Fasttrack schedule 10 license key free12/23/2023 The introduction of ERAS in a centre in the United Kingdom lead to a significant reduction in hospital stay and equivalent morbidity in radical cystectomy patients, compared to traditional approaches. 17 There are relatively few reports on the use of ERAS in urological surgery. 9, 10 The key principles of the ERAS protocol include pre-operative counselling, preoperative nutrition, avoidance of perioperative fasting and carbohydrate loading up to 2 hours preoperatively, standardized anesthetic and analgesic regimens (epidural and non-opiod analgesia) and early mobilization ( Fig. 7, 8, 15 These programs attempt to modify the physiological and psychological responses to major surgery, 16 and have been shown to lead to a reduction in complications and hospital stay, improvements in cardiopulmonary function, earlier return of bowel function and earlier resumption of normal activities. Initiated by Professor Henrik Kehlet in the 1990s, 11 ERAS, enhanced recovery programs (ERPs) or “fast-track” programs have become an important focus of perioperative management after colorectal surgery, 12 vascular surgery, 13 thoracic surgery 14 and more recently radical cystectomy. The present article discusses particular aspects of ERAS protocols which represent fundamental shifts in surgical practice, including perioperative nutrition, management of postoperative ileus and the use of mechanical bowel preparation. Although much of the data arise from colorectal surgery, the evidence is applicable to major urological surgery, in particular radical cystectomy. 4 – 8 Despite the significant body of evidence indicating that ERAS protocols lead to improved outcomes, 9, 10 they challenge traditional surgical doctrine, and as a result their implementation has been slow. The key elements of ERAS protocols include preoperative counselling, optimization of nutrition, standardized analgesic and anesthetic regimens and early mobilization. 3Įnhanced recovery after surgery (ERAS) protocols are multimodal perioperative care pathways designed to achieve early recovery after surgical procedures by maintaining pre-operative organ function and reducing the profound stress response following surgery. Overall complication rates have been reported as high as 64% at 90 days, 2 with an average in-patient stay of 17.4 days. ![]() 1 Despite improvements in surgical technique, anesthesia and perioperative care, radical cystectomy is still associated with greater morbidity and prolonged in-patient stay after surgery than other urological procedures. Radical cystectomy with pelvic lymph node dissection remains the standard treatment for patients with muscle invasive bladder cancer. ![]() ![]() ![]() Despite the significant body of evidence indicating that ERAS protocols lead to improved outcomes, they challenge traditional surgical doctrine, and as a result their implementation has been slow. Enhanced recovery after surgery (ERAS) protocols are multimodal perioperative care pathways designed to achieve early recovery after surgical procedures by maintaining preoperative organ function and reducing the profound stress response following surgery. Despite improvements in surgical technique, anesthesia and perioperative care, radical cystectomy is still associated with greater morbidity and prolonged in-patient stay after surgery than other urological procedures.
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