Enhanced Recovery Pathways for Cardiac Surgery
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Purpose of Review
Enhanced recovery after surgery (ERAS) has become a widespread topic in perioperative medicine over the past 20 years. The goals of ERAS are to improve patient outcomes and perioperative experience, reduce length of hospital stay, minimize complications, and reduce cost. Interventions and factors before, during, and after surgery all potentially play a role with the cumulative effect being superior quality of patient care.
Preoperatively, patient and family education, optimization of nutritional status, and antibiotic prophylaxis all improve outcomes. Recovery is also expedited by the use of multimodal analgesia, regional anesthesia, and opioid reducing approaches. Intraoperatively, the anesthesiologist can have an impact by using less-invasive monitors appropriately to guide fluid and hemodynamic management as well as maintaining normothermia. Postoperatively, early enteral feeding, mobilization, and removal of invasive lines support patient recovery. Implementation of ERAS protocol in cardiac surgery faces challenges by some unique perioperative perspectives in cardiac surgery, such as systemic anticoagulation, use of cardiopulmonary bypass, significantly more hemodynamic variations, larger volume replacement, postoperative intubation and mechanical ventilation and associated sedation, and potentially significantly more co-existing morbidities than other surgical procedures.
ERAS in cardiac surgery may benefit patients more related to its high risk and high cost nature. This manuscript specifically reviews the unique aspects of enhanced recovery in cardiac surgery.
KeywordsEnhanced recovery after surgery Cardiac surgery Cardiopulmonary bypass Pulmonary artery catheterization Transesophageal echocardiography Carbohydrate loading Antifibrinolytic agents Sternal wound infection
Compliance with Ethical Standards
Conflict of Interest
Scott R. Coleman, Ming Chen, Srikant Patel, Hong Yan, Marcus Zebrower, Julie A. Gayle, and Henry Liu declare no conflict of interest. Alan D. Kaye, MD PhD serves on the Speakers Bureau of Depomed and Merck. Richard D. Urman MD MBA received research funding from Medtronic.
Human and Animal Rights and Informed Consent
This article does not contain any studies with human or animal subjects performed by any of the authors.
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