Enhanced Recovery After Surgery (ERAS)

Question 1

Enhanced Recovery After Surgery (ERAS)

Answer 1

a modern approach to help peoplerecover quicker following surgery. Guidelines consist of a combination ofevidence-basedperioperative careelements designed toreduce post-surgical complications,length of hospital stay, andoverallcosts, by modifying the psychological and physiological responses to major surgery.

The elements that form ERAS consist of strategies that focus onpatient engagement, pre-surgicalmedical optimisation,optimal anaestheticprotocols, andpostoperative nausea prophylaxis.

From thesurgical side, key elements in ERAS include minimally invasive surgery, avoiding dehydrating bowel preparation where possible, early removal of drains and catheters, and early post-operative mobilisation.

The ERAS protocol can be divided into the 3 stages of the patient journey, each comprising several elements

Question 2

Pre-Operative

Answer 2

●Patient education regarding the surgery and the expected post-operative course and milestones
●Ensuring the patient is as healthy as possible prior to surgery through exercise and weight loss
●Optimising medical management, including smoking and alcohol cessation
●Optimal pre-operative fasting guidelines
●Altered diet prior to surgery to enhance bowel recovery and avoid bowel prep if appropriate
●Solids allowed until 6 hours pre-operatively (unless contra-indicated)
●Intake of clear fluids until 2 hours prior to surgery

Question 3

Intra-Operative

Answer 3

●Use of multimodal and opioid-sparing analgesia, including regional anaesthesia*
•Includes avoidance of short-acting benzodiazepines in the elderly
●Use ofmultimodal postoperative nausea and vomiting prophylaxis
●Use ofminimally invasive surgery
●Targeting agoal-directed fluid therapy regime, including goal-directed haemostasis management

Question 4

Post-Operative

Answer 4

●Ensureadequate pain controlis achieved to allow for early mobilisation
●Early oral intakeandoptimising nutrition
[Early feeding reduces the body’s response to surgical trauma]
●Multi-disciplinarypost-operative patient follow-up, including in the post-acute care phase
● Removal of all the tubes: NG, catheter, IV lines

Question 5

Post operative pyrexia 7Ws

Answer 5

1. Wander drugs: Anaesthetics + Transfusions
2. Wind: basal atelectasis, pneumonia
3. Water: UTI from a previous put catheter, or the one still in situ
4. Waterway: Peripheral or central venous catheter.
5. Wound: surgical site infection
6. W(veins): DVT, Pulmonary 🫁 embolism
7. W(abscess): infection of an organ or space