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ERAS.pptx

  1. 1. Tips on using my ppt. 1. You can freely download, edit, modify and put your name etc. 2. Don’t be concerned about number of slides. Half the slides are blanks except for the title. 3. First show the blank slides (eg. Aetiology ) > Ask students what they already know about ethology of today's topic. > Then show next slide which enumerates aetiologies. 4. At the end rerun the show – show blank> ask questions > show next slide. 5. This will be an ACTIVE LEARNING SESSION x three revisions. 6. Good for self study also. 7. See notes for bibliography.
  2. 2. Enhanced Recovery After Surgery (ERAS®)
  3. 3. Enhanced Recovery After Surgery (ERAS®) • Guidelines for Perioperative Care in Elective Colonic Surgery: Enhanced Recovery After Surgery (ERAS®) Society Recommendations
  4. 4. Aims and Objects
  5. 5. Aims and Objects • This review aims to present a consensus for optimal perioperative care in colonic surgery and to provide graded recommendations for items for an evidenced-based enhanced perioperative protocol.
  6. 6. Method
  7. 7. Method • Studies were selected with particular attention paid to meta-analyses, randomised controlled trials and large prospective cohorts. For each item of the perioperative treatment pathway, available English- language literature was examined, reviewed and graded. A consensus recommendation was reached after critical appraisal of the literature by the group.
  8. 8. • The delay until full recovery after major abdominal surgery has been greatly improved by the introduction of a series of evidence-based treatments covering the entire perioperative period and formulated into a standardised protocol.
  9. 9. counseling
  10. 10. counseling • Patients should routinely receive dedicated preoperative counseling
  11. 11. • Increasing exercise preoperatively may be of benefit. • Smoking should be stopped 4 weeks before surgery and • Alcohol abusers should stop all alcohol consumption 4 weeks before surgery
  12. 12. Mechanical Bowel Preparation
  13. 13. Mechanical Bowel Preparation – should not be used routinely in colonic surgery. • Evidence level: – High • Recommendation grade: • Strong
  14. 14. • Clear fluids should be allowed up to 2 h and solids up to 6 hrs prior to induction of anaesthesia. In those patients were gastric emptying may be delayed (duodenal obstruction etc.) specific safety measures should at the induction of anaesthesia. Preoperative oral carbohydrate treatment should be used routinely. In diabetic patients carbohydrate treatment can be given along with the diabetic medication.
  15. 15. – Patients should wear well-fitting compression stockings, have intermittent pneumatic compression, and receive pharmacological prophylaxis with LMWH. Extended prophylaxis for 28 days should be given to patients with colorectal cancer.
  16. 16. Antibiotics
  17. 17. Antibiotics • Routine prophylaxis with intravenous antibiotics should be given 30–60 min before initiating colorectal surgery. Additional doses should be given during prolonged procedures according to the half-life of the drug used. • Post op antibiotics - NO
  18. 18. Laparoscopy
  19. 19. Laparoscopy • Laparoscopic surgery for colonic resections is recommended if the expertise is available.
  20. 20. Ryle’s tube
  21. 21. Ryle’s tube – Postoperative nasogastric tubes should not be used routinely. Nasogastric tubes inserted during surgery should be removed before reversal of anaesthesia.
  22. 22. Temperature
  23. 23. Temperature • Intraoperative maintenance of normothermia with a suitable warming device (such as forced-air heating blankets, a warming mattress or circulating-water garment systems) and warmed intravenous fluids should be used
  24. 24. • Balanced crystalloids should be preferred to 0.9 % saline. In open surgery, patients should receive intraoperative fluids (colloids and crystalloids) guided by flow measurements to optimise cardiac output. • The enteral route for fluid postoperatively should be used as early as possible, and intravenous fluids should be discontinued as soon as is practicable.
  25. 25. Drainage
  26. 26. Drainage – Routine drainage is discouraged because it is an unsupported intervention that probably impairs mobilisation. • Evidence level: – High • Recommendation grade: – Strong
  27. 27. • Routine transurethral bladder drainage for 1–2 days is recommended
  28. 28. SPC
  29. 29. SPC • A meta-analysis has shown that suprapubic bladder catheterisation in abdominal surgery is associated with lower rates of bacteriuria and lower patient discomfort than transurethral drainage
  30. 30. Postoperative analgesia in open surgery
  31. 31. Nutrition
  32. 32. Nutrition • In enhanced-recovery programmes, oral nutritional supplements (ONS) have been used on the day before surgery and for at least the first 4 postoperative days to achieve target intakes of energy and protein during the very early postoperative phase
  33. 33. Nutrition • In the postoperative phase, patients undergoing ERAS can drink immediately after recovery from anaesthesia and then eat normal hospital food and, in doing so, spontaneously consume ≈1,200– 1,500 kcal/day . • This is safe. RCTs of early enteral or oral feeding versus ‘nil by mouth’ show that early feeding reduces the risk of infection and LOSH, and is not associated with an increased risk of anastomotic dehiscence
  34. 34. Take Home Message 1. Preop counseling, exercise, smoking, alcohol. 2. Mechanical Bowel Preparation –NO 3. Preop antibiotic –Yes 4. Post op antibiotics –NO 5. Intraabdomina drainage –NO 6. SPC in place of urethral catheter 7. NG tube – NO 8. Post of NPO for 4 hours only.
  35. 35. Get this ppt in mobile 1. Download Microsoft PowerPoint from play store. 2. Open Google assistant 3. Open Google lens. 4. Scan qr code from next slide.
  36. 36. Get this ppt in mobile
  37. 37. Get my ppt collection • https://www.slideshare.net/drpradeeppande/ edit_my_uploads • https://www.dropbox.com/sh/x600md3cvj8 5woy/AACVMHuQtvHvl_K8ehc3ltkEa?dl =0 • https://www.facebook.com/doctorpradeeppa nde/?ref=pages_you_manage

Notes de l'éditeur

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