Essential elements of anaesthesia practice in ERAS programs
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TOPIC PAPER
Essential elements of anaesthesia practice in ERAS programs Géraldine Pignot1 · Clément Brun2 · Maxime Tourret2 · François Lannes1 · Sami Fakhfakh1 · Stanislas Rybikowski1 · Thomas Maubon1 · Marion Picini3 · Jochen Walz1 Received: 5 May 2020 / Accepted: 11 August 2020 © Springer-Verlag GmbH Germany, part of Springer Nature 2020
Abstract Purpose Enhanced recovery pathways vary amongst institutions but include key components for anesthesiologists, such as haemodynamic optimization, use of short-acting drugs (and monitoring), postoperative nausea and vomiting (PONV) prophylaxis, protective ventilation, and opioid-sparing multimodal analgesia. Methods After critical appraisal of the literature, studies 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 literature was examined and reviewed. Results Patients should be permitted to drink clear fluids up to 2 h before anaesthesia and surgery. Oral carbohydrate loading should be used routinely. All patients may have an individualized plan for fluid and haemodynamic management that matches the monitoring needs with patient and surgical risk. Minimizing the side effects of anaesthetics and analgesics using shortacting drugs with careful perioperative monitoring should be encouraged. Protective ventilation with alveolar recruitment maneuvers is required. Preventive use of a combination with 2–3 antiemetics in addition to propofol-based total intravenous anaesthesia (TIVA) is most likely to reduce PONV. While the ideal analgesia regimen remains to be determined, it is clear that a multimodal opioid-sparing analgesic strategy has significant benefits. Conclusion Careful evaluation of single patient and planning of the anesthetic care are mandatory to join the ERAS philosophy. Optimal fluid management, use of short-acting drugs, prevention of PONV, protective ventilation, and multimodal analgesia are the cornerstones of the anaesthesia management within ERAS protocols. Keywords ERAS · Urology · Surgery · Analgesia · Anaesthesia
Introduction Surgery is a complex treatment method, where tissue insult is an expected part of patient care. Extended surgical interventions in abdominal surgery result in major surgical stress (including anxiety, pneumoperitoneum, tissue aggression, blood transfusion, and hypothermia) but also anaesthesia stress (opioids, ventilation, fasting, and filling). This may induce post-aggressive response with insulin resistance, * Géraldine Pignot [email protected] 1
Department of Oncological Surgery 2, Institut PaoliCalmettes, 13009 Marseille, France
2
Department of Anesthesiology, Institut Paoli-Calmettes, 13009 Marseille, France
3
Department of Care Coordination, Institut Paoli-Calmettes, 13009 Marseille, France
increased catabolism and secretion of cortisol, catecholamines, prostaglandins, and cytokines. And this can lead to direct and/or indirect complications [1]. T
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