Enhanced Recovery After Surgery (ERAS) for gastrointestinal surgery, part 1: pathophysiological considerations.
BACKGROUND
The present article has been written to convey concepts of anaesthetic care within the context of an Enhanced Recovery After Surgery (ERAS) programme, thus aligning the practice of anaesthesia with the care delivered by the surgical team before, during and after surgery.


METHODS
The physiological principles supporting the implementation of the ERAS programmes in patients undergoing major abdominal procedures are reviewed using an updated literature search and discussed by a multidisciplinary group composed of anaesthesiologists and surgeons with the aim to improve perioperative care.


RESULTS
The pathophysiology of some key perioperative elements disturbing the homoeostatic mechanisms such as insulin resistance, ileus and pain is here discussed.


CONCLUSIONS
Evidence-based strategies aimed at controlling the disruption of homoeostasis need to be evaluated in the context of ERAS programmes. Anaesthesiologists could, therefore, play a crucial role in facilitating the recovery process.
Royal Surrey County Hospital NHS Foundation Trust, University of Surrey, Guildford, UK.
M J
MJ
Scott
Department of Anesthesia, McGill University Health Centre, Montreal General Hospital, Montreal, QC, Canada.
G
G
Baldini
University of Edinburgh, The Royal Infirmary, Clinical Surgery, Edinburgh, UK.
K C H
KC
Fearon
Department of Anesthesiology and Intensive Care Medicine Campus Charit, Mitte and Campus Virchow-Klinikum Charit, University Medicine, Berlin, Germany.
A
A
Feldheiser
Department of Surgery, McGill University Health Centre, Montreal General Hospital, Montreal, QC, Canada.
L S
LS
Feldman
Department of Anesthesiology, Duke University Medical Center, Durham, NY, USA.
T J
TJ
Gan
Department of Surgery, Faculty of Medicine and Health, Orebro University, Orebro, Sweden.
O
O
Ljungqvist
Division of Gastrointestinal Surgery, Nottingham Digestive Diseases Centre National Institute for Health Research Biomedical Research Unit, Nottingham University Hospitals, Queen's Medical Centre, Nottingham, UK.
D N
DN
Lobo
Royal Surrey County Hospital NHS Foundation Trust, University of Surrey, Guildford, UK.
T A
TA
Rockall
Department of Anesthesia, McGill University Health Centre, Royal Victoria Hospital, Montreal, QC, Canada.
T
T
Schricker
Department of Anesthesia, McGill University Health Centre, Montreal General Hospital, Montreal, QC, Canada.
F
F
Carli
D000767:Anesthesia, Epidural; D000776:Anesthesiology; D003072:Cognition Disorders / Q000209:etiology; D013505:Digestive System Surgical Procedures; D006706:Homeostasis; D006801:Humans; D007333:Insulin Resistance; D010149:Postoperative Pain / Q000517:prevention & control; D019990:Perioperative Care; D010819:Physician's Role; D011182:Postoperative Care; D020127:Recovery of Function; D013312:Stress, Physiological; D014882:Water-Electrolyte Balance