RT Book, Section
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.
SR Print(0)
ID 1164321781
T1 Optimizing Perioperative Care: Enhanced Recovery and Chinese Medicine
T2 Schwartz's Principles of Surgery, 11e
YR 2019
FD 2019
PB McGraw-Hill Education
PP New York, NY
SN 9781259835353
LK accessmedicine.mhmedical.com/content.aspx?aid=1164321781
RD 2024/04/18
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.