Enhanced recovery after surgery: Progress in adapted pathways for implementation in standard and emerging surgical settings

Table 1 Modified enhanced recovery after surgery pathway in pediatric surgical patients[13]

Preoperative	Intraoperative	Postoperative
Counsel about ERAS, obtained from caregiver	Regional anesthesia with catheter-based block	Prevention of nausea and vomiting
Clear-liquid carbohydrate load (10 mL/kg up to 350 mL)	Avoiding excess drains, intraperitoneal or subcutaneous	Early feeding, clear fluids in post-operative day zero, regular diet on post-operative day one
Avoid prolonged fasting, eat regular diet, clears-only diet is given in the day prior to surgery	Ensure euvolaemia, parenteral fluids are crystalloid administered 4–7 mL/kg/h	Early mobilization, out-of-bed in the post-operative day one
No bowel preparation	Normothermia (36 °C–38 °C during the surgical procedure. (skin-to-skin time/ endoscopy/ laparoscopy)	Adjunctive pain medication (acetaminophen and non-steroidal anti-inflammatory drugs)
Antibiotic prophylaxis	Minimizing opioids (< 0.15 mg/kg intravenous morphine equivalents)	Early stoppage of intravenous fluids (either discontinue or lower rate to keep vein open. Post-operative day two)
Prophylaxis against deep vein thrombosis (age ≥ 14, or presence of risk factors)	Minimally invasive surgical procedures	Early removal of extra drains/catheters. Non-urinary drain is removal by post-operative day four

ERAS: Enhanced recovery after surgery.