Table 1 Changes in perioperative care for patients with obstructive colorectal cancer
Traditional care | Modified ERAS | |
|---|---|---|
preoperative counseling | advice given only by surgeons | intensive (by both surgeons and anesthesiologist) |
preoperative fasting (oral intake) | no food and no drink | |
preoperative bowel preparation | no | |
perioperative fluid management (avoidance of sodium/fluid overload) | no | yes (goal-directed fluid therapy) |
intraoperative warm air body heating | sometimes | always |
nasogastric tube | used (remove by POD3) | used (remove on POD1) |
postoperative fasting | no oral intake for 3 days after surgery | start drinking oral hydration solution by POD2 |
start eating soup on POD5 | start eating rice on POD3 | |
routine postoperative mobilization care | yes (walk by POD2) | enforced (walk in the morning of POD1) |
non-opiate oral analgesics/NSAIDs | no | given routinely |
stimulation of gut motility | no | yes (use of oral magnesium oxide) |
early removal of urinary catheter | no | Yes |
multidisciplinary team approach | few cases | all cases |
anesthesia and analgesic | combination epidural analgesia and general anesthesia (use of remifentanil) | |
avoidance of pre-anesthetic medication (no premed) | Yes | |
abstinence from smoking and drinking | Yes | |