Who is protocol recovery

This paper shows that by implementing a comprehensive rapid recovery protocol that patients can not only be safely discharged home sooner, but are more likely to obtain higher levels of motion at a faster pace.

This type of change promotes immediate ambulation, day of surgery physical therapy and same-day discharge. This new protocol proved effective at helping patients obtain higher levels of motion at all time points in the first 12 weeks. Despite being a retrospective, single surgeon, unblinded study with potential for bias, this paper was well powered and showed statistically and clinically significant improvements in range of motion with a rapid recovery protocol.

This paper adds to the current evidence supporting multimodal pain management and rapid recovery protocols for TKA. By Casey Tingle. Perspective from Benjamin M. Frye, MD. Source: Plessl D, et al. Disclosures: Dasa reports he is a consultant for Pacira. Click 'Find out more' for information on how to change your cookie settings. Continue Find out more. Results Study Protocol Archive. Welcome For patients Why is this research being done? What is the purpose of this study?

Who is doing the study? ERAS program is feasible, and its results are superior to conventional postoperative care for patients undergoing elective colonic or rectal resection.

Patients treated according to an ERAS program develop significant fewer complications and have shorter hospital stay. However, no difference in mortality has been found. Abrir menu Brasil. Revista Brasileira de Anestesiologia. Abrir menu. E-mail: ripo gmail. Abstract Background Enhanced recovery after surgery ERAS protocols consist of a set of perioperative measures aimed at improving patient recovery and decreasing length of stay and postoperative complications.

Methods Single center observational study. Conclusions The implementation of ERAS protocol for colorectal surgery was associated with a significantly reduction of postoperative complications and length of stay. Introduction Despite all advances in surgical and anesthetic care, morbidity after abdominal surgery it remains high.

Materials and methods This study is reported according to the STROBE guidelines for the conducting and reporting of observational cohort studies. Study design As part of a quality improvement initiative, the working group was established in to implement the ERAS protocol for colorectal procedures.

Table 1 ERAS guidelines recommendations. Table 3 Demographic and perioperative characteristics of included patients. Table 4 Postoperative complications after colorectal surgery. This study has no funding. Ripolles Melchor J, Espinosa A. Publication Dates Publication in this collection Jul-Aug History Received 5 July Accepted 3 Jan This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial No Derivative License, which permits unrestricted non-commercial use, distribution, and reproduction in any medium provided the original work is properly cited and the work is not changed in any way.

Figures 3 Tables 5. Item ERAS recommendation Preoperative information, education and counseling Patients should routinely receive dedicated preoperative counseling Preoperative optimization Smoking and alcohol consumption alcohol abusers should be stopped four weeks before surgery Preoperative bowel preparation Mechanical bowel preparation should not be used routinely in colonic surgery Preoperative fasting and carbohydrate treatment Clear fluids should be allowed up to 2 h and solids up to 6 h prior to induction of anesthesia.

Preoperative oral carbohydrate treatment should be used routinely Preanesthetic medication Patients should not routinely receive long- or short- acting sedative medication before surgery because it delays immediate postoperative recover Prophylaxis against thromboembolism Patients should wear well-fitting compression stockings, have intermittent pneumatic compression, and receive pharmacological prophylaxis Antimicrobial prophylaxis and skin preparation Routine prophylaxis using intravenous antibiotics should be given min before initiating surgery.

Additional doses should be given during prolonged operations according to half life of the drug used preparation with chlorhexidine-alcohol should be used Standard anesthetic protocol A standard anesthetic protocol allowing rapid awakening should be given the anesthetist should control fluid therapy, analgesia and hemodynamic changes to reduce the metabolic stress response Postoperative nausea and vomiting PONV A multimodal approach to PONV prophylaxis should be adopted in all patients with 2 or more risk factors undergoing major colorectal surgery Laparoscopy and modifications of surgical access Laparoscopic surgery for colonic resections is recommended if the expertise is available Nasogastric intubation Postoperative nasogastric tubes should not be used routinely.

