Gan TJ, Thacker JK, Miller TE, Scott MJ, and Holubar SD (eds)
Professional Communications, Inc: West Islip, USA, 2016, pp 397; US$34.95
The book is a first edition manual by the American Society of Enhanced Recovery which provides a structured process with an emphasis on the importance of collaboration between patients, anaesthetists, surgeons and nurses and is authored by members of the last three groups.
At the start of the book the authors provide an overview of the roles of the surgeon, anaesthetist and nurses. The surgeons are encouraged to engage in a team approach, demonstrate leadership, and participate in research and audit. The overview of the anaesthetist describes the use of different elements of enhanced recovery protocols (ERP) in the pre-operative, intra-operative and immediate and postoperative care. In the overview of the nurses role, there is an emphasis on preparation for change by identification of advanced nurse practitioners, clinician leaders, and nurse educators who should be engaged early on in the planning and implementation phase of ERPs.
The book is divided in to five sections and twenty-four chapters. The first section titled ‘Preoperative’ provides a review of patient education, pre-operative nutrition and prehabilitation, bowel preparation, pre-operative assessment and optimisation, pre-operative antiemetic and analgesic management and postoperative medical prophylaxis of postoperative complications. A chapter on patient education focuses on increasing patient understanding, recommending the creation of patient education material. The concept of metabolic condition is introduced, along with prehabilitation. The use of up-to-date evidence in all the chapters is very beneficial.
The second section titled ‘Intraoperative’ includes chapters on fluid management, goal directed fluid therapy, regional anaesthesia, maintenance of normothermia, surgical approaches and techniques, the stress response, and enhanced recovery. The use of protocols with flow diagrams helps the reader to understand fluid balance. The evidence for thoracic epidural and TAP block in ERP is analysed and discussed. The book favours the use of minimally invasive surgery, but suggests that if open surgery is required then ERP can result in benefits equivalent to those seen with laparoscopic surgery.
The third section is about the postoperative phase, with chapters on postoperative nutrition and postoperative ileus and its prevention. It is interesting to note the multimodal analgesic approach to pain management for abdomino-pelvic surgery, as well the regimen used in bigger centers in the USA. The chapter on postoperative outcomes helps the reader to appreciate the clinical, patient reported and economic benefits of ERAS.
The fourth section contains information on overcoming challenges faced by the anaesthetists, surgeons and nurses. There are chapters on the business case for enhanced recovery, sustainability and audit. This section provides a useful insight on challenges faced, specific clinical implementation gaps, key health care changes and management principle.
In the final section the authors have included examples of six specific protocols for major abdomino-pelvic surgery: radical cystectomy, liver resection, gynae-oncology, colorectal and pancreatic surgery. The authors state that these protocols should be used as a starting point for discussion, and urges readers not to view them as the end-product. The final part is the American Society of Enhanced Recovery anaesthetic checklist.
Overall, this book is the first of its kind to be published on enhanced recovery protocols by a team of surgeons, anaesthetists and nurses. It is well presented with figures, flowcharts, tables, graphs and the latest evidence, making it easy to read and understand. The book is only 397 pages long and is portable enough to carry in a bag. It can be used as a reference for day-to-day clinical practice and as a starting point for implementing local enhanced recovery protocols. Hopefully in the future the book will refined to discuss enhanced recovery in more specific types of surgery.
Kambasi Mohammed Rafi
Nottingham University Hospitals NHS Trust