From
StayCurrentMD
Update Course Rewind: 2020 ERAS
With Dr. Kurt Heise · hosted by Dr. Todd Ponsky
Part of
Crohn's Disease 6 items
Chapter 1 of 7 · Fundamentals
ERAS introduction
Introduction to ERAS in Pediatric Surgery
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Educational content from recorded physician discussions — not medical advice. Talk to your (or your child's) care team about your situation.
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What the experts said
Pediatric surgery knowledge is growing exponentially, making it impossible to stay up to date
The 16-year-old patient with tight ileocecal stricture was given protein shakes preoperatively for nutritional optimization
The patient drank high carbohydrate clear liquids on the day of operation, stopping one hour before surgery
Total IV fluids for the case was less than 4 ccs per kilo per hour using ERAS anesthesia protocol
Postoperatively, multimodal analgesia included Tylenol, Toradol, and Neurontin
The patient was allowed to drink immediately after surgery and started to snack that night
The patient was hep locked, on regular diet, pain well controlled, walking with PT, and having bowel movements on postoperative day one
The patient was discharged the evening after partial colectomy when physiologically ready
Setting expectations with families about discharge goals preoperatively through heavy counseling is important
In the adult population, mobilization and early PO intake are the most important drivers to early discharge
Over half of bariatric patients after sleeve gastrectomy can be discharged on the first postoperative day
Regional blocks used include QL blocks, rectus sheath blocks, or TAP blocks to allow earlier patient mobilization compared to epidurals
Big surgeries including colectomies and craniofacial reconstructions can be performed without the use of narcotics using premedications and regional blocks
ERAS is a multidisciplinary, multimodal, evidence-based way of delivering care to patients
The goals of ERAS are to optimize patient physiology throughout the entire perioperative pathway
ERAS strategy aims to decrease operative trauma, inflammatory response, and stress
ERAS tactics include optimizing fluid and analgesia, mobilizing early, and feeding early, which work synergistically when bundled
ERAS outcomes include faster healing, earlier discharge, and fewer complications of all types, not just surgical complications
When ERAS is done well with focus on the full spectrum of care, it should decrease readmission rates
Implementation of ERAS elements over time shows decreased intraoperative fluids, decreased intraoperative and postoperative narcotics, and decreased time to full diet