ERAS-Implementierung in der Thoraxchirurgie

Zusammenfassung

Zielsetzung

Dieses Manuskript gibt einen Überblick über die Prinzipien und Voraussetzungen zur Implementierung eines ERAS-Programms in der Thoraxchirurgie.

Methoden

Basierend auf den ERAS-Guidelines für Thorachirurgie der ERAS Society wird das ERAS-Programm mit seinen einzelnen Maßnahmen bei elektiven Lungenoperationen dargestellt. Mit besonderem Augenmerk auf das postoperative Outcome werden die klinischen Maßnahmen anhand einer aktuellen Literaturübersicht beschrieben. Das ERAS-Programm zum optimierten perioperativen Management für elektive lungenresezierende Eingriffe besteht derzeit aus 45 Maßnahmen, die sich auf 4 perioperative Phasen verteilen. Diese Maßnahmen umfassen von der Zeit vor der Krankenhausaufnahme (Patientenaufklärung, Screening und Behandlung möglicher Risikofaktoren wie Anämie, Mangelernährung, Beendigung des Nikotin- oder Alkoholmissbrauchs, Prähabilitation, Kohlenhydratbelastung) über die unmittelbare präoperative Phase (verkürzte Nüchternheitsphase, nicht sedative Prämedikation, Prophylaxe von PONV und thromboembolischen Komplikationen), die intraoperativen Maßnahmen (Antibiotikaprophylaxe, standardisierte Anästhesie, Normothermie, zielgerichtete Flüssigkeitstherapie, minimalinvasive Chirurgie, Vermeidung von Kathetern und Sonden) und die postoperativen Maßnahmen (frühzeitige Mobilisierung, frühzeitige Ernährung, Entfernung eines Blasenkatheters, Hyperglykämiekontrolle). Die meisten dieser Maßnahmen beruhen auf wissenschaftlichen Studien mit hohem Evidenzlevel und führen zu einer Reduktion postoperativer allgemeiner Komplikationen.

Schlussfolgerung

Das ERAS-Programm ist ein optimiertes perioperatives Behandlungsverfahren und kann die postoperative Genesung von Patienten bei elektiven Lungenresektionen durch eine Verringerung der allgemeinen Komplikationsrate und der Gesamtmorbidität verbessern.

Abstract

Background

This manuscript provides an overview of the principles and requirements for implementing the ERAS program in thoracic surgery.

Methods

The ERAS program optimises perioperative management of elective lung resection procedures and is based on the ERAS Guidelines for Thoracic Surgery of the ERAS Society. The clinical measures are described as in the current literature, with a focus on postoperative outcome. There are currently 45 enhanced recovery items covering four perioperative phases: from the prehospital admission phase (patient education, screening and treatment of potential risk factors such as anaemia, malnutrition, cessation of nicotine or alcohol abuse, prehabilitation, carbohydrate loading) to the immediate preoperative phase (shortened fasting period, non-sedating premedication, prophylaxis of PONV and thromboembolic complications), the intraoperative measures (antibiotic prophylaxis, standardised anaesthesia, normothermia, targeted fluid therapy, minimally invasive surgery, avoidance of catheters and probes) through to the postoperative measures (early mobilisation, early nutrition, removal of a urinary catheter, hyperglycaemia control). Most of these measures are based on scientific studies, with a high level of evidence and aim to reduce general postoperative complications.

Conclusion

The ERAS program is an optimised perioperative treatment approach aiming to improve the postoperative recovery in patients after elective lung resection by reducing the overall complication rates and overall morbidity.

Schlüsselwörter

perioperatives Management - ERAS - fast-track - Morbidität - postoperative Komplikationen - perioperative Medizin

Keywords

perioperative management - ERAS - enhanced recovery after surgery - fast-track - postoperative complications - perioperative medicine

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