Table 1 Modified ERAS protocol
Item | Component |
|---|---|
Preoperative | Stop smoking since deciding to do the surgery |
No bowel preparation until planned for colon involvement | |
Diet: fasting 6 h before surgery (according to anesthesia), carbohydrate loading 4 h before surgery (water with glucose 400 mg) | |
Prophylactic antibiotic (cephalosporin 2nd or cefazolin) | |
Consultation with hemato-oncology division for the evaluation of LMWH heparin for the prevention of DVT | |
Intraoperative | Prevention of hypothermia |
Use of multimodal analgesia | |
Goal directed intraoperative fluid therapy | |
NGT is removed immediately after surgery | |
Postoperative | Avoid the use of opioid, instead of using paracetamol and NSAIDS |
Postoperative oral intake as early as possible. If tolerance is good, fluid diet can be started 12 h after surgery | |
Chew gum for 15 min 3 times a day on delayed intake patients | |
Administration of alinamin F, if needed, to stimulate intestinal motility | |
If the patient is unable to take diet after 3–4 days, but bowel activity is present, consider diet through NGT. If there is no bowel activity, begin total parenteral nutrition | |
Postoperative gradual mobilization (since H-0 start to sitting) | |
Intravenous fluid restriction. Oral fluid intake is more preferred | |
Giving gastrointestinal prophylaxis with ranitidine until bowel function returns to normal | |
Administration of anti-emetic, Metoclopramide if needed |