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Regurgitation under the ERAS Program: A Case Report.

Marta Pires1, Margarida Marcelino1

  • 1Instituto Português de Oncologia de Lisboa, 1099-023 Lisbon, Portugal.

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Summary

Enhanced recovery after surgery (ERAS) protocols recommend carbohydrate drinks up to two hours before anesthesia. A case study revealed regurgitation in a low-risk patient, suggesting further gastric emptying evaluation may be needed.

Keywords:
ERASaspirationcarbohydrate drinkregurgitation

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Area of Science:

  • Anesthesiology
  • Gastroenterology
  • Surgical Recovery

Background:

  • Enhanced Recovery After Surgery (ERAS) protocols optimize patient recovery post-major abdominal surgery.
  • Preoperative carbohydrate solutions, consumed up to two hours before anesthesia, are generally considered safe and beneficial.
  • This study details a case of regurgitation despite adherence to ERAS guidelines for preoperative fluid intake.

Observation:

  • An 80-year-old male with comorbidities underwent rectal cancer surgery under an ERAS program.
  • The patient consumed a 200 mL carbohydrate drink two hours prior to anesthesia induction.
  • Regurgitation of clear fluid occurred immediately after loss of consciousness.

Findings:

  • The patient experienced significant regurgitation despite being considered low-risk for delayed gastric emptying.
  • This event challenges the assumption of universal safety for carbohydrate solutions within the two-hour preoperative window.
  • Standard risk assessment may not always predict adverse events related to gastric contents.

Implications:

  • Consideration of additional gastric emptying assessments, such as gastric ultrasonography, may be warranted even in non-high-risk patients.
  • ERAS protocols might require refinement to account for individual patient variability in gastric motility.
  • Further research is needed to identify predictors of delayed gastric emptying in patients undergoing elective surgery.