Evidence based medicine underpinning the ERAS protocol in elective colorectal patients: A mini review
Roisin Taplin, Gavin David O’Connor*
Department of Anaesthesiology and Intensive Care, University Hospital Limerick, Ireland
Introduction: The enhanced recovery after surgery (ERAS) protocol is a set of international guidelines developed with the purpose of decreasing the hospital stay of a patient undergoing elective colorectal surgery. The ERAS protocol outlines a variety of measures that should be taken throughout a patients’ surgical stay, including at the first meeting in the preoperative phase, perioperatively and postoperatively.
Methods: PubMed database was accessed with the aim of finding relevant material on the subject of the ERAS protocol and colorectal surgery, and the outcomes for patients pre and post implementation of the ERAS protocol. The keywords chosen included ERAS protocol, implementation and colorectal surgery. Filters included access to full free text, available in English, published in the last 5 years and included clinical trials, meta-analysis, randomised controlled trials and systematic reviews. This returned 32 results of which 9 articles were included. These nine articles were reviewed and the outcomes pre and post implementation of the ERAS protocol were examined.
Results: The opinion of all the articles reviewed recommend implementation of the ERAS protocol. Each site reported improvements in various factors from length of stay, to post op complications and patient satisfaction. Implementation of ERAS protocols in elective colorectal surgery is associated with improved outcomes.
Conclusion: The ERAS protocol is a highly effective protocol for patients undergoing elective colorectal surgery. It has proven benefit in terms of decreased postoperative complications, and reduced length of hospital stay. The ERAS protocol has been successfully implemented in a variety of hospitals around the world with great effect. Future research should focus on the implementation of the protocol on other patient demographics, such as patients undergoing emergency colorectal surgery to explore its benefits in such situations.
DOI: 10.29245/2768-5365/2025/1.1156 View / Download PdfCombined Use of Remimazolam and Propofol in Total Intravenous Anesthesia: A Retrospective Analysis
Shinju Obara*, Yuki Watanabe Hoshino, Satoki Inoue
Department of Anesthesiology, Fukushima Medical University School of Medicine, Hikarigaoka, Fukushima, Japan
Remimazolam is a newly introduced benzodiazepine anesthetic. Despite being classified as ultrashort-acting, it may cause delayed emergence owing to its not-so-short 80% context-sensitive decrement time. This study retrospectively analyzed 21 patients (12 men and 9 women; median age, 65 years; range, 17–82 years) classified as ASA I or II who underwent general anesthesia with a combination of remimazolam and propofol for anesthesia maintenance during the study period (May 2022 to May 2023). It aimed to determine the optimal effect-site concentrations of remimazolam, propofol, and remifentanil during surgery and recovery times. The population median values of individual median effect-site concentrations for remimazolam, propofol, and remifentanil during adequate sedation (patient state index 25–50) were 0.34 µg/mL, 1.00 µg/mL, and 5.00 ng/mL, respectively. At the recovery of responsiveness, the median values of individual median effect-site concentrations for remimazolam, propofol, and remifentanil were 0.17 µg/mL, 0.53 µg/mL, and 0.88 ng/mL, respectively. There was a significant negative correlation between the individual median propofol effect-site concentrations and age during patient state index range of 25–50. However, no correlation was observed between age and the other effect-site concentrations mentioned above. The patients regained responsiveness at a median of 13 min after termination of anesthetics, except for 2 who required flumazenil before tracheal extubation. Flumazenil was administered to facilitate emergence from sedation in two patients before extubation and in another two after extubation. No adverse events occurred, including resedation or intraoperative awareness. This study demonstrates the potential of combining remimazolam and propofol for effective anesthesia and rapid recovery. To optimize dosing strategies for the combination of remimazolam and propofol, larger prospective pharmacokinetic and pharmacodynamic studies are warranted.
DOI: 10.29245/2768-5365/2024/3.1153 View / Download PdfSmall stuff, deep underlying emotions: An overview of the positive effect of laughing
View / Download PdfHilde M. Buiting1,2,3,4*, Lisan Ravensbergen4,5, Christa van Schaik6, Vincent K.Y. Ho7
1Antoni van Leeuwenhoek, Netherlands Cancer Institute, Amsterdam, the Netherlands
2University Medical Center, Utrecht, the Netherlands
3University of Amsterdam, Amsterdam, the Netherlands
4O2PZ, Platform of Palliative Care, Amsterdam, the Netherlands
5Red Cross Hospital, Department of Anesthesiology, Beverwijk, the Netherlands
6Meander Medisch Centrum, Department of Medical Oncology, Amersfoort, the Netherlands
7Netherlands Comprehensive Cancer Organization, Utrecht, the Netherlands