Anaesthetic perioperative management according to the ERAS protocol

Abstract

After many years of experience in surgery, a series of recommendations have been created by a group of European specialists to improve the quality of perioperative care and maximize postoperative outcomes. Early mobilization and oral feeding, preoperative oral intake of carbohydrate-rich fluids, proper fluid and pain management, intensive postoperative nausea and vomiting prophylaxis, and antimicrobial and thromboembolism prophylaxis are the interventions that may decrease surgery-induced metabolic stress and facilitate the return of bowel function and early discharge. The Enhanced Recovery After Surgery (ERAS) Society is the group that focuses on these perioperative issues. This paper aims to summarize the role of anaesthesiologists in the implementation of the ERAS protocol.

Perioperative Nutritional Support or Perioperative Fasting?

“…Several studies show that nutrition preparation leads to a significant reduction in thirst, hunger and, at the same time, drinking certain beverages provides energy [8]. Burch [11] describes how the use of a preoperative carbohydrate-loading drink can be safely consumed a few hours before surgery and it is associated with fewer complications and a shorter length of stay in hospital.…”

“…The goals of ERAS protocols include attenuating the surgical stress response and reducing end organ dysfunction through integrated preoperative, intraoperative, and postoperative pathways. Initiated by Professor Henrik Kehlet in Denmark in the 1990s, the ERAS Protocol allows the patient to take nutrients up to a few hours before surgery [5,6,7,8].…”

“…Nutrition preparation leads to a significant reduction in thirst, hunger and, at the same time, drinking certain beverages provides energy [8].…”

Impact of epidural bupivacaine on perioperative opioid requirements, recovery characteristics, and duration of hospitalization in dogs undergoing cystotomy: A retrospective study of 56 cases

“…Epidural anesthesia, on the other hand, causes fewer negative physiological effects compared with systemic opioids. Epidural anesthesia attenuates surgically induced stress and reduces intraoperative sympathetic activation, incidence of arrhythmias, time to extubation, and duration of intensive care unit stay and thus improves postoperative outcome …”

“…Epidural anesthesia attenuates surgically induced stress and reduces intraoperative sympathetic activation, incidence of arrhythmias, time to extubation, and duration of intensive care unit stay and thus improves postoperative outcome. [6][7][8][9][10] Epidural anesthesia is considered a simple, safe, and effective technique. Adverse effects are rare in dogs but include phrenic nerve paralysis secondary to cervical spread of the local anesthetic, hypotension, Horner's syndrome caused by sympathetic blockade, and, infrequently, signs of cardiotoxicity and neurotoxicity in the event of accidental intravascular injection of the local anesthetic.…”