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Review
. 2015 Nov;59(10):1212-31.
doi: 10.1111/aas.12601. Epub 2015 Sep 8.

Enhanced Recovery After Surgery (ERAS) for gastrointestinal surgery, part 1: pathophysiological considerations

M J Scott  1 , G Baldini  2 , K C H Fearon  3 , A Feldheiser  4 , L S Feldman  5 , T J Gan  6 , O Ljungqvist  7 , D N Lobo  8 , T A Rockall  1 , T Schricker  9 , F Carli  2
Affiliations
Review

Enhanced Recovery After Surgery (ERAS) for gastrointestinal surgery, part 1: pathophysiological considerations

M J Scott et al. Acta Anaesthesiol Scand. 2015 Nov.

Abstract

Background: The present article has been written to convey concepts of anaesthetic care within the context of an Enhanced Recovery After Surgery (ERAS) programme, thus aligning the practice of anaesthesia with the care delivered by the surgical team before, during and after surgery.

Methods: The physiological principles supporting the implementation of the ERAS programmes in patients undergoing major abdominal procedures are reviewed using an updated literature search and discussed by a multidisciplinary group composed of anaesthesiologists and surgeons with the aim to improve perioperative care.

Results: The pathophysiology of some key perioperative elements disturbing the homoeostatic mechanisms such as insulin resistance, ileus and pain is here discussed.

Conclusions: Evidence-based strategies aimed at controlling the disruption of homoeostasis need to be evaluated in the context of ERAS programmes. Anaesthesiologists could, therefore, play a crucial role in facilitating the recovery process.

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Figures

Figure 1
Figure 1
ERAS elements. Reproduced from Varadhan KK et al. with permission.105
Figure 2
Figure 2
Perioperative fluid administration with and without an ERAS surgical pathway: risk of perioperative fluid excess and tissue hypoperfusion.104 Reproduced from Minto G et al. with permission.
Figure 3
Figure 3
Pathogenesis of post‐operative ileus. MLC, myosin light chain; STAT, signal transducer and activator of transcription; TNF, tumour necrosis factor; VIP, vasoactive intestinal polypeptide. From Bragg et al. with permission.74
Figure 4
Figure 4
Post‐operative pain: physiological consequences and impact on outcomes and ERAS protocol. CNS, Central Nervous System; HPA axis, Hypothalamic‐Pituitary‐Adrenal axis; CV, Cardiovascular; HR, Heart Rate; SVR, Systemic Vascular Resistance; MRO2, Metabolic Rate of Oxygen; FRC, Functional Residual Capacity; VC, Vital Capacity; MV, Minute Ventilation; GI, Gastrointestinal; ADH, Antidiuretic Hormone; PG, Prostaglandins; UO, Urinary Output; UR, Urinary Retention; VTE, Venous Thromboembolism; IR, Insulin Resistance. Reproduced from Cologne K et al. with permission.106
See this image and copyright information in PMC

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