Enhanced Recovery Pathways for Cardiac Surgery

• Published in: Current pain and headache reports Vol. 23; no. 4; p. 28
• Main Authors: Coleman, Scott R., Chen, Ming, Patel, Srikant, Yan, Hong, Kaye, Alan D., Zebrower, Marcus, Gayle, Julie A., Liu, Henry, Urman, Richard D.
• Format: Journal Article
• Language: English
• Published: New York Springer US 01.04.2019; Springer Nature B.V
• Subjects: Anesthesia; Anesthesiology; Antibiotics; Bone surgery; Carbohydrates; Cardiovascular disease; Clinical outcomes; Heart surgery; Hospitals; Insulin resistance; Internal Medicine; Local anesthesia; Malnutrition; Medicine; Medicine & Public Health; Nutrition; Nutritional status; Other Pain (A. Kaye and N. Vadivelu; Pain; Pain Medicine; Patients; Pulmonary arteries; Section Editors; Staphylococcus infections; Stress response; Surgical outcomes; Topical Collection on Other Pain; Cardiopulmonary bypass; Transesophageal echocardiography; Carbohydrate loading; Pulmonary artery catheterization; Enhanced recovery after surgery; Cardiac surgery; Antifibrinolytic agents; Sternal wound infection
• ISSN: 1531-3433; 1534-3081
• DOI: 10.1007/s11916-019-0764-2

Purpose of Review 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. Recent Findings 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. Summary 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.