Table 1.

Adaptation of standard ERAS principles to The Johns Hopkins Children’s Center Pilot ERAS Implementation in Adolescent (12 years and older) Colorectal Surgery

ERAS	JH CC
Preoperative
Preadmission counseling and education	Included
Fluid and carbohydrate loading	Gatorade® / Pedialyte® 2 hours prior to surgery
No prolonged fasting	Gatorade® / Pedialyte® 2 hours prior to surgery
Standardized bowel prep	Antibiotic + mechanical
Antibiotic prophylaxis	Included
Skin preparation	Chlorhexidine wash night before and morning of surgery; provided in clinic packet
Thromboprophylaxis	All patients > 14 years
Avoid anxiolytic premedication	Included
Intraoperative
Short-acting anesthetics	Internal anesthesia consensus group
Mid-thoracic epidural	Regional approach: transversus abdominis plane block versus epidural for open cases
Avoiding drains	Excluded – rarely applicable to population
Avoidance of salt and water overload	Internal anesthesia consensus group
Maintenance of normothermia	Included
Postoperative
Continuing mid-thoracic epidural	Low thoracic epidural
Avoid nasogastric tubes	Included
Prevention of nausea and vomiting	Included
Avoidance of salt and water overload	Included
Early removal of catheter	Included
Early oral nutrition	Included
Non-opioid analgesia	Opioid minimization
Early mobilization	Included
Stimulation of gut motility	Excluded – lacking evidence
Outcomes reporting	Included