Enhanced Recovery After Surgery

00:00

Mr. Novák (55 years old, smoker) is admitted to the surgical ward. He has been diagnosed with colorectal adenocarcinoma in the region of colon descendens and indicated for resection. The patient has been selected for the programme ERAS (enhanced recovery after surgery). The ERAS protocol focuses on prehabilitation of the patient, preoperative counseling about the surgical and anaesthetic procedures, possible complications and early postoperative care. It is generally accepted that preoperative medical optimization is necessary before surgery, so Mr. Novák had been advised to stop smoking at least 4 weeks before surgery and reduce alcohol consumption. How will his preoperative preparation look like?

Preoperative bowel preparation, administration of LMWH, intravenous antibiotics, preoperative fasting: solids up to 6 hours, 400 mL carbohydrate treatment up to 2-3 hours or clear fluids up to 2 hours before the procedure.

Wrong answer

Mechanical bowel preparation should not be used routinely in colonic surgery because it has adverse physiologic effects attributed to dehydration, is distressing for the patient, and is associated with prolonged ileus after colonic surgery.


Back

Administration of LMWH, intravenous antibiotics, preoperative fasting: solids and fluids until midnight before surgery.

Wrong answer

Pharmacological prophylaxis with low-molecular-weight-heparin (LMWH) reduces the prevalence of symptomatic venous thromboembolism (VTE). Sometimes an extended prophylaxis for 28 days is suggested to patients with colorectal cancer. Routine prophylaxis with intravenous antibiotics (cover against aerobic and anaerobic bacteria) reduces the risk of surgical-site infections and should be given 30–60 min before initiating colorectal surgery. However, it is recommended to optimise the fasting time before the procedure.


Back

Preoperative bowel preparation, preoperative fasting: solids and fluids until midnight before surgery.

Wrong answer

Mechanical bowel preparation should not be used routinely in colonic surgery because it has adverse physiologic effects attributed to dehydration, is distressing for the patient, and is associated with prolonged ileus after colonic surgery. Moreover it is recommended to optimise the fasting time before the procedure.


Back

Administration of LMWH, intravenous antibiotics, preoperative fasting: solids up to 6 hours, 400 mL carbohydrate treatment up to 2-3 hours or clear fluids up to 2 hours before the procedure.

Correct answer

Prehabilitation is the one and only chance to improve the patient's physical condition. It helps to lower the cardiovascular risks of general anaesthesia and the surgical procedure.
Pharmacological prophylaxis with low-molecular-weight-heparin (LMWH) reduces the prevalence of symptomatic venous thromboembolism (VTE). Sometimes an extended prophylaxis for 28 days is suggested to patients with colorectal cancer. Routine prophylaxis with intravenous antibiotics (cover against aerobic and anaerobic bacteria) reduces the risk of surgical-site infections and should be given 30–60 min before initiating colorectal surgery. Carbohydrate treatment 2-3 hours prior to surgery reduces preoperative thirst, hunger, and anxiety as well as postoperative insulin resistance and results in less postoperative losses of nitrogen and protein.


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ERAS = Enhanced Recovery After Surgery
LMWH = low molecular weight heparin
ATB = antibiotics×
 
RR

16 bpm

HR

68 bpm

SpO2

not available

BP

124/81 mmHg

ECG

sinus rythm, regular pace, BPM 68 bpm, 45° axis, 150 ms PR, 90 ms QRS, 340 ms QT

 

Gly

results

ABG

not available

CBC

results

biochemistry

results