Table 2.
ERAS element with high/moderate level evidence | ERAS element with low level evidence |
Stopping smoking 4 wk prior to surgery | Pre-operative information and counselling |
No routine use of bowel preparation | Stopping drinking alcohol 4 wk prior to surgery |
Allowing clear fluids up until 2 h before and solids 6 h before anaesthetic induction | Peri-operative oral nutritional supplements and carbohydrate loading |
No routine use of sedative premedication | Standard anaesthetic that allows rapid awakening |
Routine thromboprophylaxis | Post-operative nausea and vomiting prophylaxis |
Antimicrobial prophylaxis and skin preparation | Routine urinary drainage |
Balanced intravenous fluids guided by flow measurements | Using stress reducing elements of ERAS to minimise hyperglycaemia |
Use of mid thoracic epidural blocks in open surgery | Early mobilisation |
Us of spinal analgesia or PCA in laparoscopic surgery | |
Laparoscopic surgery | |
No routine use of nasogastric tubes | |
Maintenance of normothermia | |
No routine intra-abdominal drains | |
Early post-operative enteral feeding | |
Insulin treatment of severe hyperglycaemia in ICU | |
Use of chewing gum to prevent post-operative ileus |
ERAS: Enhanced recovery after surgery; PCA: Patient controlled analgesia; ICU: Intensive care unit.