[Enhanced recovery after surgery (ERAS): less is more : What must be considered from an anesthesiological perspective?]

backgroundEnhanced recovery after surgery (ERAS) is a multidisciplinary treatment model with the aim of guaranteeing a reduction of postoperative complications by the maintenance or early restoration of the patient-specific homoeostasis. From the anesthesiologist's perspective in all three areas of the perioperative phases there are important aspects that need to be addressed in the sense of a holistic treatment concept in order to achieve the highest possible benefit for the patient.

objectiveIn the perioperative period there is a bundle of anesthesiological measures, which make the ERAS concept into what it is now. At this point the focus is on the preoperative preparation and optimization of the patient and on the intraoperative and postoperative fluid management. MATERIAL AND

methodsA selective literature search was carried out in the Medline and Cochrane Library databases including consideration of national and international guidelines.

resultsFrom an anesthesiological perspective there are relevant aspects in all three pillars of the perioperative phase, the adherence of which will improve the outcome of the patient: a comprehensive risk evaluation in the preoperative period and the avoidance of any sedative drugs; intraoperative individualized fluid management in the sense of a target-oriented optimization; early postoperative enteral nutrition and the avoidance of intravenous fluid administration, whenever justifiable.

conclusionImplementing the ERAS concept in the daily clinical routine in combination with maintaining a high compliance with the protocols is a demanding interdisciplinary challenge that urgently needs to be continued.