ERAS + Rehab+ Biofeeback🧑🏻‍🚒

Question 1

Overview of ERAS

Answer 1

• Multimodal, multidisciplinary approach to the care of the surgical patient
• Pathways that involve protocols to minimize the stress response to surgery and enable rapid recovery and retain anabolic homeostasis

Question 2

Overview of ERAS flowchart

Answer 2

Question 3

Preoperative ( ERAS)

Answer 3

Question 4

Preoperative ( Carbohydrate loading)

Answer 4

Question 5

Preoperative ( Mechanical Bowel Preparation)

Answer 5

Question 6

Preoperative (Antibiotic prophylaxis and pre-warming)

Answer 6

Question 7

Intraoperative and post operative ERAS

Answer 7

Question 8

Intraoperative ERAS

Answer 8

The Bispectral Index (BIS) is a cerebral monitoring technique used in surgery and critical care to assess the depth of anesthesia and sedation by analyzing the brain’s electrical activity (EEG). The BIS monitor calculates a value from 0 to 100, where 100 represents a fully awake state and 0 represents an isoelectric EEG (no brain activity). This value provides a real-time measure of the patient’s level of consciousness and can help guide anesthetic and sedation administration.

Question 9

Postoperative ERAS

Answer 9

Early Oral Nutrition - to support mobilization, energy and protein supply and reduces starvation- induced insulin resistance

Reducing the risk of ileus:
- Epidural analgesia in open surgery
- Avoidance of opiods and fluid overload
- no oral laxatives usage early after surgery

Question 10

Conclusion of ERAS

Answer 10

Question 11

Overview of Rehabilitation

Answer 11

Question 12

Prehabilitation

Answer 12

Question 13

Espen prehabilitation guideline

Answer 13

Question 14

Biofeedback

Answer 14

🧻🔄 Anorectal Biofeedback:
Anorectal biofeedback is a specialized form of biofeedback therapy that helps patients gain control over anorectal muscles (e.g., external anal sphincter, puborectalis, and rectum) by using real-time feedback.

It’s non-invasive, usually done in an outpatient clinic, and involves a training process guided by sensors and monitors.

🔬 How It Works: Step-by-Step
🧪 1. Assessment Phase:
A pressure-sensitive probe (anorectal manometry catheter or EMG sensor) is inserted into the rectum and/or anal canal.
Measures:
- Resting tone
- Squeeze pressure
- Push effort
- Rectal sensation/threshold

🖥️ 2. Feedback Display:
Data is shown on a monitor using:
📉 Pressure curves
🔊 Audio tones
🎮 Interactive software

🧠 3. Training Sessions (typically weekly):
Pelvic floor retraining: Patient learns to coordinate abdominal pushing with anal relaxation during defecation.
Sphincter strengthening: For fecal incontinence — repetitive squeeze exercises guided by visual/audio feedback.
Rectal sensitivity training: Controlled balloon distension helps patients perceive rectal filling earlier.

📅 Duration:
Typically 4–8 sessions, once per week, each lasting 30–60 minutes.
Improvement usually seen by session 3–5.

✅ Evidence-Based Benefits:
Endorsed by American Gastroenterological Association and Rome IV guidelines
Effective in:
🚽 Up to 80% of patients with dyssynergic defecation
💩 Reducing incontinence episodes
Improving quality of life

⚠️ Limitations & Considerations:
Requires patient motivation & cooperation
Not helpful for:
- Structural obstruction (e.g., rectocele, prolapse) unless corrected
- Neurogenic bowel (e.g., complete spinal injury)
- Must be guided by trained physiotherapists or GI specialists