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Enhanced Recovery Pathways for Cardiac Surgery.

Scott R Coleman1, Ming Chen2, Srikant Patel1

  • 1Department of Anesthesiology and Perioperative Medicine, Hahnemann University Hospital, Drexel University College of Medicine, 245 N. 15th Street, MS 310, Philadelphia, PA, 19102, USA.

Current Pain and Headache Reports
|March 15, 2019
PubMed
Summary

Enhanced recovery after surgery (ERAS) protocols improve patient outcomes and reduce hospital stays. Applying ERAS in cardiac surgery presents unique challenges but offers significant benefits due to the high-risk nature of these procedures.

Keywords:
Antifibrinolytic agentsCarbohydrate loadingCardiac surgeryCardiopulmonary bypassEnhanced recovery after surgeryPulmonary artery catheterizationSternal wound infectionTransesophageal echocardiography

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Area of Science:

  • Perioperative Medicine
  • Surgical Outcomes
  • Patient Recovery

Background:

  • Enhanced Recovery After Surgery (ERAS) has gained prominence in perioperative medicine over the last two decades.
  • ERAS aims to optimize patient outcomes, enhance the perioperative experience, shorten hospital stays, reduce complications, and lower costs.
  • A multimodal approach, encompassing pre-, intra-, and postoperative interventions, contributes to superior patient care.

Purpose of the Study:

  • To review the unique aspects and implementation challenges of Enhanced Recovery After Surgery (ERAS) protocols specifically within the context of cardiac surgery.
  • To highlight the potential benefits of ERAS in high-risk, high-cost cardiac surgical procedures.

Main Methods:

  • Review of pre-, intra-, and postoperative interventions contributing to enhanced recovery.
  • Analysis of specific challenges in applying ERAS protocols to cardiac surgery.
  • Examination of the potential benefits of ERAS in cardiac surgical patients.

Main Results:

  • Preoperative strategies include patient education, nutritional optimization, and antibiotic prophylaxis.
  • Intraoperative management involves less-invasive monitoring, judicious fluid/hemodynamic guidance, and maintaining normothermia.
  • Postoperative care emphasizes early enteral feeding, mobilization, and early removal of invasive lines.
  • Cardiac surgery presents unique challenges for ERAS implementation, including anticoagulation, cardiopulmonary bypass, hemodynamic variability, and postoperative ventilation.

Conclusions:

  • ERAS protocols offer a framework for improving patient care and outcomes across surgical disciplines.
  • Despite unique challenges, ERAS in cardiac surgery holds significant promise for improving recovery and potentially reducing the high risks and costs associated with these procedures.