Enhanced Recovery after Surgery

159 Pages·2018·4.44 MB·English

by  Ryoji Fukushima

Enhanced Recovery
after Surgery
Ryoji Fukushima
Masaki Kaibori
Editors
123
Enhanced Recovery after Surgery
Ryoji Fukushima • Masaki Kaibori
Editors
Enhanced Recovery after
Surgery
Editors
Ryoji Fukushima Masaki Kaibori
Department of Surgery Department of Surgery
Teikyo University School of Medicine Kansai Medical University
Tokyo, Japan Hirakata, Osaka, Japan
ISBN 978-981-10-6795-2 ISBN 978-981-10-6796-9 (eBook)
https://doi.org/10.1007/978-981-10-6796-9
Library of Congress Control Number: 2017962628
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Preface
Today, “team medical care” and “standardization of medical care” are both trends in
the medical profession, and we are required to be able to provide the same level of
medical care all over the country. As an example of team medical care, nutrition
support teams have been in operation at many institutions and have shown the great
clinical effect of nutritional therapy, which has become widely accepted as an essen-
tial supportive therapy. In addition, the various academic societies are making
efforts so that various surgical procedures can be designated as the standard surgical
procedure for given conditions. Perioperative management is not universalized to
the degree that surgical procedures are, and traditional surgical perioperative man-
agement continues to be at a great advantage. Although there are many wonderful
methods in accordance with these traditional clinical experiences, there are also
management methods described in senior commentaries that are not suitable for
today’s surgery. The enhanced recovery after surgery (ERAS®) protocol originating
in Northern Europe is soon to be introduced into Japan as a “standardization” tool
for perioperative management, but simply incorporating this protocol into the clini-
cal process will not lead to its successful use in daily clinical practice. Because we
are involved in surgery, it is important to always think about the metabolic fluctua-
tion of patients who have undergone the stress of surgery in a rational way. Above
all, the perioperative management we provide must be acceptable to the patient.
The “postoperative recovery ability program,” which reduces the physical bur-
den of patients who undergo surgery, is the first line of effort in Japan in the field of
surgery. The content of the program is said to range from presurgical meals to medi-
cation, intraoperative anesthesia, drip infusion, and rehabilitation after surgery,
which will shorten the length of stay. By doing this, the patients themselves will be
able to restore their physical fitness in a shorter period of time and will be able to
return to work earlier. For medical institutions as well, it is thought that by expedit-
ing discharge from the hospital earlier, this program is advantageous in that it makes
it possible to receive more patients.
The Essential Strategy for Early Normalization After Surgery with Patient’s
Excellent Satisfaction (ESSENSE) project, which we have been working on for
several years at the Japanese Society for Surgical Metabolism and Nutrition, is
v
vi Preface
equally important to both the theory of biological response to surgical invasion and
the satisfaction level of patients.
ESSENSE is planned to be a trigger initiative for all surgeons in all areas, anes-
thesiologists, rehabilitation doctors, nurses, and co-medical staff in their respective
positions. We anticipate that it will help to develop highly satisfying surgical man-
agement for patients.
Tokyo, Japan Ryoji Fukushima
Hirakata, Japan Masaki Kaibori
July, 2017
Contents
Part I Introduction
1 ESSENSE Project for the Sound Recovery of the Patient . . . . . . . . . . . . . 3
Go Miyata
Part II Mitigative Methods for Biological Invasive Reaction
2 Minimizing the Length of the Preoperative Fasting Period to Prevent
Stress and Dehydration . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13
Hideki Taniguchi and Keiko Ushigome
3 Preoperative Bowel Preparation in ERAS Program:
Would-Be Merits or Demerits . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21
Takeshi Yamada, Yasuyuki Yokoyama, Kouki Takeda, Goro
Takahashi, Takuma Iwai, Michihiro Koizumi, Akihisa Matsuda,
