Enhanced Recovery After Surgery Flashcards

1
Q

Where is enhanced recovery after surgery (ERAS) commonly employed?

A

Colorectal and orthropaedic surgery

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2
Q

What are the aims of ERAS?

A

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

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3
Q

What adverse physiological/immunological responses to surgery are attempted to be avoided in ERAS?

A

Increase cortisol and decrease in insulin (absolute or relative)
Hypercoagulability
Immunosuppression

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4
Q

How is pre-op optimisation carried out?

A

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

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5
Q

What is involve in aggressive physiological optimisation pre-operatively?

A
Hydration
BP management to within normal ranges
Correction of anaemia
Management of diabetes
Management of co-morbidities
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6
Q

When should smoking be stopped before surgery?

A

At least 4 weeks

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7
Q

How is physical stress reduced intra-operatively?

A

Short-acting anaesthetic agents
Epidural use
Minimally invasive techniques
Avoid drains and NGTs where possible

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8
Q

How is early return to mobilisation and function achieved post-operatively?

A
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
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