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Anesthesia for Colorectal and Surgical Oncology Surgery

Welcome to the Colorectal and Surgical Oncology Anesthesia home page. I hope this will be a useful resource for perioperative management of colorectal and surgical oncology patients as we work to improve patient care, communication and collaboration. This is a work in progress...thanks for your patience as it grows

-Francis Wolf, MD

Director, Surgical Oncology and Colorectal Anesthesia for EUH

Emory University Department of Anesthesiology

francis.wolf@emory.edu

Anesthesia Tips and Guidelines for Surgical Oncology Procedures

Breast Surgery

Nephrectomy/VC Thrombectomy

Radical Cystectomy Pathway

Sarmiento Cases

Sugammadex Key Information

ERAS COLORECTAL

Enhanced Recovery After Surgery

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ERAS includes a set of interventions to improve care for colorectal patients. Goals of ERAS include:

  • Decreasing length of stay
  • Decreasing complications

ERAS principles for anesthetic management include

  • Minimizing harmful effects of the fasting state
  • Minimizing opioid medications
  • Preventing PONV, hypothermia and hyperglycemia
  • Optimizing patient fluid status with goal-directed fluid therapy or at least avoiding fluid overload

ERAS Colorectal Quick Guide

Esophageal Doppler Protocol (Fluid Optimization)

EUH Pathway Notes and References

GOAL-DIRECTED FLUID THERAPY

Goal-directed fluid therapy (GDFT) uses dynamic indicators of fluid responsiveness such as stroke volume, arterial pressure variability, or pleth variability to optimize intravascular volume while avoiding harmful effects of volume overload. Rather than estimate fluid requirements based on assumptions about deficits and losses, GDFT uses measurements of fluid responsiveness to guide fluid administration.

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Esophageal Doppler to Guide Fluid Management

The esophageal Doppler measures blood flow in the descending aorta and can be used to optimize fluid status by assessing stroke volume response to a fluid bolus.

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PPV from Arterial Line to Guide Fluid Management

Pulse pressure variability (PPV) predicts fluid responsiveness in patients with an arterial line who are mechanically ventilated and in sinus rhythm.

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PVI from Pulse Oximeter to Guide Fluid Management

Plethysmography variability index (PVI) uses pulse oximeter analysis to predict fluid responsiveness in patients who are mechanically ventilated and in sinus rhythm.

Pathway info including NPO guidelines (physician info)

NPO and Bowel Prep for ERAS Colorectal Patients (patient info)

Surgical Oncology/Colorectal Anesthesiology Attendings:

Colette Curtis

Beth Duggan

Philip Kalarickal

Kavitha Mathew

Tom Philpot

Jayashree Raikhelkar

Cinnamon Sullivan

Joe Webb

Francis Wolf

Joel Zivot