Please use this identifier to cite or link to this item: http://ahro.austin.org.au/austinjspui/handle/1/16415
Title: Enhanced Recovery After Surgery protocols for radical cystectomy surgery: review of current evidence and local protocols
Authors: Mir, Maria C;Zargar, Homayoun;Bolton, Damien M;Murphy, Declan G;Lawrentschuk, Nathan L
Issue Date: Jul-2015
EDate: 2015-03-17
Citation: ANZ Journal of Surgery 2015; 85(7-8): 514-520
Abstract: BACKGROUND: Radical cystectomy (RC) remains a morbid procedure. The use of Enhanced Recovery After Surgery (ERAS) pathways has proven to reduce care time and post-operative complications after colorectal surgery. There is a high potential for reducing morbidity associated with RC by utilizing ERAS in this setting. The purpose of this review is to examine the current evidence for ERAS in preoperative, intra-operative and post-operative setting of care for RC patients and to propose ERAS evidence-based protocol for patients undergoing RC in the Australian and New Zealand environment. PREOPERATIVE: Patient's medical optimization, avoidance of oral mechanical bowel preparation and emphasis on preoperative administration of high-energy carbohydrate drinks from colorectal literature has led to inclusion of these strategies in the preoperative considerations of ERAS in RC. INTRA-OPERATIVE: Epidural analgesia has an integral role in reducing surgical stress response, improving analgesia and expediting functional recovery and should be included in ERAS RC protocols. Of relevance is 72 h maximum length of its duration. With regard to minimally invasive approach to RC, despite encouraging results from high-volume centres, high-level evidence in this field are lacking (ongoing clinical trials). Standardized anaesthetic protocols with particular emphasis on perioperative fluid management are essential components of ERAS protocols. POST-OPERATIVE: Avoidance of routine nasogastric tube placement, early mobilization and multifaceted approach to optimization of gut function and elimination of post-operative ileus are the cornerstones of post-operative care in the setting of ERAS in RC patients.
URI: http://ahro.austin.org.au/austinjspui/handle/1/16415
DOI: 10.1111/ans.13043
ORCID: 0000-0002-5145-6783
0000-0001-8553-5618
PubMed URL: https://www.ncbi.nlm.nih.gov/pubmed/25781409
Type: Journal Article
Subjects: Periopearative care
Cystectomy
Postoperative complications
Appears in Collections:Journal articles

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