Seiichi Shinji, Keisuke Hara, Satoshi Matsumoto, Keiichiro Ohta,
and Eiji Uchida
4 Objective and Quantitative Assessment of Postoperative
Pain in Digestive Surgery . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 29
Masaki Kaibori, Hiroya Iida, Morihiko Ishizaki, Kosuke Matsui,
Tatsuma Sakaguchi, Hideyuki Matsushima, Junichi Fukui, Kentaro
Inoue, Yoichi Matsui, and Masanori Kon
Part III Early Independence of Physical Activity
5 Pros and Cons of Abdominal Drain in Digestive Surgery . . . . . . . . . . . . 45
Morihiko Ishizaki, Kosuke Matsui, and Masaki Kaibori
6 Avoiding Gut Starvation is Key to Early Recovery After Surgery . . . . . . . 57
Kazuhiko Fukatsu
vii
viii Contents
Part IV R eduction of Perioperative Anxiety and Excitation
of Recovery Will
7 Reduction of Perioperative Anxiety Before Surgery
and to Incentives to Get Well by Patients Themselves . . . . . . . . . . . . . . . 67
Naohiro Washizawa
8 Perioperative Management for Early Recovery after
Esophageal Cancer Surgery . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 73
Yoshihiro Nabeya, Isamu Hoshino, Matsuo Nagata,
and Akio Sakamoto
9 ERAS for Gastric Surgery . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 93
Ryoji Fukushima
10 Negative Effects of Mechanical Bowel Preparation
on the Postoperative Intestinal Motility of Patients
with Colorectal Cancer . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 101
Takeshi Yamada, Yasuyuki Yokoyama, Kouki Takeda,
Goro Takahashi, Takuma Iwai, Michihiro Koizumi, Akihisa
Matsuda, Seiichi Shinji, Keisuke Hara, Satoshi Matsumoto,
Keiichiro Ohta, and Eiji Uchida
11 Enhanced Recovery After Surgery Program for Patients
Undergoing Resection of Hepatocellular Carcinoma . . . . . . . . . . . . . . 109
Masaki Kaibori, Kosuke Matsui, Morihiko Ishizaki, Kentaro Inoue,
Kengo Yoshii, and Masanori Kon
12 Enhanced Recovery After Surgery (ERAS) for Postoperative
Pediatric Surgical Disorders . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 129
Akira Toki
13 Enhanced Recovery (Fast-Track) After Cardiac
and Vascular Surgery . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 135
Wataru Tatsuishi, Kiyoharu Nakano, Sayaka Kubota, Ryota Asano,
Atsuhiko Sato, and Go Kataoka
14 ERAS in the Respiratory Surgery . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 151
Takayuki Kori and Masashi Yanada
Part I
Introduction
Chapter 1
ESSENSE Project for the Sound Recovery
of the Patient
Go Miyata
Abstract Postoperative patient recovery continues to improve with the adoption of
the enhanced recovery after surgery (ERAS) program established in 2005 in
Northern European countries. The Japanese Society for Surgical Metabolism and
Nutrition launched the ESSENSE project to introduce this program in Japan and to
demonstrate its effectiveness. “ESSENSE” is an acronym for ESsential Strategy for
Early Normalization after Surgery with patient’s Excellent satisfaction.
With the premise of alleviating the biological response to surgical invasion,
physical restoration is inevitably promoted by stimulating early physical activity
autonomy, early nutrition intake independence, anxiety mitigation, and recovery
motivation. It is also important to set evaluation items so that the surgical clinical
team staff can share these goals. The ESSENSE project is an evaluation method that
takes into account the patient’s preferences, rather than a procedure focused on the
medical provider.
Keywords ERAS • Patient’s satisfaction • Surgical invasion
1.1 Surgeon’s Nature and Postoperative Management
When thinking about improving perioperative management, we can consider surgi-
cal treatment from the point of view of the surgeon, rather than from the patient’s
point of view. Many surgeons regard surgery as their primary task, and perioperative
management is an appendix to the job.
In this era, especially when the difficulty of surgery is also increasing, such as
endoscopic surgery, the sense of accomplishment of surgery itself is often the enjoy-
ment of modern surgeons to live.
G. Miyata
Department of Gastroenterological Surgery, Iwate Prefectural Central Hospital,
Morioka, Japan
e-mail: [email protected]
© Springer Nature Singapore Pte Ltd. 2018 3
R. Fukushima, M. Kaibori (eds.), Enhanced Recovery after Surgery,
https://doi.org/10.1007/978-981-10-6796-9_1