Guidelines For Enhanced Recovery Research Articles

6277872 Prophylactic Ondansetron Administration for Nausea Management in Elective Caesarean Sections: A Paradigm Shift in Enhanced Recovery Guidelines

6277872 Prophylactic Ondansetron Administration for Nausea Management in Elective Caesarean Sections: A Paradigm Shift in Enhanced Recovery Guidelines

Chest wall resections for sulcus superior tumors.

Chemoradiotherapy followed by surgical resection (trimodality therapy) is a guideline recommended treatment for sulcus superior tumors (SST). By definition, SSTs invade the chest wall and therefore require en-bloc chest wall resection with the upper lung lobe or segments. The addition of a chest wall resection, potentially results in higher morbidity and mortality rates when compared to standard anatomical pulmonary resection. This, together with their anatomical location in the thoracic outlet, and varying grades of fibrosis and adhesions resulting from induction chemoradiotherapy in the operation field, make surgery challenging. Depending on the exact location of the tumor and extent to which it invades the surrounding structures, the preferred surgical approach may vary, e.g., anterior, posterolateral, hemi-clamshell, or combined approach; all with their own potential advantages and morbidities. Careful patient selection, adequate staging and discussion in a multidisciplinary tumor board in a center experienced in complex thoracic oncology leads to the best long-term survival outcomes with the least morbidity and mortality. Enhanced recovery guidelines are now available for thoracic surgery, promoting faster recovery and helping to minimize complications and morbidity, including infections and thoracotomy pain. Although minimally invasive surgery can enhance recovery and reduce chest wall morbidity, and is in widespread use in thoracic oncology, its use for SST has been limited. However, this is an evolving area and hybrid surgical approaches (including use of the robot) are being reported. Chest wall reconstruction is rarely necessary, but if so, the prosthetic materials are preferably radiolucent/non-scattering, rigid enough while still being somewhat flexible, and inert, providing structural support, allowing chest wall movement, and closing defects, while inciting a limited inflammatory response. New techniques such as 3D image reconstructions/volume rendering, 3D-printing, and virtual reality modules may help pre-operative planning and informed patient consent.

Enhanced Recovery after Surgery (ERAS) in Gynecologic Surgery—A Review

The purpose of this review is to summarize the newly published guidelines on enhanced recovery after surgery (ERAS) in gynecologic oncology and discuss recent studies evaluating the outcomes of ERAS implementation in general gynecology and gynecologic oncology. ERAS guidelines for gynecologic surgery include preoperative diet, preoperative education, multimodal analgesia, early postoperative feeding, early mobilization and urinary catheter removal, avoidance of mechanical bowel preparation and drains, maintenance of normothermia, and minimal fluid shifts. The studies evaluated in this update include mostly retrospective observational studies and few randomized controlled trials. The primary outcome of the majority of studies, length of stay, was found to be less after ERAS implementation than prior to implementation. Secondary outcomes such as rates of readmission, mortality, and postoperative complications yielded mixed results; however, most differences were not statistically significant. Hospital costs also decreased after ERAS implementation, but the cost differences were only statistically significant in half of the studies with a single dissenting study. Implementation of ERAS protocols in gynecologic surgery is becoming ubiquitous as more evidence demonstrates improved patient outcomes and decreased healthcare costs. However, the majority of studies evaluating the efficacy of ERAS protocols are retrospective studies. Now that a standardized set of enhanced recovery guidelines in gynecologic oncology have been published, more institutions will hopefully begin to implement ERAS programs. Future research should subsequently include prospective, randomized controlled trials to validate the benefits concluded from studies based on historical data.

Understanding of the 2014 guidelines for enhanced recovery after gastrectomy published by European Enhanced Recovery After Surgery Society

Enhanced recovery after surgery (ERAS) is a multimodal perioperative care pathway designed to achieve early recovery for patients undergoing major surgery. The ERAS programs aim to reduce traumatic stress and postoperative complications, improve full recovery of patients or combine and coordinate evidence-based perioperative care interventions that support standardizing and optimizing surgical care. The international working group assembled by the ERAS Society composed the 2014 Consensus guidelines for enhanced recovery after gastrectomy Enhanced Recovery After Surgery (ERAS®) Society recommendations in July 2014. This guideline is designed for optimal perioperative care for patients undergoing gastrectomy. This paper presented the understanding of hot issues of the guidelines in order to provide the clinical evidence of evidence-based medicine for the surgical field in China. Key words: Enhanced recovery after surgery; Guideline; Therapy; Understanding