ERAS (AB) Flashcards
What are the three main phases of Enhanced Recovery After Surgery (ERAS)?
Preoperative. intraoperative. postoperative
What are two key areas of focus in anesthesia for ERAS?
Fluid therapy and analgesia
What is Goal-Directed Fluid Therapy (GDFT)?
Individualized fluid management to optimize cardiac output and avoid hypovolemia or fluid overload
Why is multimodal, opioid-sparing analgesia preferred in ERAS?
To reduce opioid side effects like nausea, vomiting, and urinary retention
What was the first surgical procedure to employ ERAS protocols?
Colonic surgery
What lifestyle changes are emphasized preoperatively in ERAS?
Smoking cessation and cessation of alcohol intake
What is an important preoperative element to prevent postoperative nausea and vomiting (PONV)?
Prevention strategies and multimodal antiemetics
What is recommended to ensure full recovery of neuromuscular blockade in ERAS?
Careful titration of anesthesia
What surgical technique is preferred in ERAS to minimize stress response?
Minimally invasive surgery (laparoscopic)
What type of anesthesia is recommended for major open abdominal and thoracic procedures in ERAS?
Thoracic epidural anesthesia
What are the benefits of thoracic epidural anesthesia in ERAS?
Excellent analgesia. facilitates mobilization. decreases ileus
How long should prophylactic antibiotics be continued after surgery (non-cardiothoracic)?
Within 24 hours
How long can prophylactic antibiotics be continued for cardiothoracic surgery?
48 hours
What is a key strategy to minimize surgical stress response?
Maintenance of normothermia
What types of anesthesia techniques help minimize surgical stress response?
Neural blockade. multimodal opioid-sparing analgesia
What regional anesthesia technique blocks nociceptive pathways and reduces opioid use?
Peripheral nerve blocks (PNBs)
What nerve block is an alternative to femoral nerve block with better-preserved quadriceps strength?
Hunter Canal Block
How does regional anesthesia contribute to faster recovery in ERAS?
Provides targeted pain relief. reduces opioid use. enhances early mobilization
What type of intravenous infusion is used in colorectal and radical rectal surgeries for analgesia?
Intravenous lidocaine infusion
What is the typical dose for IV lidocaine infusion in colorectal surgery?
100 mg bolus followed by 1.5-3 mg/kg/h continuous infusion
What drug class helps blunt the sympathetic response during laryngoscopy in ERAS?
Beta-blockers (e.g.esmolol)
What are benefits of esmolol in ERAS?
Reduces MAC. post-op pain. opioid consumption and PONV
What alpha-2 agonists are used for analgesia in ERAS?
Clonidine and dexmedetomidine
What is the intravenous anesthetic drug of choice in ERAS?
Propofol
What two inhalational anesthetics are preferred in ERAS?
Desflurane and sevoflurane
What is the importance of maintaining normothermia in ERAS?
Prevents surgical wound infections
How does early mobilization affect postoperative oxygenation and DVT risk?
Improves oxygenation and reduces DVT risk
What is the preferred type of fluid for extracellular losses in ERAS?
Isotonic balanced crystalloid
What type of fluid is used to replace physiologically important blood losses in ERAS?
Iso-oncotic colloids
What is a key mechanism that contributes to postoperative ileus?
Sympathetic inhibitory reflexes
What postoperative intervention can help reduce postoperative shivering?
Maintaining normothermia
What are key components of multimodal analgesia in ERAS?
NSAIDs. acetaminophen. gabapentinoids. NMDA antagonists. lidocaine. regional blocks
What analgesic technique can provide up to 72 hours of pain relief post-surgery?
Single-shot perineural liposomal bupivacaine
What factors contribute to postoperative ileus?
Sympathetic reflexes. local inflammation. systemic opioids. bowel edema
What is the recommended use of nasogastric tubes in ERAS?
Discouraged or used for very short periods
What genetic condition predisposes patients to malignant hyperthermia (MH)?
Mutation in RYR1 gene on chromosome 19
What triggers malignant hyperthermia in susceptible patients?
Inhaled anesthetics and succinylcholine
What is the earliest and most sensitive intraoperative indicator of malignant hyperthermia?
Sudden rise in end-tidal CO2
What is the definitive treatment for malignant hyperthermia?
IV dantrolene
What is the mechanism of action of dantrolene?
Inhibits calcium release from the sarcoplasmic reticulum
What is the initial dose of dantrolene for malignant hyperthermia?
2.5 mg/kg IV every 5 minutes (up to 10 mg/kg)
Why should calcium channel blockers not be given with dantrolene?
Risk of severe hyperkalemia
What diagnostic test confirms malignant hyperthermia susceptibility?
Halothane-caffeine contracture test
What is the genetic testing approach for malignant hyperthermia in family members?
RYR1 genetic testing
What are key signs of malignant hyperthermia?
Hyperthermia. tachycardia. muscle rigidity. hypercapnia. metabolic acidosis
What muscular condition increases susceptibility to malignant hyperthermia?
Central core disease
What is the gold standard diagnostic test for malignant hyperthermia?
Halothane-caffeine contracture test
Can malignant hyperthermia occur after uneventful anesthesia?
Yes
What type of anesthesia is recommended if surgery must proceed in a patient with malignant hyperthermia susceptibility?
Total intravenous anesthesia (TIVA)
What environmental factor can trigger malignant hyperthermia in susceptible individuals outside the OR?
Excessive exertion or extreme heat
