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Enhanced Recovery After Surgery (ERAS)
TEXTGeneral Principles VIII · 8 min read
ERAS is a 20-element multidisciplinary bundle that consistently shortens length of stay 30–50% and cuts complications by a third. Recognize the elements that fall under anesthesia ownership.
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2 min read5 sectionsWhat ERAS is
Developed in colorectal surgery (Kehlet 1997, ERAS Society 2001) and now adapted across colorectal, urologic, gynecologic, thoracic, cardiac, orthopedic, and bariatric pathways.
Core principle: each element is modest in isolation; the COMBINED bundle reduces length of stay 30–50% and complications 30–50%.
Anesthesia owns or co-owns roughly half the 20 elements — fluid plan, multimodal analgesia, regional anesthesia, normothermia, PONV prophylaxis, and lung-protective ventilation.
Preoperative elements
Intraoperative elements (anesthesia-owned)
4–8 mg, lidocaine infusion in select cases.36°C.6–8 mL/kg IBW, PEEP 5–8, recruitment.Postoperative elements
Outcomes evidence
ERAS pathways consistently shorten length of stay 30–50%, reduce postoperative complications 30–50%, lower 30-day readmission, and decrease opioid consumption versus traditional care.
Larger benefit when COMPLIANCE with bundle elements exceeds 70% (POLARIS, EVR-USA data).
NOT a license for early discharge of unsafe patients — the bundle works because each piece reduces a specific physiologic insult, not because care is rushed.
The CRNA's role is owning the anesthesia-side elements consistently every case in an ERAS pathway.
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