Enhanced Recovery After Surgery (ERAS) for gastrointestinal surgery, part 1: pathophysiological considerations

Abstract

BackgroundThe present article has been written to convey concepts of anaesthetic care within the context of an Enhanced Recovery After Surgery (ERAS) programme, thus aligning the practice of anaesthesia with the care delivered by the surgical team before, during and after surgery.MethodsThe physiological principles supporting the implementation of the ERAS programmes in patients undergoing major abdominal procedures are reviewed using an updated literature search and discussed by a multidisciplinary group composed of anaesthesiologists and surgeons with the aim to improve perioperative care.ResultsThe pathophysiology of some key perioperative elements disturbing the homoeostatic mechanisms such as insulin resistance, ileus and pain is here discussed.ConclusionsEvidence‐based strategies aimed at controlling the disruption of homoeostasis need to be evaluated in the context of ERAS programmes. Anaesthesiologists could, therefore, play a crucial role in facilitating the recovery process.

Same-day discharge after craniotomy for supratentorial tumour surgery: a retrospective observational single-centre study

“…1 Enhanced Recovery after Surgery represents a paradigm shift in perioperative care where traditional practices were re-examined and replaced with evidence-based best practices that cover all aspects of patient care through the surgical process. 2 Though pioneered for colorectal surgery, ERAS is gaining momentum in other major surgeries, such as pelvic and orthopedic procedures. 3,4 Traditionally, neurosurgery is a resource-intensive surgical specialty where surgery for a brain tumour often involves a large craniotomy with invasive intraoperative monitoring and frequent admission to the postoperative intensive care unit (ICU).…”

Enhanced Recovery After Surgery Pathway: How its Implementation Influenced Digestive Surgery Outcomes?

“…The increase of preoperative insulin levels, reduces postoperative insulin resistance [9], maintains glycogen reserves, decreases protein breakdown and reduces the loss of muscle strength [2,7,9,10]. In addition to this, treatment with CHOs also has been shown to reduce preoperative thirst, hunger and anxiety [7,9].…”

“…The elimination of ileus, allows for earlier initiation of enteral nutrition, which is essential to reduce risk of infection [5]. Strategies to reduce the risk of postoperative ileus, included in the ERAS pathway, are balancing fluids, avoiding nasogastric tubes [7,9], opioid analgesia, and PONV [2,9].…”

“…The ERAS programs, originally based on the "fast track" surgery concept introduced by Henrik Kehlet [1], were developed as multimodal perioperative pathways that include multiple interventions that individually produce small insignificant effects, but collectively have a strong synergistic impact on the patients' homeostasis [2]. These protocols strike to attenuate the metabolic stress through perioperative measures, and simultaneously to support the patient's rapid return to baseline function, producing therefore a decrease in complication rates and lessening the recovery time after surgery.…”

How to implement an enhanced recovery program? Proposals from the Francophone Group for enhanced recovery after surgery (GRACE)

“…A better understanding of the pathophysiologic phenomena that surround surgery (surgical insult or stress), the development of mini-invasive surgical techniques, improvement of perioperative analgesia, and the publication of several scientific studies on perioperative care with a high level of evidence have led to the advent of ERP [5]. In the mid 1990s, Henrik Kehlet from Copenhagen was the first to talk about ''fasttrack surgery'' in colorectal surgery.…”