shift of the dose-response curves.
Journal ArticleDOI
Evolution of the Southampton Enhanced Recovery Programme for radical cystectomy and the aggregation of marginal gains
Julian Smith,Zhao Wu Meng,Richard C. Lockyer,Tim Dudderidge,John S. McGrath,M.C. Hayes,Brian Birch +6 more
TL;DR: To describe and assess the evolution of an enhanced recovery programme (ERP) for open radical cystectomy, a large number of patients with a history of cystic fibrosis were treated with an ERP.
Journal ArticleDOI
Dysfunctional Natural Killer Cells in the Aftermath of Cancer Surgery
Leonard Angka,Sarwat T. Khan,Sarwat T. Khan,Marisa K Kilgour,Rebecca Xu,Michael A. Kennedy,Rebecca C. Auer,Rebecca C. Auer +7 more
TL;DR: The post-operative environment is described and how the release of sympathetic stress-related factors, anti-inflammatory cytokines, and myeloid derived suppressor cells, mediate NK cell dysfunction.
Journal ArticleDOI
Ultrasound-guided bilateral quadratus lumborum block vs. intrathecal morphine for postoperative analgesia after cesarean section: a randomized controlled trial.
TL;DR: QLB provides better long-lasting analgesia and reduced total postoperative morphine consumption, compared with ITM, which is effective analgesic regimens after cesarean section but with higher incidence of morphine-related side effects.
References
More filters
Journal ArticleDOI
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.
Journal ArticleDOI
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.
Journal ArticleDOI
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.