Anesthesia management for ambulatory surgery under the concept of enhanced recovery after surgery_West China Medical Journal

Authors：

GAO Zunzheng , FENG Yan ,  SUN Defeng

Department of Anesthesiology, the First Affiliated Hospital of Dalian Medical University, Dalian, Liaoning 116011, P. R. China;

Corresponding author：

SUN Defeng, Email: sdf-yl@163.com

Keywords：

Enhanced recovery after surgery; ambulatory surgery; perioperative period; pain management; postoperative nausea and vomiting

DOI：

10.7507/1002-0179.202211071

Video：

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Enhanced recovery after surgery (ERAS) is a protocol designed to improve perioperative outcomes by multidisciplinary team with evidence-based interventions. The implementation of ERAS concept has been proved to reduce postoperative complications and hospital stay. The anesthesia management under the concept of ERAS is the basis of safe and smooth ambulatory surgical protocol. This article summarizes the latest clinical evidence at home and abroad, and reviews the preoperative optimization, anesthesia mode selection, ventilation strategies, fluid management, temperature support, pain management, postoperative nausea and vomiting prevention, postoperative nutritional support, and postoperative sleep improvement in the management of anesthesia under ERAS concept, in order to provide a reference for anesthesia management in ambulatory surgery.

Citation： GAO Zunzheng, FENG Yan, SUN Defeng. Anesthesia management for ambulatory surgery under the concept of enhanced recovery after surgery. West China Medical Journal, 2023, 38(2): 170-179. doi: 10.7507/1002-0179.202211071 Copy

