Department of Oncological Surgery 2, Institut Paoli-Calmettes, 13009, Marseille, France.
Department of Anesthesiology, Institut Paoli-Calmettes, 13009, Marseille, France.
World J Urol. 2022 Jun;40(6):1299-1309. doi: 10.1007/s00345-020-03410-w. Epub 2020 Aug 25.
Enhanced recovery pathways vary amongst institutions but include key components for anesthesiologists, such as haemodynamic optimization, use of short-acting drugs (and monitoring), postoperative nausea and vomiting (PONV) prophylaxis, protective ventilation, and opioid-sparing multimodal analgesia.
After critical appraisal of the literature, studies were selected with particular attention being paid to meta-analyses, randomized controlled trials, and large prospective cohort studies. For each item of the perioperative treatment pathway, available English literature was examined and reviewed.
Patients should be permitted to drink clear fluids up to 2 h before anaesthesia and surgery. Oral carbohydrate loading should be used routinely. All patients may have an individualized plan for fluid and haemodynamic management that matches the monitoring needs with patient and surgical risk. Minimizing the side effects of anaesthetics and analgesics using short-acting drugs with careful perioperative monitoring should be encouraged. Protective ventilation with alveolar recruitment maneuvers is required. Preventive use of a combination with 2-3 antiemetics in addition to propofol-based total intravenous anaesthesia (TIVA) is most likely to reduce PONV. While the ideal analgesia regimen remains to be determined, it is clear that a multimodal opioid-sparing analgesic strategy has significant benefits.
Careful evaluation of single patient and planning of the anesthetic care are mandatory to join the ERAS philosophy. Optimal fluid management, use of short-acting drugs, prevention of PONV, protective ventilation, and multimodal analgesia are the cornerstones of the anaesthesia management within ERAS protocols.
强化康复路径在不同机构之间有所不同，但包括麻醉医师的关键组成部分，如血流动力学优化、使用短效药物（和监测）、术后恶心和呕吐（PONV）预防、保护性通气和阿片类药物节约多模式镇痛。
在对文献进行批判性评估后，选择了研究，特别注意荟萃分析、随机对照试验和大型前瞻性队列研究。对于围手术期治疗路径的每一项，都检查并审查了可用的英文文献。
患者应在麻醉和手术前 2 小时允许饮用清亮液体。应常规使用口服碳水化合物负荷。所有患者可能都有个体化的液体和血流动力学管理计划，该计划与监测需求、患者和手术风险相匹配。使用短效药物并进行仔细的围手术期监测，以减少麻醉剂和镇痛药的副作用，应受到鼓励。需要进行保护性通气和肺泡复张手法。除依托咪酯全身静脉麻醉（TIVA）外，联合使用 2-3 种止吐药预防性使用，最有可能减少 PONV。虽然理想的镇痛方案仍有待确定，但很明显，多模式阿片类药物节约镇痛策略具有显著益处。
仔细评估单个患者并规划麻醉护理是加入 ERAS 理念的必要条件。最佳液体管理、使用短效药物、预防 PONV、保护性通气和多模式镇痛是 ERAS 方案中麻醉管理的基石。
