Background
Surgery perturbs normal homeostasis and triggers a stress response as well as an immune-altered state in patients. These perturbations can impede wound healing and recovery from surgery, so ERAS efforts are aimed at minimizing the stress response to surgery and preserving normal physiology in the perioperative period.
An ERAS Pathway is an integrated care approach that includes planning, education, and interventions that follow the patient through all perioperative phases of care (pre-op planning, day of surgery, intraop, post-op care, discharge).
Goals
- prevent/treat post-operative nausea
- reduce ileus
- decrease hyperglycemia and insulin resistance
- promote wound healing and prevent surgical site infection
- prevent other hospital acquired infections (CAUTI, pneumonia)
- shorten length of stay
- improve patient experience
Anesthesia Care for ERAS Pathway Patients
Anesthesia providers are integral to the care of ERAS Pathway patients, particularly in the intraop phase of care. Anesthesia care and interventions for ERAS patients include:
- optimizing prophylactic anti-emetics preop and intraop
- optimizing analgesia while avoiding opioids
- active warming of patients
- glucose checks and treatment of hyperglycemia
ZSFG Colorectal ERAS
At ZSFG, the ERAS pathway for patients undergoing colorectal surgery is live as of September 2023. Anesthesia interventions recommended by the pathway can be found here:
Colorectal ERAS Pathway - AnesthesiA Care
Further Reading/Resources
ERAS Society - Colorectal ERAS
Review Articles
Simpson JC, Bao X, Agarwala A. Pain Management in Enhanced Recovery after Surgery (ERAS) Protocols. Clin Colon Rectal Surg. 2019 Mar;32(2):121-128. doi: 10.1055/s-0038-1676477. Epub 2019 Feb 28. PMID: 30833861; PMCID: PMC6395101. (Open Access via Pubmed Central)