Didactics-ERAS enhanded recovery after surgery _ Limor Helpman March 2020 Belarus ECHO.mp4

Video Transcription

Video Summary

The video discusses Enhanced Recovery After Surgery (ERAS), a state-of-the-art approach to perioperative care that challenges surgical traditions and dogmas. The speaker highlights the importance of evidence-based care and implementing interventions to improve patient outcomes. The history of ERAS is traced back to the introduction of fast-track surgery in Denmark about 20 years ago, leading to the founding of ERAS and the publication of guidelines.<br /><br />The speaker focuses on several elements of care, including pain control, nutrition and GI management, fluid management, and prevention of infection and thromboembolic complications. They discuss the importance of prehabilitation, optimizing patients' medical condition, and providing education and counseling. In terms of pain control, the speaker emphasizes the use of multimodal analgesia and the benefits of preemptive analgesia. They also mention alternative options to epidural analgesia, such as tap blocks and wound infiltration.<br /><br />Regarding fluid management, the speaker highlights the disadvantages of using normal saline and advocates for the use of balanced crystalloids. They also discuss the importance of goal-directed fluid therapy in maintaining normal blood volume and reducing complications. In terms of nutrition and GI management, the speaker addresses the impact of surgery-related stress and patient starvation on insulin resistance and suggests strategies to break this cycle. They discuss the role of mechanical bowel preparation, preoperative carbohydrate loading, and early post-operative feeding. The speaker also emphasizes the importance of VTE prophylaxis and SSI prevention, including bundled interventions and extended prophylaxis.<br /><br />The video underscores the need for consistent implementation of ERAS programs, as evidence has shown significant improvements in patient outcomes, decreased length of stay, and cost savings. The speaker acknowledges the barriers to implementation and the importance of multidisciplinary collaboration, championing team members, and consistent training. They emphasize the iterative process of quality improvement, with self-auditing and monitoring to achieve sustainability.

Keywords

Enhanced Recovery After Surgery

perioperative care

evidence-based care

patient outcomes

fast-track surgery

pain control

nutrition and GI management