Principal of Eras

 

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ENHANCED RECOVERY AFTER SURGERY (ERAS) ANAESTHESIA TUTORIAL OF THE WEEK 204
  8TH NOVEMBER 2010

  Cathryn Matthews, Derriford Hospital, Plymouth. Correspondence to cathrynmatthews@gmail.com
 
 
 
  QUESTIONS
1. The stress response causes a. Hepatic glycogenolysis b. Insulin resistance c. Increased ACTH levels d. Reduced growth hormone levels Enhanced recovery programmes include a. Use of nasogastric tubes b. Carbohydrate drinks on day 1 postoperatively c. Transverse incisions d. Fasting from midnight before surgery Anaesthetic management of enhanced recovery patients can involve a. Regional techniques b. Sedative premedication c. Antiemetics d. Goal Directed fluid therapy

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INTRODUCTION
Enhanced recovery is a combination of elements of care for elective surgery which aims to: • • • • • Optimise pre-operative preparation for surgery Avoid iatrogenic problems such as postoperative ileus Minimise the stress response to surgery Speed recovery and return to normal function Early recognition of abnormal recovery and intervention if necessary

The overall strategy is that patients are in the best health for surgery, have evidence based care throughout their hospital stay and have the best possible rehabilitation. They also have partnership and responsibility for their care. The principles of this approach can be used for any surgery anywhere in the world. This approach has been used in many centres in the UK for different procedures, especially colorectal and orthopaedic surgery, and is now the focus of the Enhanced Recovery Partnership Programme (ERPP), which aims to spread the technique across the UK. Evidence is continuing to emerge about the benefits of enhanced or rapid recovery, and many other countries are incorporating it into their care; from Denmark, where Professor Kehlet first pioneered the technique, to the USA. The applications are likely to...