ERAS become popular topic in modern surgical practice. In these slides I have summarized ERAS in thoracic surgery.

1. Enhanced Recovery After Surgery (ERAS)
in Thoracic Surgery
Dr. K Khaing Saw Lwin
MBBS, MRCSEd, MMedSc (Thoracic Surgery)

2. • A strategy that seeks to reduce patients'
perioperative stress response
reducing potential complications,
decreasing hospital length of stay and
enabling patients to return more quickly to
their baseline functional status

3. • Preoperative Phase : Patient Optimization
• Intra-operative phase: technical aspects
designed to achieve maximum reduction of
trauma and complications;
• Post-operative phase: management and
removal criteria for pleural drains and other
invasive devices [e.g., nasogastric tube (NGT),
central venous catheter (CVC), urinary
catheter, arterial catheter]

4. • Team Approach together with patient
cooperation

5. PREOPERATIVE PREPARATION

6. • One Stop Clinic Strategy
- Preoperative investigations
- Surgical Review
- Consultant-led anesthetic assessment
- Patient education

7. INTRAOPERATIVE CARE

8. • Perioperative care
- Adequate Hydration ( fast only 6 hr for food, 2
hr for fluid)
- Antibiotic Prophylaxis (60 min before surgery)
- DVT Prophylaxis
- (Transfer to OT in a wheelchair)

9. Three Key Elements For ER Pathway
1. VATS
2. Short acting anesthetic drugs and limited
invasive monitoring
3. Aggressive Pain Management

10. Gonfiotti et al. ERAS and VATS-L: the Italian VATS group surgical protocol

11. POSTOPERATIVE CARE

12. • Adequate Post Operative Analgesia
• Early Mobilization (D1)
• Physiotherapy
• Restrict IV fluid administration
• Stop Supplemental O2 when SPO2 >90%

13. Gonfiotti et al. ERAS and VATS-L: the Italian VATS group surgical protocol

14. References
• Enhanced recovery after thoracic surgery: patient
information and care-plans , Refai M , J Thorac Dis.
2018 Mar;10(Suppl 4)
• Enhanced recovery after surgery and video-assisted
thoracic surgery lobectomy: the Italian VATS Group
surgical protocol, Gonfiotti A et al
• Enhanced recovery pathway for thoracic surgery in
the UK , Marco Scarci et al, J Thorac Dis
2016;8(Suppl 1)

15. • THANK YOU