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 .
Development of postoperative insulin resistance is associated with the magnitude of operation.
OBJECTIVE To study the development of insulin resistance and changes in stress hormone concentrations in patients undergoing elective operations of different magnitude . DESIGN Prospect i ve open study . SETTING University hospital , Sweden . SUBJECTS 12 otherwise healthy patients , undergoing elective surgery for cholecystectomy ( n = 6 ) and inguinal hernia repair ( n = 6 ) . INTERVENTIONS Insulin sensitivity was measured by the normoglycaemic , hyperinsulinaemic glucose clamp technique before operation ( control ) and on the first postoperative day . MAIN OUTCOME MEASURE Relative insulin sensitivity ( compared with preoperative ) on the day after each operation . Changes in stress hormone concentrations in relation to the relative change in insulin sensitivity . RESULTS After hernia repair , mean ( SEM ) insulin sensitivity was reduced by 32 (4)% , p < 0.05 compared with baseline , and after open cholecystectomy by 56 (3)% , ( p < 0.05 ) . The difference between the two groups was highly significant ( p < 0.01 ) . The changes in concentrations of catecholamines , glucagon , cortisol and growth hormone after operation were only small , and did not correlate with the relative changes in insulin sensitivity . CONCLUSIONS Insulin resistance develops even after a minor elective operation , ( inguinal hernia repair ) . The degree of postoperative insulin resistance was more pronounced after open cholecystectomy . The alteration in insulin sensitivity could not be related to simultaneous changes in the hormones studied
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 .