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 .
Epidural Anesthesia, Hypotension, and Changes in Intravascular Volume
Background The most common side effect of epidural or spinal anesthesia is hypotension with functional hypovolemia prompting fluid infusions or administration of vasopressors . Short-term studies ( 20 min ) in patients undergoing lumbar epidural anesthesia  suggest that plasma volume may increase when hypotension is present , which may have implication s for the choice of treatment of hypotension . However , no long-term information or measurements of plasma volumes with or without hypotension after epidural anesthesia are available . Methods In 12 healthy volunteers , the authors assessed plasma ( 125I-albumin ) and erythrocyte ( 51Cr-EDTA ) volumes before and 90 min after administration of 10 ml bupivacaine , 0.5 % , via a thoracic epidural catheter ( T7–T10 ) . After 90 min ( t = 90 ) , subjects were r and omized to administration of fluid ( 7 ml/kg hydroxyethyl starch ) or a vasopressor ( 0.2 mg/kg ephedrine ) , and 40 min later ( t = 130 ) , plasma and erythrocyte volumes were measured . At the same time points , mean corpuscular volume and hematocrit were measured . Systolic and diastolic blood pressure , heart rate , and hemoglobin were measured every 5 min throughout the study . Volume kinetic analysis was performed for the volunteers receiving hydroxyethyl starch . Results Plasma volume did not change per se after thoracic epidural anesthesia despite a decrease in blood pressure . Plasma volume increased with fluid administration but remained unchanged with vasopressors despite that both treatments had similar hemodynamic effects . Hemoglobin concentrations were not significantly altered by the epidural blockade or ephedrine administration but decreased significantly after hydroxyethyl starch administration . Volume kinetic analysis showed that the infused fluid exp and ed a rather small volume , approximately 1.5 l. The elimination constant was 56 ml/min . Conclusions Thoracic epidural anesthesia per se does not lead to changes in blood volumes despite a reduction in blood pressure . When fluid is infused , there is a dilution , and the fluid initially seems to be located central ly . Because administration of hydroxyethyl starch and ephedrine has similar hemodynamic effects , the latter may be preferred in patients with cardiopulmonary diseases in which perioperative fluid overload is undesirable
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 .