Penerapan Enhanced Recovery after Surgery (ERAS) pada Bedah Saraf

Abstract

Enhanced recovery after surgery atau ERAS adalah suatu protokol perawatan perioperasi terstandar multidisiplin pada pasien bedah yang bertujuan untuk meminimalkan stres perioperasi sehingga menghasilkan luaran yang lebih baik. Protokol ERAS tersusun dari berbagai komponen perawatan yang terbukti mendukung pemulihan dan/atau menghindari komplikasi pascaoperasi. Komponen-komponen tersebut mengikutsertakan ahli bedah, ahli anestesi, perawat, farmasi, ahli gizi yang terlibat dalam perawatan pasien sehingga memberikan perbaikan yang lebih baik. Protokol ERAS tersusun dari berbagai komponen perawatan dari mulai praoperasi (konseling, pemberian nutrisi, pengelolaan kebiasaan, trombofilaksis, persiapan daerah operasi dan profilaksis antimikroba), intraoperasi (teknik anestesi, manajemen anestesi, analgesia, manajemen cairan, pengaturan suhu, teknik pembedahan) hingga pascaoperasi (kejadian post-operative nausea and vomiting (PONV), drainase urin, asupan nutrisi, mobilisasi dini). Penerapan ERAS menunjukkan hasil yang baik, dapat diterapkan, dan memberikan keuntungan bagi pasien bedah saraf. Walau demikian, protokol ERAS dalam bedah saraf masih sangat terbatas dan memerlukan penelitian lebih lanjut mengikuti berbagai jenis tindakan/operasi dan keadaan pasien yang berbeda-beda.

Implementation of Enhanced Recovery after Surgery (ERAS) in Neurosurgery

Abstract

Enhanced recovery after surgery (ERAS) is a multidisciplinary standardized perioperative treatment protocol in surgical patients that aims to minimize perioperative stress and result in better outcomes. The ERAS protocol is composed of various components of care that have been shown to support recovery and/or avoid postoperative complications. These components include surgeons, anesthesiologists, nurses, pharmacists, nutritionists who are involved in patient care to provide better improvements. The ERAS protocol is composed of various components of preoperative care (counseling, nutrition, lifestyle management, thromboprophylaxis, preparation of the surgical area and antimicrobial prophylaxis), intraoperative care (anesthetic technique, anesthesia management, analgesia, fluid management, temperature regulation, surgical technique) and postoperative care (PONV management, urinary drainage, nutritional intake, early mobilization). Implementation of ERAS is applicable and shows good results along with the benefits for patients undergoing neurosurgery. However, ERAS in neurosurgery is still very limited and requires further research following different types of procedures / operations and different patient conditions.