Geleceğin Protokolü Eras ve Anestezi
Özet
ERAS (Enhanced Recovery After Surgery - Cerrahi Sonrası İyileşmenin Hızlandırılması) protokolü, büyük cerrahi operasyonlar sonrasında hastaların vücut işlevlerine erken dönmesini sağlamak, komplikasyonları asgari düzeye indirmek ve hastanede yatış süresini kısaltmak amacıyla kanıta dayalı tıp ilkelerine göre geliştirilmiş çok yönlü perioperatif bakım ilkelerinden oluşmaktadır. Preoperatif dönemde hastanın ayrıntılı bilgilendirilmesi, rutin mekanik bağırsak temizliğinden kaçınılması, uzun süreli açlık yerine ameliyattan altı saat öncesine kadar katı ve iki saat öncesine kadar berrak/karbonhidratlı sıvı alımına izin verilmesi ve derlenmeyi geciktiren premedikasyondan kaçınılması temel alınır. İntraoperatif süreçte vücut sıcaklığının ısıtıcılarla korunması, aşırı sıvı yüklemesinden sakınılarak dengeli sıvı-vazopresör yönetimi, en kısa cerrahi kesilerin tercih edilmesi ve midtorasik epidural anestezi ile kısa etkili anestetiklerin (propofol, desfluran, remifentanil) kullanılması öne çıkar. Postoperatif dönemde ise opioid kullanımının azaltılarak multimodal analjezi ve parasetamol uygulanması, rutin nazogastrik sonda ile peritoneal dren kullanımından kaçınılması, idrar sondasının hızla çıkarılması, ameliyat sonrası 2. saatte oral sıvı alımıyla erken beslenmenin başlatılması, gastrointestinal motilitenin uyarılması ve hastanın günde en az altı saat yatak dışında erken mobilizasyonu hedeflenir. Cerrah, anestezist, hemşire, diyetisyen ve fizyoterapistten oluşan multidisipliner bir ekibin uyumlu çalışmasıyla yürütülen bu protokoller, cerrahi travmaya verilen metabolik stresi ve morbiditeyi düşürerek hasta iyileşme kalitesini artırmaktadır.
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