Eras
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The document discusses Enhanced Recovery After Surgery (ERAS), a program that aims to safely allow patients to return to daily living as quickly as possible after surgery by decreasing complications and length of hospital stay. ERAS, also called fast-track surgery programs, modifies physiological and psychological responses to surgery. The goal is to improve outcomes and reduce costs without compromising care. Patient factors, quality of care during surgery and recovery, and random healthcare variations can all influence surgical outcomes. The document lists recommended intraoperative practices for ERAS in colorectal surgery. It also discusses several postoperative analgesic options.
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The document discusses the concept of progressive mobility, which involves early ambulation of ICU patients starting on the first day. It outlines the benefits of early mobility such as improved morale, health, and faster recovery times. Additionally, it discusses how prolonged immobility can lead to physical disabilities, weakness, and inability to return to work. The document then describes the components and goals of progressive mobility programs, which include head of bed elevation, verticalization techniques like tilt tables, standing, and walking training. It provides evidence that early and frequent mobilization can safely be achieved in the ICU with positive outcomes such as better functional status and lower complication rates.
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Critical care patients who are immobilized experience increased mortality, length of hospital stay, and duration of mechanical ventilation. Prolonged immobility leads to ICU-acquired weakness and muscle atrophy of up to 1-1.5% per day. Early mobilization of critical care patients, beginning within 24-48 hours of admission, provides benefits like decreased neuromuscular weakness, skin breakdown, anxiety, and depression while improving outcomes. Implementing an early mobilization program requires a multidisciplinary team approach and culture change to overcome barriers.
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Constrained induced movement therapy
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Constraint Induced Movement Therapy (CIMT) is an evidence-based rehabilitation technique for improving upper limb function after stroke or cerebral palsy. It involves restraining the unaffected limb while intensively training the affected limb for several hours per day. Studies show CIMT leads to cortical reorganization and improved real-world arm use. The key elements are restraint of the less affected side and intensive task-specific training of the affected side. CIMT protocols have been developed for both adults and children with varying durations and intensities depending on the individual. Long-term follow up studies show benefits can persist for years after treatment.
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This document summarizes an enhanced recovery care pathway for patients undergoing surgery. It discusses:
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- How enhanced recovery aims to get patients recovering sooner by preparing them before surgery and providing standardized post-operative care and early mobilization.
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Enhanced recovery programs are evidence-based protocols designed to standardize medical care, improve outcomes, and lower health care costs. These protocols include evidence-based techniques to minimize surgical trauma and postoperative pain, reduce complications, improve outcomes, and decrease hospital length of stay, while expediting recovery following elective procedures.Protocols have been developed for colorectal surgery patients to reduce physiological stress and postoperative organ dysfunction through optimization of perioperative care and recovery
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The document discusses the role of nurses in improving patient safety in colorectal surgery. It emphasizes that patient safety should be the top priority and is a shared responsibility. The Enhanced Recovery After Surgery (ERAS) program plays an important role in pre-operative patient safety, focusing on goals like reduced fasting and avoidance of unnecessary interventions. Proper pre-operative stoma site marking by nurses is also discussed as an important way to reduce postoperative complications. Overall, the document stresses the importance of multidisciplinary teamwork and a holistic, patient-centered approach to ensure high quality, safe care.
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ERAS Protocol
The document discusses the Enhanced Recovery After Surgery (ERAS) protocol. ERAS aims to optimize patient care and recovery through a multidisciplinary, evidence-based approach. It challenges traditional practices like prolonged preoperative fasting and use of drains. The ERAS protocol incorporates recommendations across the preoperative, intraoperative and postoperative periods. This includes carbohydrate loading, minimal fasting, optimized fluid management, multimodal analgesia, early nutrition and mobilization to reduce complications and length of stay while improving outcomes.
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The document discusses the role of anesthesiologists in Enhanced Recovery After Surgery (ERAS) protocols, which are multimodal perioperative care pathways designed to achieve early recovery after surgery through interventions in the preoperative, intraoperative, and postoperative periods to minimize physiological stress and complications. Key anesthesiologist interventions include opioid-sparing anesthesia, regional analgesia, fluid management, prevention of hypothermia and nausea/vomiting, and avoiding unnecessary tubes or lines. ERAS protocols have been shown to reduce complications, hospital stay, and improve quality of life outcomes compared to traditional care.
