The present systematic review shows that , with the exception of laparoscopic surgery , objective evidence of the effect of individual components of ERAS protocol s in reducing the stress response following colorectal surgery is limited
Abstract Enhanced Recovery or Fast Track Recovery after Surgery protocol s ( ERAS ) have significantly changed perioperative care following colorectal surgery and are promoted as reducing the stress response to surgery .
The effect of anesthetic technique on early postoperative gastric emptying: comparison of propofol-remifentanil and opioid-free sevoflurane anesthesia
Purpose A postoperative decrease in the gastric emptying ( GE ) rate may delay the early start of oral feeding and alter the bioavailability of orally administered drugs . The aim of this study was to compare the effect on early gastric emptying between two anesthetic techniques . Methods Fifty patients ( age , 19–69 years ) undergoing day-case laparascopic cholecystectomy were r and omly assigned to received either total intravenous anesthesia with propofol/remifentanil/rocuronium ( TIVA ; n = 25 ) or inhalational opioid-free anesthesia with sevoflurane/rocuronium ( mask induction ; GAS ; n = 25 ) . Postoperative gastric emptying was evaluated by the acetaminophen method . After arrival in the recovery unit , acetaminophen ( paracetamol ) 1.5 g was given through a nasogastric tube , and blood sample s were drawn during a 2-h period . The area under the serum-acetaminophen concentration curve from 0–60 min ( AUC60 ) , the maximal concentration ( Cmax ) , and the time to reach C-max ( Tmax ) were calculated . Results Twelve patients were excluded due to surgical complications ( e.g. , conversion to open surgery ) and difficulty in drawing blood sample s ( TIVA , n = 7 ; GAS , n = 5 ) . Gastric emptying parameters were ( mean ± SD ) : TIVA , AUC60 , 2458 ± 2775 min·µmol·l−1 ; Cmax , 71 ± 61 µmol·l−1 ; and Tmax , 81 ± 37 min ; and GAS , AUC60 , 2059 ± 2633 min·µmol·l−1 ; Cmax , 53 ± 53 µmol·l−1 ; and Tmax , 83 ± 41 min . There were no significant differences between groups . Conclusion There was no major difference in early postoperative gastric emptying between inhalation anesthesia with sevoflurane versus total intravenous anesthesia with propofol-remifentanil . Both groups showed a pattern of delayed gastric emptying , and the variability in gastric emptying was high . Perioperative factors other than anesthetic technique may have more influence on gastric emptying
The present systematic review shows that , with the exception of laparoscopic surgery , objective evidence of the effect of individual components of ERAS protocol s in reducing the stress response following colorectal surgery is limited
Abstract Enhanced Recovery or Fast Track Recovery after Surgery protocol s ( ERAS ) have significantly changed perioperative care following colorectal surgery and are promoted as reducing the stress response to surgery .