Tong J Gan： A New Paradigm for Surgical Patients
Evidence-based medicine has arguably been the biggest driver for the change in practice and improvement in outcomes seen over the last twenty years. So a pertinent question is: how much of our routine perioperative care in general surgical surgery is evidence-based? Is there evidence that epidural analgesia improve outcomes after surgery? Is there evidence that hemodynamic optimization during surgery shorten length of hospital stay? Is there evidence for the routine use of nasogastric tubes after major surgery? Is there evidence for the routine use of bowel preparation in colorectal surgery? And is there evidence that nil by mouth orders should be enforced until bowel sounds are heard postoperatively? These are commonly asked questions among health care providers.
Enhanced Recovery After Surgery (ERAS) is the name that has been applied to a multidisciplinary perioperative care pathway that aims to standardize perioperative care, and apply evidence-based medicine to all aspects of a patient’s operative journey. Elements which have been incorporated into an ERAS protocol include epidural for analgesia, intraoperative goal directed fluid therapy, avoidance of nasogastric tube in the postoperative period, encourage early feeding and early mobilization as well as a number of others.
Although Enhanced Recovery has been described for some time, implementation is not widespread. There are many barriers to implementation that need to be overcome to achieve success. This presentation will review the evidence for the critical elements within an ERAS protocol and discuss the outcomes of an ERAS approach and factors that can affect the successful implementation of such a protocol within a busy clinical setting.
编辑: lil 作者:丁香园通讯员
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