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SAGES

Reimagining surgical care for a healthier world

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Building Blocks: Intraoperative

Click on the title to get more information about this element of the SMART pathway.

Both laparoscopic surgery and ERPs result in improved outcomes when used in isolation. But additional benefits are seen when they are combined. In a large multicenter trial where patients were allocated to four groups combining surgical approach (laparoscopic or open) and perioperative care (enhanced recovery or standard), the combination of MIS and ERP resulted in […]

Posted on
07/01/2015
Surgery Type
Bowel
Building Blocks
Intraoperative

Multimodal analgesia: Optimal pain management while avoiding opioids is a key enabler of patient recovery. Furthermore, poor acute pain management is a strong risk factor for the development of chronic pain. A multimodal approach is recommended, using multiple strategies before, during and after surgery. Intraoperatively: For open surgery, neuraxial blockade via thoracic epidural combining local […]

Posted on
07/01/2015
Surgery Type
Bowel
Building Blocks
Intraoperative

There is a narrow range for optimal fluid therapy with a goal of maintaining euvolemia and avoiding both underhydration and salt and water excess. The complication rate goes up with fluid overload of as little as 3L in elective bowel surgery, especially with crystalloids (1). Use of a balanced crystalloid solution (eg Ringer’s lactate) is […]

Posted on
07/01/2015
Surgery Type
Bowel
Building Blocks
Intraoperative

Mild hypothermia through shivering and vasoconstriction elicits a stress response and increases rates of surgical site infection. Passive and active warmers are used to maintain normothermia (>35.5°). (1) For more information, see Chapter 7: Prevention of Hypothermia in The SAGES / ERAS® Society Manual of Enhanced Recovery Programs for Gastrointestinal Surgery References 1. Forbes SS, […]

Posted on
07/01/2015
Surgery Type
Bowel
Building Blocks
Intraoperative

Enhanced recovery programs depend greatly on the ability to support patients with early nutrition, multimodal analgesia and ambulation, none of which can be achieved unless the GI tract is functioning well. PONV prophylaxis begins in the operative room. Laparoscopic surgery may increase the risk of PONV while adequate hydration and opioid minimization are protective. A […]

Posted on
07/01/2015
Surgery Type
Bowel
Building Blocks
Intraoperative

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SAGES Enhanced Recovery

SAGES improves quality patient care through education, research, innovation and leadership, principally in gastrointestinal and endoscopic surgery.

Representing a worldwide community of more than 6,000 surgeons, SAGES sets the clinical and educational guidelines on standards of practice in various procedures, critical to enhancing patient safety and health.

SAGES Support

SAGES gratefully acknowledges Medtronic for its generous educational grant in support of the SMART Enhanced Recovery Program.

Preoperative
Intraoperative
Postoperative

SAGES Smart Task Force

  • Liane Feldman, Chair
  • Thomas Aloia, Co-Chair
  • Gina Adrales
  • Rajesh Aggarwal
  • Joselin Anandam
  • Conor Delaney
  • Diana Diesen
  • Justin Dimick
  • Julio Fiore Jr.
  • Gerald Fried
  • Pascal Fuchshuber
  • I. Gorgun
  • Alexis Grucela
  • Matthew Hutter
  • Edmundo Inga-Zapata
  • Rohan Joseph
  • Deborah Keller
  • Anne Lidor
  • David Liska
  • Sumeet Mittal
  • Charles Paget III
  • Michele Riordon
  • Vadim Sherman
  • Andrew Wright
  • Tonia Young-Fadok
  • Yulia Zak
  • Foundation
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  • MyCME
  • Educational Activities

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