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Korean J Anesthesiol > Epub ahead of print
DOI: https://doi.org/10.4097/kja.d.19.00010    [Epub ahead of print]
Published online March 6, 2019.
Enhanced recovery after surgery in liver resection: current concepts and controversies
Vandana Agarwal, Jigeeshu V Divatia
Department of Anaesthesia, Critical Care and Pain Tata Memorial Centre, Homi Bhabha National Institute Dr Ernest Borges Marg, Parel Mumbai 400012, India
Corresponding author:  Jigeeshu V Divatia, Tel: 91-22-24177000, Fax: +91-22-24146937, 
Email: jdivatia@yahoo.com
Received: 9 January 2019   • Revised: 2 March 2019   • Accepted: 5 March 2019
Enhanced recovery after surgery (ERAS) attenuates the stress response to surgery in the perioperative period and hastens recovery. Liver resection is a complex surgical procedure where enhanced recovery program has been shown to be safe and effective in terms of postoperative outcomes. ERAS programmes have been shown to be associated with lower morbidity, shortened postoperative stay and reduced cost with no difference in mortality and readmission rates. However, there are challenges that are unique to hepatic resection such as the safety after epidural catheterization and postoperative coagulopathy, intraoperative fluids and postoperative organ dysfunction, need for low central venous pressure to reduce blood loss and non-lactate containing intravenous fluids. This narrative review briefly discusses these concerns and controversies and suggests revisiting some of the strong recommendations made by the ERAS society in light of the recent evidence.
Key Words: Balanced crystalloid; Central venous pressure; Coagulopathy; Enhanced recovery after surgery; Epidural analgesia; Liver resection; Perioperative
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