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The document introduces the ERAS (Enhanced Recovery After Surgery) initiative for elective general surgery, aiming to reduce stress responses and accelerate recovery. Key goals include decreasing length of stay, postoperative mortality, and readmission rates, while promoting early mobilization and oral intake. It outlines specific strategies such as preoperative carbohydrate loading, prevention of postoperative nausea, and the use of non-opiate analgesia to enhance patient recovery.

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landegre K
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33 views19 pages

Update

The document introduces the ERAS (Enhanced Recovery After Surgery) initiative for elective general surgery, aiming to reduce stress responses and accelerate recovery. Key goals include decreasing length of stay, postoperative mortality, and readmission rates, while promoting early mobilization and oral intake. It outlines specific strategies such as preoperative carbohydrate loading, prevention of postoperative nausea, and the use of non-opiate analgesia to enhance patient recovery.

Uploaded by

landegre K
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PPTX, PDF, TXT or read online on Scribd
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QI Initiative- Introduction of ERAS for Elective

General Sugery in Surgical Ward, CRRH


Evolution of Surgical principles brought the concepts of

ERAS

The concepts of ERAS was first described in 1990s by Henrik Kehlet.


What is ERAS?

ERAS stands for Enhanced Recovery After Surgery


also known as

Fast Track Surgery.

ERAS is a multimodal perioperative care pathway that aims at


reducing stress respons to surgery and acceleration of recovery.
Goals of ERAS
• Reduction of stress response to surgery.
• Acceleration of recovery.
• Decreased length of stay (LOS).
• Decreased post operative mortality and
morbidity.
• Reduction of rate of readmission after surgery.
3. Pre operative carbohydrate loading and
metabolic conditioning.
• Use of Clear carbohydrate rich beverage.
• This helps to reduces preoperative thirst,
hunger and anxiety, and significantly, reduces
postoperative insulin resistance.
4. Prevention of Postoperative Nausea and
Vomitting (PONV).

• PONV is unpleasant, delays gut function,


affects mobility and has metabolic
conseqences.
• Give prophyatic anti-emetics i.e
Ondansetron during anesthesia around 30
mins before end of surgery.
5. Encouarge Early Postoperative Oral Intake.

• Facilitates early return of bowel function.


• Allows stopping of IVF.
• Aids mobilization.
• Leads to faster recovery.
• Reduces posteroperative morbidity.
6. Early Mobilization.
Bed rest:
• Increased insulin resistance, muscle loss and
risk of thromboembolism.
• Decreased muscle strength, pumonary
function and tissue oxygenation.
• Early mobilization helps prevention of DVT,
PE, aids in faster wound healing, etc.
• The aim is for patients to be out of bed for 2
hrs on the day of surgery, and for 6hr until
discharge.
7. Non-opiate Analgesia/ NSAIDS.
• Opiates are associated with decreased gut
mobility.
• Short term NSAID use can avoid Gastric
irritation.
• NSAIDS and COX-2 Inhibitors such as
celecoxib have shown to improve postop
analgesia by reducing opioid consumption.

8. Early Removal of catheter.


ERAS- Discharge criteria.
Pateint can be discharged when they meet the
following criteria:
• Good pain control with oral analgesia.
• Taking solid food, no IVF.
• Independently mobile.
• All of above and willing to go home.
THANK YOU <3

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