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ERAS guidelines for antenatal and preoperative care in caesarean delivery
By: Anaesthesiology.asia | Last updated: 21st January 2019 | In: Anaesthesiology, caesarean delivery, ERAS, News
ERAS, ERAS society, Guideline, preoperative care
The Enhanced Recovery after Surgery (ERAS) Society recently published Part 1 of the Society’s 3-part caesarean delivery guidelines, focussed on pre-operative care for women undergoing scheduled and unscheduled caesarean delivery, in the American Journal of Obstetrics & Gynecology.1Wilson RD, et al. Am J Obstet Gynecol 2018;219(6):523.e1-523.e15. doi: 10.1016/j.ajog.2018.09.015.
Caesarean delivery is the most common surgical procedure in the modern world.
A literature search using Embase and PubMed articles published between 1996 and 2017 was performed by an ERAS Society Guideline Committee selected author panel. Individual reviewers screened the titles and abstracts of selected studies to identify potentially relevant articles. The board then evaluated the quality of evidence and recommendations according to the Grading of Recommendations, Assessment, Development, and Evaluation system. Whereas a weak recommendation indicates that the panel is less confident on the intervention, a strong recommendation shows the panel’s confidence that the effectivity outweighs the undesirable effects (Table 1).
|–||Weak||The trade-offs are less certain, due to:
|++||Strong||The desirable effects of an intervention:
Table 1. recommendation grading according to the Grading of Recommendations, Assessment, Development, and Evaluation system.
Table 2 summarises the ERAS Society’s evidence-based recommendations for process-directed maternal care for the preoperative caesarean delivery guidelines for improved surgical quality and safety during obstetric surgical deliveries promoting the enhanced recovery for maternal and fetal/neonatal outcome.
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|Item||Recommendation Grading||Level of Evidence||Recommendation|
|Optimisation element (antenatal pathway)|
|Preadmission data, patient education and counselling||++||Very low-low||High-quality evidence lacking. Optimised clinical practice include:
|++||Very low-low||Caesarean delivery without medical indication:
|Focussed preoperative elements (preoperative pathway)|
|Preanaesthetic drugs||++||Low||Reduction of aspiration pneumonitis risks:
|Bowel preparation||++||High||Oral or mechanical bowel preparation:
|Fasting||++||High||Encourage women to drink:
|Carbohydrate supplementation||–||Low||Oral carbohydrate fluid supplementation:
|Maternal comorbidity optimisation (appendix)||++||High||Maternal obesity
|++||High||Maternal gestational diabetes mellitus (DM)
|++||High||Maternal tobacco smoking
This article is not medical advice. Patients should seek personal assessment by a licenced specialist. Physicians are recommended to read the full publication(s) as cited in the article before making medical decisions. This article does not supersede nor replace the published article(s).