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, […]
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 […]
Urinary catheter: For routine laparoscopic right colectomy, the urinary catheter is removed in the operating room. Even in the presence of a thoracic epidural, urinary catheters can be removed on POD1 in patients at low risk for urinary retention. A bladder scan based protocol is used to monitor for urinary retention in patients who do […]
There are many key aspects of ERPs under the primary responsibility of the anesthesiology team including attenuation of surgical stress, fluid therapy, analgesia, and maintenance of normothermia and euglycemia. An anesthesia protocol allowing for rapid awakening is used. Deep neuromuscular blockade may help with exposure during laparoscopic surgery at lower pressures of pneumoperitoneum. For more […]
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. Postoperatively: patients are prescribed routine (not PRN) acetominophen 1gm q6hours and […]
Nasogastric tubes: Prophylactic NG tubes are not inserted routinely after bowel surgery. Meta-analyses of trials in mainly lower GI surgery found that bowel function was accelerated and pulmonary complications reduced when NGs were not used (1). NG tube insertion postoperatively may be required in up to 15% of patients. After gastrectomy, a meta-analysis comparing routine […]
Beginning in the surgeon’s office and continued with the preoperative clinic education, the patient and their family are provided with the daily plan for each day of hospitalization. These include milestones to achieve for diet and activities, information about management of pain and drains and the target discharge day if all goes well. These are […]