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Using Enhanced Recovery After Surgery (ERAS) to Enhance Postoperative Outcomes
Speaker: Francesco Carli, MD, MPhil, senior staff anesthesiologist at the McGill University Health Centre
Cost: Complimentary, sponsored by Wellbe
There is strong evidence that many of aspects of surgical care have little evidence, and therefore the Enhanced Recovery After Surgery (ERAS) program has been set up to accelerate the recovery process and decrease the rate of postoperative complications. There is an opportunity to improve outcomes by using team approach and revision of the standard procedures.
Learn about:
– The elements of ERAS protocols
– How to structure the Team approach
– The role of the patient in ERAS
– How to perform an audit of your program
About the Speaker:
Francesco Carli, MD, MPhil, is Professor of Anesthesia at McGill University and Associate Professor in the School of Dietetics and Human Nutrition at McGill University and a senior staff anesthesiologist at the McGill University Health Centre. He is currently an Elected Member of the American Academy of Anesthesia and a Board Member of the Enhanced Recovery After Surgery (ERAS) Society. Dr. Carli completed his medical training and anesthesia training in Turin, Italy, Paris, France, and London, England. He completed a Master’s Degree in surgical metabolism at the University of London, England.
His research interests are: metabolic changes associated with surgery and the impact of perioperative interventions (regional analgesia, nutrition, hormones, exercise) on postoperative recovery; evaluation of functional outcome measures during the surgical recovery process; prehabilitation of surgical patients. He is the author of over 250 peer-review scientific articles and has been a recipient of over 50 peer and non peer-review grants.
Acute pain - dr. ike
Conclusions:
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ED patients should receive proper pain management, avoiding delays such as those related to diagnostic testing or consultation
In order to further improve patient care we must now apply our knowledge regarding acute and chronic pain treatment base on pharmacology of the drugs
Ongoing research in the area of ED patient pain management conducted and an algorythm or clinical guidelines in this area should be developed
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This document summarizes guidelines for preoperative evaluation of adult patients undergoing non-cardiac surgery, with an emphasis on respiratory diseases. It identifies several risk factors for postoperative pneumonia, including age over 60, dependent functional status, weight loss, COPD, and surgery type. A risk index for predicting postoperative respiratory failure is also described, which includes patient factors like albumin level, BUN, functional status, and COPD, as well as surgery type. The document discusses strategies for reducing postoperative pulmonary complications, such as various lung expansion techniques.
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Eras
- 1. ERAS “ENHANCED RECOVERY AFTER SURGERY” dr. M. Arief Kurniawan, SpAn, FIP SMF Anestesi, Terapi Intensif dan Manajemen Nyeri RSU Hasanah Graha Afiah
- 2. WHAT IS ENHANCED RECOVERY AFTER SURGERY? A History
- 3. ERAS (ENHANCED RECOVERY AFTER SURGERY) Fast-track Programs Enhanced Recovery Programs – ERP Programs which attempt to modify physiological and psychological responses to major surgery
- 4. Goal of ERASProgram Safe and comfortable • Allow early return to daily living asap • Decrease the incidence and severity of perioperative complications • Reduce postop readmission rates • Reduction in length of stay • Reduce healthcare costs without compromising patient care • Improve patient satisfaction Scot MJ, Miller TE. Anesthesiology Clin 33 (2015) 79–91
- 11. What are factors that influence surgical outcome ? Surgical Nurse care Perioperative Anesthesia management management QUALITYOFP A TIENTCARE OUTCOME Patient’s factors • Severity of diseases • Comorbid • Age Healthcare random variation • Complication • Quality of life
- 12. Intraoperative Items Gustafsson UO, Scott MJ, Hubner M, Nygren J, Demartines N, Francis N, Rockall TA, Young-Fadok TM, et.al. Guidelines for Perioperative Care in Elective Colorectal Surgery: Enhanced Recovery After Surgery (ERASÒ) Society Recommendations: 2018 . World Journal of Surgery. 2018
- 13. ANALGETIK POST OP - ketorolac 3x30mg iv + PCT 4x1 gr po - TAP block + ketorolac 3x30mg iv - CBI