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Physiology and Pathophysiology of ERAS

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Enhanced Recovery After Surgery

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Abstract

In the development and implementation of the enhanced recovery after surgery (ERAS) program, there has been the need to understand the mechanism and the factors that affect the recovery process. Most of the elements considered by the ERAS® Society to have an impact on recovery have a physiological basis, and the interaction between them characterizes the modulation of the stress response. For example, besides surgical incision, some of them such as pain, hemorrhage, immobilization, and quasi starvation have a synergistic effect. The activation of the sympathetic system and the inflammatory response associated with all these surgical elements characterize the surgical stress response, thus leading to a state of low insulin sensitivity, which represents the most important pathogenic factor modulating the perioperative outcome.

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Notes

  1. 1.

    Please note: the infusion of a 100 ml bag of dextrose 5% (=5 g of glucose) almost doubles the amount of circulating glucose in a 70 kg nondiabetic patient (assuming a glycemia level of 5 mmol/L = 0.9 g/L and a blood volume of 77 ml/kg) [5].

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Authors and Affiliations

  1. Department of Anesthesia, McGill University Health Centre, Montreal, QC, Canada

    Thomas Schricker

  2. Department of Anaesthesia, Royal Victoria Hospital, Montreal, QC, Canada

    Ralph Lattermann

  3. Department of Anesthesia, McGill University, Montreal, QC, Canada

    Francesco Carli

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  1. Thomas Schricker
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  2. Ralph Lattermann
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  3. Francesco Carli
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Correspondence to Francesco Carli .

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Editors and Affiliations

  1. Department of Surgery, Örebro University Hospital, Örebro, Sweden

    Olle Ljungqvist

  2. Yeovil District Hospital NHS Foundation Trust Higher Kingston, Yeovil, Somerset, UK

    Nader K. Francis

  3. Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women’s, Hospital Harvard Medical School, Boston, MA, USA

    Richard D. Urman

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Schricker, T., Lattermann, R., Carli, F. (2020). Physiology and Pathophysiology of ERAS. In: Ljungqvist, O., Francis, N., Urman, R. (eds) Enhanced Recovery After Surgery. Springer, Cham. https://doi.org/10.1007/978-3-030-33443-7_2

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