Enhanced Recovery After Surgery (ERAS)

ERAS, enhanced recovery after surgery have become an important focus of perioperative management after colorectal surgery, vascular surgery, thoracic surgery and radical cystectomy. These programs attempt to modify the physiological and psychological responses to major surgery, and have been shown to lead to a reduction in complications and hospital stay, improvements in cardiopulmonary function, earlier return of bowel function and earlier resumption of normal activities. The stress response is initiated by a variety of physical insults, such as tissue injury, infection, hypovolemia or hypoxia. The ERAS program is aimed at attenuating the body’s response to surgery which is characterized by its catabolic effect. Autonomic afferent impulses from the area of injury or trauma stimulate the hypothalamus-pituitary-adrenal axis and mediate the body’s subsequent endocrine response. Enhanced recovery after surgery (ERAS) protocols starts preoperatively, and continue during anesthesia and surgery and post operatively. Pre-operative overnight fasting is not good!! It is claimed to avoid pulmonary aspiration without evidence to support this!!Shortened fluid fast does not increase risk of aspiration, regurgitation or related morbidity while preoperative long fasting increases metabolic stress, hyperglycemia and insulin resistance. Best practice is fasting patients for solids up to 6 hours preoperatively and clear fluids up to 2 hours only, without increase in complications. Early postoperative nutrition as soon as it is safe to swallow, decreases metabolic response leading to less insulin resistance, reduces loss of muscle strength and lowers incidence of wound infection, pneumonia, intra-abdominal abscess or even mortalityThis proocedures may facilitate postoperative safe recovary.