Centro Universitário de Varzea Grande, Department of Surgery - Varzea Grande (MT), Brazil.
Universidade de São Paulo, Faculty of Medicine, Department of Gastroenterology - São Paulo (SP), Brazil.
Arq Bras Cir Dig. 2024 May 6;37:e1794. doi: 10.1590/0102-672020240001e1794. eCollection 2024.
BACKGROUND: The concept introduced by protocols of enhanced recovery after surgery modifies perioperative traditional care in digestive surgery. The integration of these modern recommendations components during the perioperative period is of great importance to ensure fewer postoperative complications, reduced length of hospital stay, and decreased surgical costs. AIMS: To emphasize the most important points of a multimodal perioperative care protocol. METHODS: Careful analysis of each recommendation of both ERAS and ACERTO protocols, justifying their inclusion in the multimodal care recommended for digestive surgery patients. RESULTS: Enhanced recovery programs (ERPs) such as ERAS and ACERTO protocols are a cornerstone in modern perioperative care. Nutritional therapy is fundamental in digestive surgery, and thus, both preoperative and postoperative nutrition care are key to ensuring fewer postoperative complications and reducing the length of hospital stay. The concept of prehabilitation is another key element in ERPs. The handling of crystalloid fluids in a perfect balance is vital. Fluid overload can delay the recovery of patients and increase postoperative complications. Abbreviation of preoperative fasting for two hours before anesthesia is now accepted by various guidelines of both surgical and anesthesiology societies. Combined with early postoperative refeeding, these prescriptions are not only safe but can also enhance the recovery of patients undergoing digestive procedures. CONCLUSIONS: This position paper from the Brazilian College of Digestive Surgery strongly emphasizes that the implementation of ERPs in digestive surgery represents a paradigm shift in perioperative care, transcending traditional practices and embracing an intelligent approach to patient well-being.
背景:手术后加速康复方案引入的理念改变了消化道手术围手术期的传统护理。在围手术期整合这些现代推荐方案的组成部分对于确保术后并发症更少、住院时间更短和手术费用降低非常重要。
目的:强调多模式围手术期护理方案的最重要要点。
方法:仔细分析 ERAS 和 ACERTO 方案的每一项建议,证明其纳入消化道手术患者多模式护理的合理性。
结果:增强恢复方案(ERPs),如 ERAS 和 ACERTO 方案,是现代围手术期护理的基石。营养治疗在消化道手术中至关重要,因此,术前和术后的营养护理是确保术后并发症更少和住院时间更短的关键。预康复的概念是 ERPs 的另一个关键要素。晶体液的平衡处理至关重要。液体超负荷会延迟患者的恢复并增加术后并发症。麻醉前两小时缩短术前禁食时间的做法现在已被各种外科和麻醉学会的指南所接受。与早期术后再喂养相结合,这些处方不仅安全,而且可以促进接受消化道手术患者的康复。
结论:巴西消化外科学院的这份立场文件强烈强调,在消化道手术中实施 ERPs 代表了围手术期护理的范式转变,超越了传统实践,采用了一种智能的患者福祉方法。
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