Enhanced Recovery After Surgery Flashcards
Where is enhanced recovery after surgery (ERAS) commonly employed?
Colorectal and orthropaedic surgery
What are the aims of ERAS?
Optimise pre-op prep for surgery
Avoid iatrogenic problems, e.g. ileus
Minimise adverse physiological/immunological responses to surgery
Increase speed of recovery and return to function
Recognise abnormal recovery and allow for early intervention
What adverse physiological/immunological responses to surgery are attempted to be avoided in ERAS?
Increase cortisol and decrease in insulin (absolute or relative)
Hypercoagulability
Immunosuppression
How is pre-op optimisation carried out?
Aggressive physiological optimisation
Smoking cessation
Admission on day of surgery with avoidance of prolonged fast
Carb loading prior to surgery
Fully informed patient encouraged to participate in recovery
What is involve in aggressive physiological optimisation pre-operatively?
Hydration BP management to within normal ranges Correction of anaemia Management of diabetes Management of co-morbidities
When should smoking be stopped before surgery?
At least 4 weeks
How is physical stress reduced intra-operatively?
Short-acting anaesthetic agents
Epidural use
Minimally invasive techniques
Avoid drains and NGTs where possible
How is early return to mobilisation and function achieved post-operatively?
Aggressive management of pain and nausea Early mobilisation and physiotherapy Early resumption of oral intake Early discontinuation of IV fluids Removal of drains and urinary catheter ASAP
