Module 4 - ERAS

Question 1

What are the 6 phases of ERAS?

Answer 1

1. Primary care referral - optimise pre-existing conditions.
2. Pre-op - Control conditions and manage expectations.
3. Admission - On day of operation. Hydration, carb loading, no (or reduced) oral bowel prep.
4. Intra-op - Minimally invasive where possible, transverse incision if possible, regional block, optimise fluid.
5. Post-op - mobilise, rapid hydration and nourishment, IV therapy, no drains, early TWOC, Analgesia
6. Follow up - Early discharge, therapy support, 24 hour telephone support.

Question 2

When should food and fluids be stopped pre-op?

Answer 2

Foods 6 hours
Fluids 2 hours (although some sip ‘till send).

Question 3

What proportion of pre-operative investigations change the operative management plan?

Answer 3

3%

Question 4

Below what haemoglobin is further iron studies required?

Answer 4

Hb < 120

Question 5

What other biomarker should be carried out alongside FBC and feritin in order to differentiate iron deficient anaemia from anaemia of chronic disease?

Answer 5

CRP

Question 6

Hb >100 + normal CRP signifies what type of anaemia?

Answer 6

Anaemia of chronic disease.

Question 7

Feritin <30 or feritin 30-100 + raised CRP signifies what type of anaemia?

Answer 7

Iron deficient anaemia.

Question 8

When should warfarin be stopped pre-op? and when should it be re-started post-op?

Answer 8

Stop 5 days before.
Re-start day after (with normal dose).
Bridge from stopping until INR in correct range.

Question 9

Apixiban (DOAC) or other factor Xa inhibitirs should be stopped and restarted when perioperatively?

Answer 9

Stop 48 hours before and re-start 48 hours after surgery.

Question 10

When should aspirin be stopped/restarted peri-operatively?

Answer 10

CAN BE CONTINUED

Question 11

When should clopidogrel be stopped and re-started peri-operatively?

Answer 11

Stop 7 days before.
Bridge with Aspirin.