Geleceğin Protokolü Eras ve Anestezi
Synopsis
The Enhanced Recovery After Surgery (ERAS) protocol consists of multidisciplinary perioperative care principles developed according to evidence-based medicine to enable early recovery of physiological functions, minimize complications, and shorten hospital stay after major surgeries. In the preoperative period, it relies on detailed patient education, avoiding routine mechanical bowel preparation, permitting solid food up to six hours and clear/carbohydrate-rich liquids up to two hours prior to surgery instead of prolonged fasting, and avoiding premedication that delays recovery. During the intraoperative phase, maintaining normothermia using warmers, balanced fluid-vasopressor management avoiding fluid overload, selecting minimal surgical incisions, and employing mid-thoracic epidural anesthesia alongside short-acting anesthetics (propofol, desfluran, remifentanil) are prominent. In the postoperative period, the targets include minimizing opioid use through multimodal analgesia and paracetamol, avoiding routine nasogastric tubes and peritoneal drains, early removal of urinary catheters, initiating early oral feeding starting with liquids at the second postoperative hour, stimulating gastrointestinal motility, and encouraging early mobilization out of bed for at least six hours daily. Managed through the harmonious work of a multidisciplinary team comprising surgeons, anesthesiologists, nurses, dietitians, and physiotherapists, these protocols reduce metabolic stress caused by surgical trauma and decrease morbidity, thereby enhancing the quality of patient recovery.
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