Table 1 Changes in perioperative care
From: Enhanced recovery after surgery (ERAS) protocols for colorectal cancer in Japan
Traditional care | ERAS | |
|---|---|---|
Preoperative counseling | only by surgeons | intensive (by both surgeons and anesthesiologists) |
Preoperative fasting (oral intake) | no food on the previous day | normal diet until the previous evening |
no drink after the previous noon | drink oral hydration solution (OS-1R) until 3 hours before surgery* | |
Preoperative bowel preparation | usually | sometimes for colon cancer, and always for rectal cancer |
Perioperative fluid management (avoidance of sodium/fluid overload) | no | yes (goal-directed fluid therapy) |
Short incisions/lapascopic surgery | no | always |
Intraoperative warm-air body heating | sometimes | always |
Nasogastric tube | used (remove at POD1) | not used |
Postoperative fasting | no oral intake for 3 days postoperatively | initiate oral hydration (OS-1R) on the morning of POD1* |
start eating soup at POD5 | start eating rice at POD3 | |
Routine postoperative mobilization care | yes (walk by POD2) | enforced (walk in the morning of POD1) |
Non-opiate oral analgesics/NSAIDs | no | given routinely |
Stimulation of gut motility | no | yes (use of oral magnesium oxide) |
Early urinary catheter removal | no | yes |
Multimodal approach | few cases | every case |
Anesthesia and analgesics | combination of epidural analgesia and general anesthesis (use of remifentanil) | |
Avoidance of pre-anesthetic medication (no pre-medication) | Yes | |
Abstinence from smoking and drinking | Yes | |