Upload
others
View
1
Download
0
Embed Size (px)
Citation preview
Obj
ectiv
es•I
s ERA
S a
new
thin
g or
a re
inve
ntio
n?•A
pplic
atio
ns a
nd T
eam
wor
k•A
nesth
esia
Con
cern
s•C
o$$$
$$$$
$$t
•Whe
re c
an im
prov
emen
ts be
mad
e?
ERA
S by
Defi
nitio
n (A
AN
A)
•Enh
ance
d R
ecov
ery
afte
r Sur
gery
(ER
AS®
) ref
ers t
o pa
tient
-cen
tere
d,ev
iden
ce-b
ased
, mul
tidis
cipl
inar
y te
am d
evel
oped
pat
hway
s for
asu
rgic
al sp
ecia
lty a
nd fa
cilit
y cu
lture
to re
duce
the
patie
nt’s
surg
ical
stre
ss re
spon
se, o
ptim
ize
thei
r phy
siol
ogic
func
tion,
and
faci
litat
ere
cove
ry. T
hese
car
e pa
thw
ays f
orm
an
inte
grat
ed c
ontin
uum
, as t
hepa
tient
mov
es fr
om h
ome
thro
ugh
the
pre-
hosp
ital /
pre
adm
issi
on,
preo
pera
tive,
intra
oper
ativ
e, a
nd p
osto
pera
tive
phas
es o
f sur
gery
and
hom
e ag
ain.
Fast
Tra
ck S
urge
ry
•Hen
rik K
ehle
t pio
neer
ed th
eco
ncep
t in
the
1990
s with
an
initi
ativ
e or
igin
ally
kno
wn
as“f
ast-t
rack
surg
ery”
Old
idea
s app
lied
toda
y•T
he fi
rst E
nhan
ced
Reco
very
Afte
r Sur
gery
(ERA
S) p
roto
col w
ases
tabl
ished
in 2
001
by a
gro
up o
f sur
geon
s fro
m N
orth
ern
Euro
pe.
Thei
r prim
ary
goal
was
to o
ptim
ize
surg
ical
out
com
es th
roug
h th
eim
plem
enta
tion
of e
vide
nce-
base
d m
edic
ine
and
best
prac
tices
inpa
tient
s und
ergo
ing
colo
nic
rese
ctio
ns.
•The
cur
rent
pro
pone
nts o
f ERA
S en
cour
age
the
proc
ess o
ne st
epfu
rther
by
conc
entra
ting
on th
e qu
ality
of p
atie
nt c
are
and
impr
ovin
gpa
tient
s' fu
nctio
nal c
apac
ity, t
here
by e
xped
iting
the
retu
rn to
bas
elin
efu
nctio
n.
App
licat
ions
and
Tea
mw
ork
•The
prim
ary
goal
s of t
he m
ultim
odal
, mul
tidis
cipl
inar
y, a
ndco
mpr
ehen
sive
ER
AS
path
way
s are
to b
lunt
the
resp
onse
to su
rgic
alst
ress
thro
ugh
optim
izat
ion
of n
utrit
iona
l and
func
tiona
l sta
tus,
limita
tion
of p
reop
erat
ive
fast
ing,
indi
vidu
aliz
ed fl
uid
man
agem
ent,
opio
id-s
parin
g an
alge
sia,
min
imal
ly in
vasi
ve su
rger
y, a
nd e
arly
post
oper
ativ
e am
bula
tion
and
feed
ing.
The
se c
ompo
nent
s hav
efa
cilit
ated
a fa
ster
retu
rn to
the
patie
nt's
preo
pera
tive
func
tiona
l sta
te.
Thou
gh g
uide
lines
var
y, th
ere
are
roug
hly
20 e
lem
ents
incl
uded
inea
ch p
athw
ay. M
ultid
isci
plin
ary
team
s of p
rofe
ssio
nals
mus
t wor
kto
geth
er
App
licat
ions
•You
nam
e it…
……
…..
•Col
orec
tal
•Orth
o•G
YN
•PED
S•G
U•C
-Sec
tion
•Spi
ne
Stre
ss R
espo
nse
You
Are
Goi
ng to
Drin
k W
hat W
hen?
???
•Man
y stu
dies
hav
e de
mon
strat
ed th
at u
nder
goin
g su
rger
y in
aca
rboh
ydra
te-fe
d sta
te (b
y w
ay o
f a c
arbo
hydr
ate
clea
r liq
uid
drin
k)ve
rsus
a fa
sting
stat
e re
sults
in im
prov
ed p
atie
nt sa
tisfa
ctio
n an
dcl
inic
al b
enefi
ts du
e to
the
redu
ctio
n in
pos
tope
rativ
e in
sulin
resis
tanc
e.26
,27
ERA
S gu
idel
ines
reco
mm
end
800
mL
of a
12.
5%ca
rboh
ydra
te-c
onta
inin
g cl
ear d
rink
with
a p
rove
n sa
fety
pro
file
the
nigh
t bef
ore
surg
ery
and
400
mL
2 ho
urs b
efor
e su
rger
y.28
In p
atie
nts
with
type
I di
abet
es o
r sev
ere
type
2 d
iabe
tes,
ESPE
N re
com
men
dsav
oidi
ng c
arbo
hydr
ate
drin
ks b
ecau
se th
ese
patie
nts a
re in
sulin
defic
ient
, not
insu
lin re
sista
nt.2
9 Th
e be
nefit
s of p
reve
ntin
g ca
tabo
lism
incl
ude
impr
oved
tiss
ue h
ealin
g, d
ecre
ased
infe
ctio
n ra
tes,
decr
ease
dLO
S in
maj
or su
rger
y,27
and
redu
ced
posto
pera
tive
naus
ea a
ndvo
miti
ng.3
0,31
Are
as fo
r Im
prov
emen
t
•Sch
mid
t P, R
ao S
. Effe
cts o
f gab
apen
tin, p
rega
balin
and
gas
troet
entiv
e•g
abap
entin
on
sim
ulat
ed d
rivin
g, d
aytim
e se
datio
n an
d co
gniti
on. P
ain
•Man
ag. 2
018;
8(4)
:297
-306
.• •C
aval
cant
e A
N, S
prun
g J,
Schr
oede
r DR
, Wei
ngar
ten
TN. M
ultim
odal
•Ana
lges
ic T
hera
py W
ith G
abap
entin
and
Its A
ssoc
iatio
n W
ith•P
osto
pera
tive
Res
pira
tory
Dep
ress
ion.
Ane
sth
Anal
g. 2
017;
125(
1):1
41-
•146
.• •