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Enhanced Recovery for Colorectal Surgery

  • William John FawcettEmail author
Chapter

Abstract

The adoption of evidenced-based, multimodal pathways for the perioperative management of patients undergoing colorectal surgery has led to dramatic changes for all those involved in perioperative care. There is improved cooperation between primary and secondary care and thus the preoperative period ensures that patient’s physiological status is optimized and that the most appropriate operation and postoperative care is planned. Intraoperatively, the emphasis is twofold: minimizing the surgical stress response (with subsequent organ dysfunction) and reducing complications (both medical and surgical). There are many aspects to this area, such as small incision/laparoscopic surgery, individualized IV fluid management, multimodal opioid sparing analgesia together with minimizing tubes and drains and avoidance of hypothermia. In the postoperative period early enteral feeding and mobilization are key to continuing to reducing stress and avoiding complications. The results can be impressive, with not only significant reductions in length of stay and complications but also patients able to more quickly resume their usual lifestyle or can undertake other therapy (e.g. chemotherapy or radiotherapy) earlier. The process requires the development of, and adherence to, a number of pathways agreed by the healthcare team with regular audit of the results. Yet at the core of this process are the patients and their families and/or carers, as they move from a purely passive role to being actively involved in every aspect of the care, knowing well in advance what is planned at every stage.

Keywords

Anaesthesia, General Colorectal Surgery Preoperative care Analgesia, Postoperative Fluid therapy Complications, postoperative Stress, physiological 

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Copyright information

© Springer International Publishing Switzerland 2016

Authors and Affiliations

  1. 1.Department of AnaesthesiaRoyal Surrey County Hospital NHS Foundation TrustGuildfordUK
  2. 2.Postgraduate Medical School, University of SurreyGuildfordUK

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