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1. Kehlet H. Multimodal approach to control postoperative pathophysiology and rehabilitation. Br J Anaesth, 1997, 78(5): 606-617.
2. Zhang X, Yang J, Chen X, et al. Enhanced recovery after surgery on multiple clinical outcomes: umbrella review of systematic reviews and meta-analyses. Medicine (Baltimore), 2020, 99(29): e20983.
3. 国家卫生健康委办公厅. 国家卫生健康委办公厅关于印发日间手术推荐目录(2022 年版)的通知. (2022-02-25)[2022-11-09]. http://www.nhc.gov.cn/yzygj/s3594q/202202/f57ca70b23f34ca88308979ef19bde4b.shtml.
4. 朱宏, 黄鸿燕, 郑胄斌, 等. 日间手术的经济学评价研究综述. 卫生经济研究, 2021, 38(9): 25-28, 32.
5. Joshi GP. Enhanced recovery pathways for ambulatory surgery. Curr Opin Anaesthesiol, 2020, 33(6): 711-717.
6. 中华医学会麻醉学分会“成人日间手术加速康复外科麻醉管理专家共识”工作小组. 成人日间手术加速康复外科麻醉管理专家共识. 协和医学杂志, 2019, 10(6): 562-569.
7. Edwards R, Gibson J, Mungin-Jenkins E, et al. A Preoperative spinal education intervention for spinal fusion surgery designed using the rehabilitation treatment specification system is safe and could reduce hospital length of stay, normalize expectations, and reduce anxiety: a prospective cohort study. Bone Jt Open, 2022, 3(2): 135-144.
8. Grant MC, Pio Roda CM, Canner JK, et al. The impact of anesthesia-influenced process measure compliance on length of stay: results from an enhanced recovery after surgery for colorectal surgery cohort. Anesth Analg, 2019, 128(1): 68-74.
9. Jalilian L, Wu I, Ing J, et al. Evaluation of telemedicine use for anesthesiology pain division: retrospective, observational case series study. JMIR Perioper Med, 2022, 5(1): e33926.
10. Kamdar NV, Huverserian A, Jalilian L, et al. Development, implementation, and evaluation of a telemedicine preoperative evaluation initiative at a major academic medical center. Anesth Analg, 2020, 131(6): 1647-1656.
11. Chen W, Wu Q, Fu N, et al. Patient selection for ambulatory laparoscopic cholecystectomy: a systematic review. J Minim Access Surg, 2022, 18(2): 176-180.
12. 李俊杰, 冯艳, 孙德峰. 日间手术麻醉新进展. 华西医学, 2022, 37(2): 295-300.
13. Joshi GP, Ahmad S, Riad W, et al. Selection of obese patients undergoing ambulatory surgery: a systematic review of the literature. Anesth Analg, 2013, 117(5): 1082-1091.
14. Szeto B, Vertosick EA, Ruiz K, et al. Outcomes and safety among patients with obstructive sleep apnea undergoing cancer surgery procedures in a freestanding ambulatory surgical facility. Anesth Analg, 2019, 129(2): 360-368.
15. Bailey CR, Ahuja M, Bartholomew K, et al. Guidelines for day-case surgery 2019: guidelines from the Association of Anaesthetists and the British Association of Day Surgery. Anaesthesia, 2019, 74(6): 778-792.
16. Pattnaik S, Dixit SK, Bishnoi V. The burden of surgical cancellations: a quality improvement study on the importance of preoperative assessment. Cureus, 2022, 14(1): e21731.
17. Lee JY, Kim HT, Choi JH, et al. Effect of clinical anesthesia preoperative evaluation on the length of preoperative period and total hospitalization of patients undergoing laparoscopic cholecystectomy. Am J Transl Res, 2021, 13(10): 11943-11947.
18. Gillis C, Ljungqvist O, Carli F. Prehabilitation, enhanced recovery after surgery, or both? A narrative review. Br J Anaesth, 2022, 128(3): 434-448.
19. Gillis C, Buhler K, Bresee L, et al. Effects of nutritional prehabilitation, with and without exercise, on outcomes of patients who undergo colorectal surgery: a systematic review and meta-analysis. Gastroenterology, 2018, 155(2): 391-410.e4.
20. Barberan-Garcia A, Ubré M, Roca J, et al. Personalised prehabilitation in high-risk patients undergoing elective major abdominal surgery: a randomized blinded controlled trial. Ann Surg, 2018, 267(1): 50-56.
21. McIsaac DI, Gill M, Boland L, et al. Prehabilitation knowledge network. Prehabilitation in adult patients undergoing surgery: an umbrella review of systematic reviews. Br J Anaesth, 2022, 128(2): 244-257.
22. Badiani S, Diab J, Woodford E, et al. Impact of preoperative smoking on patients undergoing right hemicolectomies for colon cancer. Langenbecks Arch Surg, 2022, 407(5): 2001-2009.
23. Heiden BT, Eaton DB Jr, Chang SH, et al. Assessment of duration of smoking cessation prior to surgical treatment of non-small cell lung cancer. Ann Surg, 2021, 18: 10.
24. Iqbal U, Green JB, Patel S, et al. Preoperative patient preparation in enhanced recovery pathways. J Anaesthesiol Clin Pharmacol, 2019, 35(Suppl 1): S14-S23.
25. Kaka AS, Zhao S, Ozer E, et al. Comparison of clinical outcomes following head and neck surgery among patients who contract to abstain from alcohol vs patients who abuse alcohol. JAMA Otolaryngol Head Neck Surg, 2017, 143(12): 1181-1186.
26. 中华医学会外科学分会, 中华医学会麻醉学分会. 中国加速康复外科临床实践指南(2021)(一). 协和医学杂志, 2021, 12(5): 624-631.
27. Gupta R, Gan TJ. Peri-operative fluid management to enhance recovery. Anaesthesia, 2016, 71(Suppl 1): 40-45.
28. McCracken GC, Montgomery J. Postoperative nausea and vomiting after unrestricted clear fluids before day surgery: a retrospective analysis. Eur J Anaesthesiol, 2018, 35(5): 337-342.
29. Perlas A, Mitsakakis N, Liu L, et al. Validation of a mathematical model for ultrasound assessment of gastric volume by gastroscopic examination. Anesth Analg, 2013, 116(2): 357-363.
30. Spencer AO, Walker AM, Yeung AK, et al. Ultrasound assessment of gastric volume in the fasted pediatric patient undergoing upper gastrointestinal endoscopy: development of a predictive model using endoscopically suctioned volumes. Paediatr Anaesth, 2015, 25(3): 301-308.
31. Engelhardt T, Webster NR. Pulmonary aspiration of gastric contents in anaesthesia. Br J Anaesth, 1999, 83(3): 453-460.
32. Wang ML, Min J, Sands LP, et al. Midazolam premedication immediately before surgery is not associated with early postoperative delirium. Anesth Analg, 2021, 133(3): 765-771.
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West China Medical Journal

Anesthesia management for ambulatory surgery under the concept of enhanced recovery after surgery

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