Eras Management in Obstetric and Gynecological Interventions
Özet
The ERAS (Enhanced Recovery After Surgery) protocol represents a multidisciplinary, evidence-based approach designed to accelerate functional recovery, reduce surgical stress responses, and shorten hospital stays, which significantly diminishes healthcare costs and burdens on national economies. Given the high rate and financial strain of cesarean sections globally and nationally, implementing ERAS guidelines in obstetric and gynecological interventions has become increasingly vital. This comprehensive care pathway encompasses three critical phases: preoperative, intraoperative, and postoperative evaluation. Preoperatively, the focus is centered on patient counseling, managing anemia, maintaining blood glucose control between 140–180 mg/dl, providing thromboembolism prophylaxis, and administering narrow-spectrum antibiotic prophylaxis like cefazolin one hour prior to skin incision, while avoiding prolonged fasting and unnecessary bowel preparation. Intraoperatively, spinal anesthesia is heavily favored over general anesthesia due to its lower morbidity rates and faster initiation of breastfeeding, alongside strict management of perioperative thermoregulation to prevent hypothermia. Finally, the postoperative phase prioritizes multimodal, non-narcotic analgesia, aggressive prevention of nausea and vomiting to ensure the early return of oral intake, early mobilization supported by removing urinary catheters within 24 hours, and continuous patient follow-up after discharge to achieve complete recovery.
Referanslar
Demirhan İ, Pınar G. Postoperatif iyileşmenin hızlandırılması ve hemşirelik yaklaşımları. Yıldırım Beyazıt Üniversitesi Sağlık Bilimleri Fakültesi Hemşirelik E-Dergisi. 2014;2(1);43-53.
Wilson RD, Caughey AB, Wood SL, et al. Guidelines for Antenatal and Preoperative care in Cesarean Delivery: Enhanced Recovery After Surgery Society Recommendations (Part 1). AmJ Obstet Gynecol. 2018;219(6):523.e1-523.e15. https://doi.org/10.1016/j.ajog.2018.09.015
Caughey AB, Wood SL, Macones GA, et al. Guidelines for intraoperative care in cesarean delivery: Enhanced Recovery After Surgery Society Recommendations (Part 2). Am J Obstet Gynecol. 2018;219(6):533-544. https://doi.org/10.1016/j.ajog.2018.08.006.
Modesitt SC, Sarosiek BM, Trowbridge ER, et al. Enhanced Recovery Implementation in Major Gynecologic Surgeries: Effect of Care Standardization. Obstet Gynecol. 2016 Sep;128(3):457-466. doi: 10.1097/AOG.0000000000001555
Johnson K, Razo S, Smith J, et al. Optimize patient outcomes among females undergoing gynecological surgery: A randomized controlled trial. Appl Nurs Res. 2019 Feb;45:39-44. doi: 10.1016/j.apnr.2018.12.005
Huang F, Chia YY, Eng CL, et al. Evaluation of a Preoperative Clinic for Women With Gynecologic Cancer. Clin J Oncol Nurs. 2015;19(6):769-772. doi: 10.1188/15.CJON.769-772.
Browning RM, Trentino K, Nathan EA, et al. Preoperative anemia is common in patients undergoing major gynecological surgery and is associated with a fivefold increased risk of transfusion. Aust N Z J Obstet Gynaecol. 2012;52(5):455-459. doi: 10.1111/j.1479-828X.2012.01478
Nelson G, Altman AD, Nick A, et al. Guidelines for pre- and intra-operative care in gynecologic/oncology surgery: Enhanced Recovery After Surgery (ERAS®) Society recommendations--Part I. Gynecol Oncol. 2016;140(2):313-22. doi: 10.1016/j.ygyno.2015.11.015
ACOG Practice Bulletin No. 84: Prevention of Deep Vein Thrombosis and Pulmonary Embolism, Obstetrics & Gynecology: August 2007 - Volume 110 - Issue 2 Part 1 - p 429-440 doi: 10.1097/01.AOG.0000263919.23437.15
Practice Guidelines for Obstetric Anesthesia: An Updated Report by the American Society of Anesthesiologists Task Force on Obstetric Anesthesia and the Society for Obstetric AnesthesiaandPerinatology.Anesthesiology.2016;124(2):270-300. https://doi.org/10.1097/ALN.0000000000000935
Arnold A, Aitchison LP, Abbott J. Preoperative mechanical bowel preparation for abdominal, laparoscopic, and vaginal surgery: a systematic review, J Minim Invasive Gynecol. 2015 Jul-Aug;22(5):737-752. doi: 10.1016/j.jmig.2015.04.003.
Bollig C, Nothacker M, Lehane C, et al. Prophylactic antibiotics before cord clamping in cesarean delivery: a systematic review. Acta Obstet Gynecol Scand. 2018;97(5):521-535. doi: 10.1111/aogs.13276.
Kurt S, Canda MT. Obstetrik ve jinekolojide profilaktik antibiyotik kullanımı. DEÜ Tıp Fakültesi Dergisi. 2017;31(2):103-111.
Arslan K, Çetin Arslan H. Horner’s syndrome during vaginal delivery with epidural analgesia. Agri 2021;33(4):272–275. doi: 10.14744/agri.2019.71354
Lynch J, Scholz S. Anaesthetic-related complications of caesarean section. Zentralbl Gynakol. 2005;127(2): 91-95. doi: 10.1055/s-2005-836335
Uysallar E, Karaman S, Günüşen İ et al. Sezaryen operasyonlarında kombine spinal epidural blok ile spinal bloğun maternal ve neonatal etkilerinin karşılaştırılması. Agri 2011;23(4): 167-173. doi: 10.5505/agri.2011.39206
Moore ER, Anderson GC, Bergman N. Early skin-to-skin contact for mothers and their healthy newborn infants. Cochrane Database Syst Rev. 2007 jul 18;(3):CD003519. doi: 10.1002/14651858.CD003519
Wrench IJ, Allison A, Galimberti A, et al. Introduction of enhanced recovery for elective cesarean section enabling next day discharge: a tertiary center experience. Int J Obstet Anesth. 2015;24(2):124-130. https://doi.org/10.1016/j.ijoa.2015.01.003.
