Table 1.
ERAS guidelines recommendations.
| 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 30–60 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 1–2 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 |