Enhanced recovery after surgery: A clinical review of implementation across multiple surgical subspecialties

Publication date: Available online 16 November 2019Source: The American Journal of SurgeryAuthor(s): Thomas W. Smith, Xuanji Wang, Marc A. Singer, Constantine V. Godellas, Faaiza T. VainceAbstractEnhanced recovery after surgery (ERAS) is a multimodal protocol applied towards perioperative patient care. ERAS programs are implemented by a multidisciplinary team centered around the patient, incorporating outpatient clinical staff, preoperative nurses, anesthesiologists, operative nurses, postoperative recovery staff, floor inpatient nurses, dieticians, physical therapists, social workers, and surgeons. Initial studies on perioperative care measures focused on cardiac surgery. Subsequently, the development of the ERAS Study Group in 2001 focused on colorectal surgery and postoperative outcome measures. Today, ERAS protocols have been implemented across many surgical subspecialties including: bariatric, breast, plastic, cardiac, colorectal, esophageal, head and neck, hepatic, gynecologic, neurosurgical, orthopedic, pancreatic, thoracic, and urologic surgery. The goal of ERAS programs is to promote rapid recovery as quantified by decreasing the length of hospital stay, complications, and cost of specific surgical interventions. In the setting of the opioid crisis in America, there is also an increasing focus on minimizing perioperative narcotic use. The purpose of this review is to compare ERAS protocols across surgical subspecialties, focusing on quantified metrics of improvement,...
Source: The American Journal of Surgery - Category: Surgery Source Type: research

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Risk Factors for Moderate to Severe Pain during the First 24 Hours after Laparoscopic Bariatric Surgery While Receiving Intravenous Patient-Controlled Analgesia. Anesthesiol Res Pract. 2019;2019:6593736 Authors: Iamaroon A, Tangwiwat S, Nivatpumin P, Lertwacha T, Rungmongkolsab P, Pangthipampai P Abstract Objective: To investigate the incidence of and risk factors for moderate to severe pain during the first 24 hours after laparoscopic bariatric surgery. Materials and Methods: This retrospective study included morbidly obese patients who underwent laparoscopic sleeve gastrectomy or Ro...
Source: Anesthesiology Research and Practice - Category: Anesthesiology Tags: Anesthesiol Res Pract Source Type: research
Endocrine Practice, Ahead of Print.
Source: Endocrine Practice - Category: Endocrinology Authors: Source Type: research
Endocrine Practice, Ahead of Print.
Source: Endocrine Practice - Category: Endocrinology Authors: Source Type: research
Condition:   Postoperative Quality of Recovery Interventions:   Combination Product: Opioid Free Total Intravenous Anesthesia;   Combination Product: Total Intravenous anesthesia with opioid Sponsor:   Northwell Health Not yet recruiting
Source: ClinicalTrials.gov - Category: Research Source Type: clinical trials
ConclusionsPressure-controlled ventilation mode is not superior to volume-controlled ventilation mode in patients with laparoscopic bariatric surgery.ResumoJustificativaO modo de ventilação mecânica que deve ser usado em cirurgia bariátrica, uma das opções de tratamento para pacientes com obesidade, ainda não foi definido.ObjetivosComparar as ventilações controladas por volume e por pressão em termos de mecânica respiratória e dos valores da gasometria arterial em pacientes submetidos à cirurgia bariátrica laparoscópica.M...
Source: Brazilian Journal of Anesthesiology - Category: Anesthesiology Source Type: research
SUMMARY OBJECTIVE To investigate the use of Bilevel Positive Airway Pressure (BiPAP) in morbidly obese individuals in two moments following bariatric surgery (Roux-en-Y gastric bypass): post-anesthetic recovery (PAR) and first postoperative day (1PO). DESIGN Randomized and blinded clinical trial. METHODS We studied 40 morbidly obese individuals aged between 25 and 55 years who underwent pulmonary function test and chest X-ray preoperatively, and on the day of discharge (2nd day after surgery). They were randomly allocated into two groups: PAR-G (BiPAP in PAR for one hour), and 1PO-G (BIPAP for one hour on the 1PO). RESULTS...
Source: Revista da Associacao Medica Brasileira - Category: General Medicine Source Type: research
Both the American Society of Echocardiography and the Society of Cardiovascular Anesthesiologists consider transesophageal echocardiography (TEE) a relative contraindication in patients with histories of bariatric surgery, and survey data indicate that many physicians who routinely use TEE in their practice consider bariatric surgery to be an absolute contraindication or are not certain.1,2 There is currently no published evidence to support or discourage the use of TEE in this patient population.
Source: Journal of the American Society of Echocardiography - Category: Cardiology Authors: Tags: Brief Research Communications Source Type: research
The laparoscopic adjustable gastric band (AGB) is associated with poor long-term weight loss and frequent untoward outcomes. Increasingly, patients are referred for revisional bariatric surgery, wherein a previously-placed adjustable gastric band is removed in favor of laparoscopic Roux-en-Y gastric bypass or sleeve gastrectomy (SG). Recently, data have emerged that argue for the safety of a 1-stage approach to these maneuvers, which offers potential benefits over a 2-stage approach including fewer instances of general anesthesia, fewer total abdominal procedures, and fewer interruptions in patients ’ lives.
Source: Surgery for Obesity and Related Diseases - Category: Surgery Authors: Source Type: research
It has recently been suggested that liposomal bupivacaine as an extended release local anesthetic may provide lasting pain control and therefore decrease the need for narcotics in the immediate post-operative period. The aim of this study was to evaluate whether Transversus Abdominis Plane(TAP) block with liposomal bupivacaine(LB) decreased the use of post-operative narcotics compared to regular bupivacaine(RB) and no TAP block(NB) in patients undergoing laparoscopic weight loss surgeries.
Source: Surgery for Obesity and Related Diseases - Category: Surgery Authors: Source Type: research
The opiate crisis in America has prompted institutions nationwide to explore different modalities to reduce opiate use. Bariatric surgery patients are especially at risk. Long-acting liposomal local anesthetic is one of those modalities, and this medication can easily be utilized in surgical patients to reduce postoperative incisional pain. Objective: To compare the postoperative outcomes after surgical local infiltration with short-acting plain bupivacaine compared to long-acting liposomal bupivacaine in patients undergoing minimally invasive, general surgery procedures.
Source: Surgery for Obesity and Related Diseases - Category: Surgery Authors: Source Type: research
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