Enhanced Recovery After Surgery

Question 1

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

Answer 1

Colorectal and orthropaedic surgery

Question 2

What are the aims of ERAS?

Answer 2

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

Question 3

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

Answer 3

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

Question 4

How is pre-op optimisation carried out?

Answer 4

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

Question 5

What is involve in aggressive physiological optimisation pre-operatively?

Answer 5

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

Question 6

When should smoking be stopped before surgery?

Answer 6

At least 4 weeks

Question 7

How is physical stress reduced intra-operatively?

Answer 7

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

Question 8

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

Answer 8

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