Department of Anesthesiology and Perioperative Medicine, Hahnemann University Hospital, Drexel University College of Medicine, 245 N. 15th Street, MS 310, Philadelphia, PA, 19102, USA.
Department of Anesthesiology, Hubei Women and Children's Hospital, 745 Wuluo Road, Hongshan, Wuhan, 430070, Hubei, China.
Curr Pain Headache Rep. 2019 Mar 14;23(4):28. doi: 10.1007/s11916-019-0764-2.
Enhanced recovery after surgery (ERAS) has become a widespread topic in perioperative medicine over the past 20 years. The goals of ERAS are to improve patient outcomes and perioperative experience, reduce length of hospital stay, minimize complications, and reduce cost. Interventions and factors before, during, and after surgery all potentially play a role with the cumulative effect being superior quality of patient care.
Preoperatively, patient and family education, optimization of nutritional status, and antibiotic prophylaxis all improve outcomes. Recovery is also expedited by the use of multimodal analgesia, regional anesthesia, and opioid reducing approaches. Intraoperatively, the anesthesiologist can have an impact by using less-invasive monitors appropriately to guide fluid and hemodynamic management as well as maintaining normothermia. Postoperatively, early enteral feeding, mobilization, and removal of invasive lines support patient recovery. Implementation of ERAS protocol in cardiac surgery faces challenges by some unique perioperative perspectives in cardiac surgery, such as systemic anticoagulation, use of cardiopulmonary bypass, significantly more hemodynamic variations, larger volume replacement, postoperative intubation and mechanical ventilation and associated sedation, and potentially significantly more co-existing morbidities than other surgical procedures. ERAS in cardiac surgery may benefit patients more related to its high risk and high cost nature. This manuscript specifically reviews the unique aspects of enhanced recovery in cardiac surgery.
术后加速康复（ERAS）在过去 20 年中已成为围手术期医学的热门话题。ERAS 的目标是改善患者的预后和围手术期体验，缩短住院时间，最大限度地减少并发症，并降低成本。手术前后的干预措施和因素都可能发挥作用，其累积效应是提高患者护理质量。
术前，患者和家属教育、优化营养状况和抗生素预防均可改善结局。多模式镇痛、区域麻醉和减少阿片类药物的方法也加速了康复。术中，麻醉师可以通过适当使用微创监测来指导液体和血流动力学管理以及维持正常体温，从而产生影响。术后，早期肠内喂养、活动和移除侵入性导管有助于患者康复。心脏手术中的 ERAS 方案的实施面临一些独特的围手术期观点的挑战，如全身抗凝、使用体外循环、明显更多的血流动力学变化、更大的容量替代、术后插管和机械通气以及相关镇静，以及可能比其他手术更多的并存疾病。心脏手术中的 ERAS 可能更多地使患者受益，因为它具有高风险和高成本的性质。本文专门综述了心脏手术中加速康复的独特方面。
