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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Journal ArticleDOI
Nurse Practitioner–Driven Optimization of Presurgical Testing
Stacey Cuomo,Megan Abate,Celeste Springer,Denise Kessel,Deirdre Bracken,Erica Fischer-Cartlidge +5 more
TL;DR: The evolution of presurgical testing from the vantage of generic testing to one that is tailored to the patient's clinical presentation and the type of surgery to be performed, whether it is high, intermediate, or low risk is outlined.
Journal ArticleDOI
Editorial Comment on “Enhanced Recovery After Surgery (ERAS) in Head and Neck Oncologic Surgery: A Case-Matched Analysis of Perioperative and Pain Outcomes”
Shuqing Chen,Baran D. Sumer +1 more
TL;DR: A case-matched cohort study using the HNRS-ERAS pathway is conducted to intervene and track outcomes based on the principles of patient education, goal-directed fluid management, multimodal analgesia, and early mobilization, and shows the feasibility of developing a standardized and comprehensive protocol for major head and neck surgery that follows the Principles of ERAS.
Book ChapterDOI
Regional Anesthesia and Cardiovascular Disease
Veerandra Koyyalamudi,Lien Tran,Camellia D. Asgarian,Molly B Kraus,Zacherie Conover,Jeremy M. Alvord,Elyse M. Cornett,Alan D. Kaye +7 more
TL;DR: This chapter reviews some of the different regional techniques for cardiac and non-cardiac patients including neuraxial block, epidural block, paravertebral and intercostal nerve blocks, as well as peripheral nerve block in patients with cardiac disease who are undergoing non- Cardiac surgery.
Journal ArticleDOI
Evaluation of the Pharmacokinetics of Felcisetrag (TAK‐954), a 5‐HT4 Receptor Agonist, in the Presence and Absence of Itraconazole, a Potent CYP3A4 Inhibitor
Chunlin Chen,Liming Zhang,Cristina Almansa,Maria Rosario,Michael J. Cwik,Suresh K. Balani,Ruth Lock +6 more
TL;DR: The data suggest limited CYP3A4‐mediated drug‐drug interaction inhibition for felcisetrag, and this phase 1, fixed‐sequence, open‐label, crossover trial investigated the effect of itraconazole, a potent CYP 3A4 inhibitor, on felc isetrag pharmacokinetics in healthy adults.
Anesthetic management in Enhanced Recovery After Surgery (ERAS)
TL;DR: Groups of anesthesiologists and surgeons should work as a team to increase their effectiveness in two distinct areas - patient care and safety, and place emphasis on rapid recovery, optimal pain control, early mobilisation and early oral diet.
References
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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.
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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
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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.