ERAS and Transplant Flashcards
What is ERAS?
Enhanced Recovery After Surgery
What is the point of ERAS?
Start the patient on a healthy lifestyle before surgery to help recovery
What do we need to think about with alcoholics?
Cardiomyopathies
Infections
Arrythmias (dehydration electrolyte issues)
increase post op complications
Smoking cessation values
20 mins: Decreased effects on BP and vasoconstriction
8 hours: CO levels halved
12 Hours: CO levels normalized
24 Hours: Chances of MI go down
48 Hours: Cilia muscus expusion begins
2 Weeks: Lung inflammion decreases
What time frame after quitting is a mucus plug more likely?
48 hrs to 8 weeks
E-Cigs contain what
Nicotine
Glycerol
Heavy Metals
possible social drugs
What is EVALI?
E-cig or vaping use associated lung injury
NPO in ERAS?
8 hours with ability to have carb beverage up to two hours prior
What does the carb drink do for the patient?
Increased rate of bowel return to function
reduces insulin resistant
decreases anxiety
prevent catabolic state
ERAS: Intraop MMA
PLONNKED-GM
Precedex
LA
Opioids
Non-Opioids Analgesics (Acetaminophen)
NSAIDS (Toradol)
Ketamine
Esmolol (decreased sympathetic outflow)
Decadron
Gabapentin
Magnesium Sulfate
What three ways does a patient feel pain?
Perception
Transmission
Modulation
What is allodynia
pain due to a stimulus that does not usually cause pain
What is hyperalgesia
increased pain due to a stimulus that does usually cause pain
OIH?
Opiod induced hyperalgesia
short acting narcotic exposure that causes increased pain perception
Opioid Tolerance
increased naroctic need to provide analgesia
What NMDA antagoist helps with OIH?
Ketamine
CTZ
Chemoreceptor trigger zone
Factors that increase PONV
Female
Young
Anxiety
Non-smoker
Hx of PONV, Migraine, Motion Sickness
What is a PONV risk with morphine?
Histamine release
What anesthetic drugs/agents increase PONV?
Opioids
Volatile agent
NO2
Long case