Enhanced recovery after surgery and the role of the anesthetist, road to implementation

Enhanced recovery after surgery (ERAS) is an interdisciplinary and multimodal approach to surgical patient management. Two primary objectives of the ERAS philosophy have been the standardization of practices and the reduction of variations in treatment. A notable achievement of ERAS has been its ability to enhance and combine into bundles elements that were already well-known but disconnected in clinical practice, such as preadmission, prehabilitation, and multimodal analgesia. Key concepts of ERAS pathways include multimodal, optimization, early and minimal; while the essential principles for success are research, education, and audit. Current literature suggests that a compliance rate of over 70% is associated with better clinical outcomes and improved survival rates. However, it is not yet possible to determine which specific elements are the most critical for ERAS outcomes, nor it is easy to demonstrate which combinations of items are best suited to individual patients. Three types of barriers (cultural, organizational, and structural) can be highlighted as opponents to ERAS implementation. The concept of partial ERAS is gaining increased interest. Adhering to ERAS protocols was not easy, as it required anesthetists to step outside the confines of the operating room, both physically and culturally, and to consciously assume the role of clinical support to surgeons and their patients. Through innovation, collaboration, and advocacy for their indispensable role, anesthetists can lead the evolution of perioperative medicine, ensuring that both patients and the profession thrive in the era of precision care and rapidly changing healthcare environments.