Enhanced recovery after surgery (ERAS)…. still a distant speck on the horizon !

Mehdiratta, Lalit; Mishra, Sandeep Kumar; Vinayagam, Stalin; Nair, Abhijit

doi:10.4103/ija.ija_76_21

Cited by 14 publications

(9 citation statements)

References 14 publications

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“…Enhanced Recovery After Surgery (ERAS) is a multimodal perioperative care pathway designed and validated to achieve early recovery for patients undergoing major surgery [ 33 , 34 ]. Although initially ERAS pathways were supposed to be feasible for elective surgeries only as the pathways are separate for preoperative, intraoperative, and postoperative phases, the pathways have been successfully used for emergency surgeries as well.…”

Section: Reviewmentioning

confidence: 99%

Emergency Surgery Score as an Effective Risk Stratification Tool for Patients Undergoing Emergency Surgeries: A Narrative Review

Saxena¹,

Nair²

2022

Cureus

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Several risk stratification tools have been described for quantifying perioperative morbidity, mortality, and adverse events in patients undergoing elective and emergency surgeries. These tools help in decisionmaking, determining the prognosis and communicating it with patients and family members, and planning admissions to the intensive care units (ICU) if necessary. Emergency surgery poses quite a unique challenge in terms of deranged physiology, age, and comorbid conditions, and often carries a higher incidence of morbidity and mortality. Very few risk stratification tools are available to reliably predict the risk posed by emergency surgical interventions. One of the recently described tools is the Emergency Surgery Score (ESS), which comprises three demographic variables, 10 comorbidities, and nine laboratory variables, the scores of which add up to 29. Several studies have demonstrated that ESS reliably predicts morbidity, mortality, and the need for ICU admission, predicting infectious complications like pneumonia and renal failure. In this review, we analyze the current literature to investigate the efficacy and reliability of ESS as a risk stratification tool for patients undergoing emergency surgeries.

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Section: Reviewmentioning

confidence: 99%

Emergency Surgery Score as an Effective Risk Stratification Tool for Patients Undergoing Emergency Surgeries: A Narrative Review

Saxena¹,

Nair²

2022

Cureus

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“…[ 5 6 ] Early and enhanced recovery after surgery is encouraged nowadays with depth of anaesthesia monitoring being a part of it. [ 7 ] End-tidal anaesthetic gas concentration (ETAG) also reflects the anaesthetic depth. Maintaining the ETAG between 0.7 and 1.3 minimum alveolar concentration (MAC) decreases the likelihood of awareness.…”

Section: Introductionmentioning

confidence: 99%

Comparison of recovery times by using bispectral index monitoring versus end-tidal agent concentration monitoring in patients undergoing inhalational general anaesthesia

Chaudhuri¹,

Banerjee²,

Chattopadhyay³

et al. 2022

Indian J Anaesth

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Background and Aims: End-tidal anaesthetic gas concentration (ETAG) and bispectral index (BIS) are both used to monitor depth of anaesthesia. Maintaining an accurate depth of anaesthesia helps in early post-operative recovery. This study compared the recovery times from sevoflurane–nitrous oxide anaesthesia using ETAG monitoring with BIS monitoring. Methods: Four hundred and two patients undergoing elective surgeries under sevoflurane- nitrous oxide anaesthesia were enroled in this double blinded parallel group prospective randomised trial and allocated into two groups. The depth of anaesthesia was monitored using BIS in BIS group ( n = 202) and end-tidal sevoflurane concentration (EtSevo) in ETAG group ( n = 200). The time to extubation and recovery were compared between the groups. Parametric, non-parametric and categorical variables were compared using Student’s ‘ t ’ test, Wilcoxon’s rank sum test and Chi-square test, respectively. Results: Time to extubation (min) [BIS group – 10, 5; ETAG group – 10, 5 (median, inter-quartile range, IQR), P = 0.32] and time to recovery (min) [BIS group – 14, 6; ETAG group – 13.5, 7 (median, IQR), P = 0.34] did not differ significantly between the two groups. The EtSevo concentration (vol%) was significantly higher in the BIS group at 5 min [BIS group – 1.2, 0.4; ETAG group – 1.0, 0.4 (median, IQR), P < 0.001], 30 min [BIS group – 1.1, 0.4; ETAG group – 1.0, 0.3 (median, IQR), P = 0.002] and 120 min [BIS group – 1.11 ± 0.28; ETAG group – 0.96 ± 0.27 (mean ± standard deviation), P = 0.014] after induction of anaesthesia. Conclusions: BIS and ETAG monitoring are associated with comparable recovery profiles. ETAG monitoring is associated with significantly less sevoflurane consumption.

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“…Although ERAS is a well-accepted global initiative, the critical challenge in low and middle income countries is inadequate scientific evidences limiting its utility and the implementation of opioid-free protocols without escalating the cost of treatment. [ 25 ]…”

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confidence: 99%