Enhanced Recovery After Surgery (ERAS) for gastrointestinal surgery, part 2: consensus statement for anaesthesia practice

Abstract

BackgroundThe present interdisciplinary consensus review proposes clinical considerations and recommendations for anaesthetic practice in patients undergoing gastrointestinal surgery with an Enhanced Recovery after Surgery (ERAS) programme.MethodsStudies were selected with particular attention being paid to meta‐analyses, randomized controlled trials and large prospective cohort studies. For each item of the perioperative treatment pathway, available English‐language literature was examined and reviewed. The group reached a consensus recommendation after critical appraisal of the literature.ResultsThis consensus statement demonstrates that anaesthesiologists control several preoperative, intraoperative and postoperative ERAS elements. Further research is needed to verify the strength of these recommendations.ConclusionsBased on the evidence available for each element of perioperative care pathways, the Enhanced Recovery After Surgery (ERAS ®) Society presents a comprehensive consensus review, clinical considerations and recommendations for anaesthesia care in patients undergoing gastrointestinal surgery within an ERAS programme. This unified protocol facilitates involvement of anaesthesiologists in the implementation of the ERAS programmes and allows for comparison between centres and it eventually might facilitate the design of multi‐institutional prospective and adequately powered randomized trials.

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

“…Preoperative optimization also involves alcohol and smoking cessation and abstinence for at least 4 weeks before the surgery, to reduce the incidence of complications related to these habits [7][8][9][10]. Alcohol abusers have a two-to-threefold increase in postoperative morbidity, the most frequent complications being bleeding, wound and cardiopulmonary complications.…”

“…Fasting and carbohydrate loading: Standard care follows fasting guidelines supported by multiple anesthesia societies, that recommend that clear fluids and solid food should not be ingested 2 h and 6 h, respectively, before the induction of anesthesia. Although this is the recommendation, it is not uncommon for patients scheduled for elective surgery to fast since midnight [7,10]. There is no scientific evidence that fasting from midnight reduces the risk of pulmonary aspiration in elective surgery [7], and this practice has been shown to increase insulin resistance, produce patient discomfort [8] and potentially decrease intravascular volume [7,10].…”

“…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].…”

“…In addition to this, treatment with CHOs also has been shown to reduce preoperative thirst, hunger and anxiety [7,9]. Faster surgical recovery, as a consequence of this practice, still remains controversial [10].…”

“…Preoperative treatment with CHO drinks, following the "preoperative fasting status" ASA recommendations, is advised for all non-diabetic patients [9], and may be safely administered except in emergency surgeries [10,11], and in patients with documented delayed gastric emptying or gastrointestinal motility disorders [10,11]. Obese patients have been shown to have the same gastric-emptying characteristics as slim individuals.…”