Nasogastric tubes inserted during surgery should be removed before reversal of anesthesia Preventing intraoperative hypothermia Intraoperative maintenance of normothermia with a suitable warming device and warmed intravenous fluids should be used routinely to keep body temperature Perioperative fluid management Patients should receive intraoperative fluids colloids and crystalloids guided by flow measurements to optimize cardiac output Drainage of peritoneal cavity after colonic anastomosis Routine drainage is discouraged because it is an unsupported intervention that is likely to impair mobilization.

Urinary drainage Routine transurethral bladder drainage for days is recommended Prevention of postoperative ileus Fluid overload and nasogastric decompression should be avoided Postoperative analgesia Open surgery: Thoracic epidural anesthesia TEA using low-dose local anesthetic and opioids Laparoscopic surgery: No TEA Perioperative nutritional care Patients should be screened for nutritional status and if at risk of under nutrition given active nutritional support postoperatively patients should be encouraged to take normal food as soon as lucid after surgery Postoperative glucose control Hyperglycaemia is a risk factor for complications and should therefore be avoided Early mobilization Prolonged immobilization increases the risk of pneumonia, insulin resistance and muscle weakness.

Patients should therefore be mobilized. PONV, postoperative nausea and vomiting. Sociedade Brasileira de Anestesiologia R. Google Google Scholar. Enhanced recovery after surgery protocol versus conventional perioperative care in colorectal surgery. A single center cohort study. Smoking and alcohol consumption alcohol abusers should be stopped four weeks before surgery.

Mechanical bowel preparation should not be used routinely in colonic surgery. Clear fluids should be allowed up to 2 h and solids up to 6 h prior to induction of anesthesia. Preoperative oral carbohydrate treatment should be used routinely.

Patients should not routinely receive long- or short- acting sedative medication before surgery because it delays immediate postoperative recover. Patients should wear well-fitting compression stockings, have intermittent pneumatic compression, and receive pharmacological prophylaxis. Routine prophylaxis using intravenous antibiotics should be given min before initiating surgery.

Additional doses should be given during prolonged operations according to half life of the drug used preparation with chlorhexidine-alcohol should be used.

A standard anesthetic protocol allowing rapid awakening should be given the anesthetist should control fluid therapy, analgesia and hemodynamic changes to reduce the metabolic stress response. A multimodal approach to PONV prophylaxis should be adopted in all patients with 2 or more risk factors undergoing major colorectal surgery. Laparoscopic surgery for colonic resections is recommended if the expertise is available.

Postoperative nasogastric tubes should not be used routinely. Nasogastric tubes inserted during surgery should be removed before reversal of anesthesia.

Intraoperative maintenance of normothermia with a suitable warming device and warmed intravenous fluids should be used routinely to keep body temperature. Patients should receive intraoperative fluids colloids and crystalloids guided by flow measurements to optimize cardiac output. Routine drainage is discouraged because it is an unsupported intervention that is likely to impair mobilization.

Patients should be screened for nutritional status and if at risk of under nutrition given active nutritional support postoperatively patients should be encouraged to take normal food as soon as lucid after surgery. Hyperglycaemia is a risk factor for complications and should therefore be avoided. Prolonged immobilization increases the risk of pneumonia, insulin resistance and muscle weakness. Body mass index kg. Preoperative Hb g. Preoperative Albumin g. Patients with complications moderate or severe.

By using less invasive fluid monitoring, we keep our patients comfortable while ensuring their safety. The updated protocols have helped patients avoid time in the intensive care unit after surgery.

On average, 25 percent fewer patients required time in the ICU immediately after surgery since the system was implemented. Here are the length-of-stay averages for surgeries before and after implementation of the new protocols:. These new surgery guidelines are part of a wider program called the TIGER protocols, which are slowly being implemented across the surgical service lines.