3. Anaesthesia and Enhanced Recovery for Colorectal Surgery

  1. Ian Johnston3,
  2. William Harrop-Griffiths4 and
  3. Leslie Gemmell5
  1. Carol Peden1 and
  2. Christopher Newell2

Published Online: 10 NOV 2011

DOI: 10.1002/9781118227978.ch3

AAGBI Core Topics in Anaesthesia

AAGBI Core Topics in Anaesthesia

How to Cite

Peden, C. and Newell, C. (2011) Anaesthesia and Enhanced Recovery for Colorectal Surgery, in AAGBI Core Topics in Anaesthesia (eds I. Johnston, W. Harrop-Griffiths and L. Gemmell), Wiley-Blackwell, Oxford, UK. doi: 10.1002/9781118227978.ch3

Editor Information

  1. 3

    Raigmore Hospital, Inverness, UK

  2. 4

    Imperial College Healthcare NHS Trust, London, UK

  3. 5

    Wrexham Maelor Hospital, Wrexham, UK

Author Information

  1. 1

    Royal United Hospital, Bath, UK

  2. 2

    University Hospitals Bristol NHS, Foundation Trust, Bristol, UK

Publication History

  1. Published Online: 10 NOV 2011
  2. Published Print: 29 NOV 2011

ISBN Information

Print ISBN: 9780470658628

Online ISBN: 9781118227978

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Keywords:

  • colorectal surgery;
  • anaesthesia, enhanced recovery;
  • patients, optimised;
  • rapid, fast-track recovery;
  • GP health screening;
  • cardiopulmonary exercise testing (CPX);
  • ‘contract of care’;
  • ‘nil by mouth’ time;
  • surgical stress response;
  • ERAS, postoperative components

Summary

• Enhanced recovery involves redesign of the whole patient pathway in an evidence-based patient- centred approach starting at the time of GP referral.

• A multidisciplinary team approach is essential to success.

• Patients must be educated and involved in the whole process; success depends on a contract and agreed timeline between the team and the patient.

• Preparation for surgery includes minimizing the fasting period, preoperative carbohydrate loading and avoidance of mechanical bowel preparation.

• Optimal anaesthesia should minimize the stress response to surgery and provide rapid recovery with effective analgesia, which is opiate-sparing where possible.

• Goal-directed intraoperative fluid administration is a key part of the process.

• Surgeons should use short and preferably transverse incisions for open surgery and a laparoscopic technique where appropriate; postoperative drains are avoided.

• Postoperatively, enteral nutrition is reintroduced early and the patient begins a structured mobilization programme in the evening following surgery.

• Regular audit of the whole pathway and feedback of results to team members is essential for success.