Enhanced recovery after surgery in emergency colorectal surgery: Review of literature and current practices

Table 3 Evidence-based enhanced recovery after surgery protocol in emergency colorectal surgery

ERAS item	Recommendation
Preoperative phase
Education and detailed counseling	Patients should routinely receive concise and practical preoperative education including stoma counseling
Medical optimization	Preoperative risk stratification and “targeted” optimization of general conditions are recommended
Glycemic control	Perioperative blood glucose should be maintained between 140 and 180 mg/dL
Intraoperative phase
Use of epidural analgesia	Thoracic epidural analgesia may be used in patients with stable hemodynamic and no bleeding tendency
GDFT	GDFT may be beneficial in patients with high-predicted postoperative mortality
Prevention of hypothermia	All measures should be done to prevent or reverse intraoperative hypothermia
PONV	A multimodal prophylaxis of PONV should be used in all patients based on their risk factors for PONV
Minimally invasive surgery	Laparoscopy may be performed in selected patients by experienced surgeons
Avoidance of intraperitoneal drains	Intraabdominal and pelvic drains should not be used routinely
Postoperative phase
Multimodal analgesia	Opioid-sparing multimodal analgesia should be tailored to the individual and the operation involved
Early removal of NGT	NGT can be removed safely on postoperative day 1-2 unless paralytic ileus is evident
Early feeding	Oral intake can resume in stabilized patients and should progress moderately if patients can tolerate
Early removal of urinary catheter	Urinary catheter can be removed safely on postoperative day 1-2
Breathing and coughing exercise	Patients are encouraged to have sessions of deep breathing and coughing exercise postoperatively
Early mobilization	Patients are encouraged to have early independent mobilization as a part of physiotherapy and rehabilitation program

ERAS: Enhanced recovery after surgery; GDFT: Goal-directed fluid therapy; PONV: Postoperative nausea and vomiting; NGT: Nasogastric tube.