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Enhanced recovery after surgery:an anesthesiologist’s perspective
Anesth Pain Med 2018;13(4):372-82
Published online October 31, 2018
© 2018 Korean Society of Neuroscience in Anesthesiology and Critical Care.

Minsuk Chae, Hyungmook Lee, Chan-oh Park, and Sang Hyun Hong
Department of Anesthesiology and Pain Medicine, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
Correspondence to: Sang Hyun Hong, M.D., Ph.D.
Department of Anesthesiology and Pain Medicine, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, 222 Banpo-daero, Seocho-gu, Seoul 06591, Korea
Tel: 82-2-2258-2236
Fax: 82-2-537-1951
E-mail: shhong7272@gmail.com
ORCID
http://orcid.org/0000-0002-7091-8963
Received September 10, 2018; Accepted September 17, 2018.
cc This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
Abstract
Enhanced recovery after surgery (ERAS) is a multimodal and multidisciplinary approach to maintaining physiologic function and improving recovery for surgical patients. The ERAS protocol is based on a range of empirical evidence, and consensus ERAS guidelines for various surgical procedures have been published. The elements of the ERAS protocol include minimal preoperative fasting and carbohydrate treatment instead of overnight fasting; no routine use of preoperative bowel preparation; minimally invasive surgical techniques; standard anesthetic protocol; optimal fluid management rather than generous intravenous fluid administration; prevention and treatment of postoperative nausea and vomiting; active prevention of perioperative hypothermia; multimodal approaches to controlling postoperative pain; and early oral intake and mobilization. Implementation of ERAS shortened hospital stays by 30% to 50% and reduced postoperative complications by 50%. A recent study reported that, when patient compliance with the colorectal ERAS protocol was over 70%, 5-year mortality fell by 42% compared with when compliance was below 70%. Auditing process compliance and patient outcomes are key measures for assisting clinicians implementing the ERAS program. As a perioperativist, an anesthesiologist can play a crucial role in implementing the ERAS program and contribute to protocol establishment, auditing, team education and team leadership. While the ERAS protocol was first implemented for colorectal surgery, as a result of its efficacy, it is now being used in nearly all major surgical specialties.
Key Words : Enhanced recovery after surgery; Fast-track surgery.


October 2018, 13 (4)
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