Table 3. Enhanced Recovery After Thoracic Surgery (ERATS) Key Components and Process.

Components	Phase of operative care	Process
Patient education	Every phase	• Verbal education
		• Written materials
		• Video presentations
Avoidance of fasting	Preoperative	• Clear liquid diet up until 2 hours before surgery
Carbohydrate loading	Preoperative	• 800 mL of 12.5% carbohydrate-containing drink night before surgery and 400 mL the morning of surgery
Multimodal analgesia	Every phase	• Refer to Table 1
		• Acetaminophen
		• Celecoxib
		• Gabapentin
		• Tramadol
Opioid sparing	Intraoperative; postoperative	• Reserve opiates for breakthrough pain unmanaged by multimodal analgesia
Total intravenous anesthesia	Intraoperative	• Agents such as dexmedetomidine, propofol, and ketamine
Goal-directed fluid therapy	Intraoperative; postoperative	• Use of minimally/noninvasive hemodynamic tools
		• Avoid salt and fluid overload
		• Vasopressor support as needed
Postoperative nausea and vomiting preventive measures	Every phase	• Carbohydrate loading
		• Short-acting volatile anesthetics
		• Antiemetic medications
		• Dexamethasone
		• Scopolamine
		• Nonpharmacologic interventions
Liposomal bupivacaine	Intraoperative	• Dosage based on the size of surgical site
		• Injection performed by surgeon at the time of surgery
Early oral intake	Postoperative	• Clear liquid diet day of surgery
		• Diet advanced as tolerated postoperative day 1
Early mobilization	Postoperative	• Ambulation within 4 hours of admit to unit and minimum of 4 times daily thereafter
Venous thromboembolism prophylaxis	Intraoperative; postoperative	• Heparin 5,000 units subcutaneous every 8 hours
Antibiotic prophylaxis	Every phase	• Initiated 60 minutes before incision
		• Ampicillin/sulbactam or ciprofloxacin/vancomycin for penicillin allergy
		• Verified in intraoperative time out
		• Continued for 24 hours postoperatively
Chest physiotherapy	Postoperative	• Incentive spirometry
		• Oscillating positive expiratory pressure therapy
		• Albuterol and ipratropium
Avoidance of catheterization	Intraoperative; postoperative	• Refer to Figure 1
Chest tube management	Postoperative	• Minimize tubes
		• Minimize suction
		• Remove when meets criteria
Atrial fibrillation management	Postoperative	• Refer to Figure 2