Anaes · General surgery anaesthesia
Elective general surgery and ERAS: anaesthetic contribution
Also known as Elective general surgery and ERAS: anaesthetic contribution · Enhanced recovery after surgery anaesthesia · ERAS multimodal analgesia
Exam-exhaustive ERAS anaesthetic contribution in elective general surgery for ANZCA Final: risk stratification (RCRI), opioid-sparing multimodal analgesia, PONV prevention, normothermia, thoughtful fluids, shared pathway goals, and when to leave ERAS lightness for crisis care.
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Target exams
Red flags
- ERAS is a pathway, not a single drug.
- Anaesthetists own multimodal analgesia, PONV, fluids, temperature.
- Risk stratify with RCRI/functional capacity.
- Avoid harmful naive acute beta-blockade (POISE).
- Early oral intake and mobilisation need good analgesia without heavy sedation.
Meet the patient
A 72-year-old man is listed for an elective laparoscopic colorectal resection on an enhanced recovery pathway (taught vignette). He has ischaemic heart disease, takes metoprolol and a statin, and the surgeon expects him drinking by evening and walking by morning. The exam question is whether you can deliver that without harming the heart or leaving him cold, nauseated, and opioid-loaded.[4]
Enhanced recovery after surgery questions test systems thinking — not only the operation but the whole pathway (taught exam framing). The examiner listens for the anaesthetist-owned elements, linked to outcomes, and for the humility to leave pathway moment a crisis appears.[4]
References7ShowHide
- [1]Lee TH, Marcantonio ER, Mangione CM, et al. Derivation and prospective validation of a simple index for prediction of cardiac risk of major noncardiac surgery Circulation, 1999.PMID 10477528
- [2]Devereaux PJ, Yang H, Yusuf S, et al. Effects of extended-release metoprolol succinate in patients undergoing non-cardiac surgery (POISE trial): a randomised controlled trial Lancet, 2008.PMID 18479744
- [3]Shakur H, Roberts I, Bautista R, et al. Effects of tranexamic acid on death, vascular occlusive events, and blood transfusion in trauma patients with significant haemorrhage (CRASH-2): a randomised, placebo-controlled trial Lancet, 2010.PMID 20554319
- [4]Gustafsson UO, Scott MJ, Hubner M, et al. Guidelines for Perioperative Care in Elective Colorectal Surgery: Enhanced Recovery After Surgery (ERAS) Society Recommendations: 2018. World J Surg, 2019.PMID 30426190
- [5]Apfel CC, Laara E, Koivuranta M, et al. A simplified risk score for predicting postoperative nausea and vomiting: conclusions from cross-validations between two centers Anesthesiology, 1999.PMID 10485781
- [6]Gan TJ, Belani KG, Bergese S, Chung F, et al. Fourth Consensus Guidelines for the Management of Postoperative Nausea and Vomiting. Anesth Analg, 2020.PMID 32467512
- [7]American Society of Anesthesiologists Committee on Standards and Practice Parameters Practice Guidelines for Preoperative Fasting and the Use of Pharmacologic Agents to Reduce the Risk of Pulmonary Aspiration: Application to Healthy Patients Undergoing Elective Procedures: An Updated Report by the American Society of Anesthesiologists Task Force on Preoperative Fasting and the Use of Pharmacologic Agents to Reduce the Risk of Pulmonary Aspiration. Anesthesiology, 2017.PMID 28045707