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Enhanced Recovery Pathways for Cardiac Surgery

  • Scott R. Coleman
  • Ming Chen
  • Srikant Patel
  • Hong Yan
  • Alan D. Kaye
  • Marcus Zebrower
  • Julie A. Gayle
  • Henry LiuEmail author
  • Richard D. Urman
Other Pain (A. Kaye and N. Vadivelu, Section Editors)
  • 71 Downloads
Part of the following topical collections:
  1. Topical Collection on Other Pain

Abstract

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.

Recent Findings

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.

Summary

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.

Keywords

Enhanced recovery after surgery Cardiac surgery Cardiopulmonary bypass Pulmonary artery catheterization Transesophageal echocardiography Carbohydrate loading Antifibrinolytic agents Sternal wound infection 

Notes

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.

References

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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  • Scott R. Coleman
    • 1
  • Ming Chen
    • 2
  • Srikant Patel
    • 1
  • Hong Yan
    • 3
  • Alan D. Kaye
    • 4
  • Marcus Zebrower
    • 1
  • Julie A. Gayle
    • 4
  • Henry Liu
    • 1
    Email author
  • Richard D. Urman
    • 5
  1. 1.Department of Anesthesiology and Perioperative Medicine, Hahnemann University HospitalDrexel University College of MedicinePhiladelphiaUSA
  2. 2.Department of AnesthesiologyHubei Women and Children’s HospitalWuhanChina
  3. 3.Department of AnesthesiologyWuhan Central HospitalWuhanChina
  4. 4.Department of AnesthesiologyLouisiana State University Health Sciences CenterNew OrleansUSA
  5. 5.Department of Anesthesiology, Perioperative and Pain MedicineBrigham and Women’s HospitalBostonUSA

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