TY - CHAP M1 - Book, Section TI - Optimizing Perioperative Care: Enhanced Recovery and Chinese Medicine A1 - Holder-Murray, Jennifer A1 - Esper, Stephen A1 - Wang, Zhiliang A1 - Cui, Zhigang A1 - Wang, Ximo A2 - Brunicardi, F. Charles A2 - Andersen, Dana K. A2 - Billiar, Timothy R. A2 - Dunn, David L. A2 - Kao, Lillian S. A2 - Hunter, John G. A2 - Matthews, Jeffrey B. A2 - Pollock, Raphael E. Y1 - 2019 N1 - T2 - Schwartz's Principles of Surgery, 11e AB - Key Points Enhanced recovery after surgery (ERAS) is a paradigm shift in the surgical care of patients. As a multimodal, integrated, evidence-based care pathway, ERAS optimizes patient care in the preoperative, intraoperative, and postoperative setting in order to achieve best patient outcomes. Patients recover faster, experience less physiological stress, enjoy shorter stays in the hospital, and have fewer complications. Setting appropriate expectations, optimizing nutritional and physical status through prehabilitation, and treating medical comorbidities optimizes patients before surgery. Achieving normovolemia both intraoperatively and postoperatively is important in order to maintain perfusion without volume overload, as hypervolemia and hypovolemia are both associated with significant complications. Goal-directed therapy approaches maintain normovolemia with zero fluid balance. Intravenous normal saline administration results in hyperchloremia, which has been associated with increased mortality and morbidity. As pain is a subjective response and cannot therefore be experienced while unconscious, the use of opioids intraoperatively should generally be avoided in order to minimize the multiorgan system side effects of these medications. Additionally, avoiding intraoperative opioids actually improves postoperative pain scores and reduces the need for postoperative opioids. Multimodal analgesia, which includes oral or IV nonopioid analgesia and regional analgesic techniques, can reduce postoperative physiological stress and decrease complications associated with surgery as part of a pain management regimen. Multimodal analgesia has been shown to reduce the number of opioids required for analgesia. The strategies for avoiding postoperative nausea and vomiting include the avoidance of general anesthesia, the use of totally intravenous anesthesia, avoidance of nitrous oxide and volatile agents, minimizing intraoperative and postoperative opioids, and adequate hydration. Enhanced recovery after surgery care pathways can be applied to numerous types of surgery including colorectal, liver, pancreas, bariatric, gynecologic, and urologic surgery with success. Traditional Chinese medicine has been practiced for thousands of years and serves as a distinct cultural heritage of China. Its unique theories and methods are still applied widely in the practice of modern medicine, including disease prevention, disease treatment, and perioperative management. Acupuncture and transcutaneous electroacupuncture can reduce the number of opioids utilized in the perioperative setting. Additionally, acupuncture, transcutaneous electroacupuncture, and some Chinese herb decoctions are effective in the prevention and treatment of postoperative nausea and vomiting. SN - PB - McGraw-Hill Education CY - New York, NY Y2 - 2024/10/07 UR - accessmedicine.mhmedical.com/content.aspx?aid=1164321781 ER -