Title : Anesthesia strategies for enhanced recovery in colorectal surgery
Abstract:
Enhanced Recovery After Surgery (ERAS) protocols aim to optimize postoperative recovery by minimizing surgical stress, reducing complications, and promoting early mobilization and feeding. Anesthesia plays a critical role in the success of ERAS in colorectal surgery by contributing to pain management, minimizing opioid use, and facilitating rapid recovery.
One of the core principles of anesthesia in ERAS is multimodal analgesia. This approach combines different pain management strategies to provide effective pain relief while reducing opioid consumption. Regional anesthesia, such as epidural or transversus abdominis plane (TAP) blocks, is commonly used to provide long-lasting pain relief with minimal systemic effects. Local anesthetics, nonsteroidal anti-inflammatory drugs (NSAIDs), and acetaminophen are also part of the regimen to further reduce pain and inflammation.
Opioid-sparing techniques are essential in ERAS protocols to reduce side effects like nausea, vomiting, constipation, and delayed recovery. Non-opioid analgesics and regional techniques, such as nerve blocks, are preferred over high doses of opioids. This approach leads to a faster return of gastrointestinal function and allows for earlier mobilization, both key components of ERAS.
Anesthesia management during colorectal surgery includes goal-directed fluid therapy, which focuses on optimizing fluid balance, improving tissue oxygenation, and reducing the risk of complications like hypovolemia or fluid overload. GDFT uses dynamic parameters (e.g., stroke volume variation) to guide fluid administration, ensuring that patients remain hemodynamically stable while avoiding unnecessary fluid infusion.
Anesthesia strategies in ERAS promote early postoperative mobilization. Short-acting anesthetic agents like sevoflurane and propofol are preferred because they allow for a quicker recovery of cognitive function. In addition, minimizing the duration of anesthesia and encouraging early extubation helps accelerate recovery and reduces the risk of complications like pneumonia.
In summary, anesthesia in ERAS for colorectal surgery focuses on multimodal pain management, opioid reduction, goal-directed fluid therapy, and strategies to promote early recovery. These efforts improve patient outcomes by enhancing recovery, minimizing complications, and reducing hospital stays.
