IMPLEMENTATION OF ERAS PROTOCOL FOR CESAREAN SECTION.

In the past few decades, many changes have been noticed in all medical branches, especially in surgery. Enhanced Recovery After Surgery (ERAS) is a completely new approach, with the main goal to change the period of patient's recovery, making perioperative time easier and shorter. The patient's recovery is faster, better and the patient's satisfaction is bigger. Patients have an active role in their own recovery, which results in faster return to work and everyday activities. Hospital Length of Stay (LOS) is shorter and associated with concomitant financial savings. After ERAS protocol had been implemented in colorectal, abdominal surgery, urology orthopedic and oncology, and finally in obstetrics for cesarean section as well. This protocol has mostly been used in developed countries, but not in all hospitals. Creation and implementation of ERAS protocol is hard work, which includes multidisciplinary team work and especially a team leader, who coordinates the medical team, the patient and hospital management. Conclusion: Creation of an ERAS protocol is very serious and long- lasting work. It is multidisciplinary and it usually has to be individually tailored for each institution itself in coordination with the health care system and with the final implementation in the medical system.

Anaphylaxis on Graft Reperfusion during Orthotopic Liver Transplantation: A Case Study.

INTRODUCTION: Hemodynamic instability is a common occurrence during liver transplantation (LT). Hypotension and hemodynamic instability during graft reperfusion are most commonly consequences of the postreperfusion syndrome (PRS). CASE OUTLINE: In this report, we present a case of severe cardiovascular collapse leading to cardiac arrest which occurred in the course of graft reperfusion during LT. Persistent hypotension, non-responsive to regular measures such as volume filling and the use of vasopressors, yielded the question of whether other mechanisms were involved in causing it. Diffuse redness of the face and body, swelling of the face, lips and tongue with tongue prolapse, accompanied with severe cardiovascular collapse indicated that it was an anaphylactic reaction. This caused a dilemma as to what instigated the reaction. The trigger may have been the pharmacological substance administered during the graft reperfusion, or the one administered immediately prior to the reperfusion.The substances in question would most likely be either the University of Wisconsin preservation solution (UW), which was administered during the reperfusion, or Hepatect, which the patient received immediately prior to reperfusion. CONCLUSION: The clinical syndrome resulting from degranulation of mast cells and basophils in anaphylaxis is very similar to the PRS in LT. Clinical features play the most important role in establishing a timely diagnosis and early treatment of anaphylaxis. Swift administration of epinephrine reduces the chances of a fatal outcome. Better information on both donor and recipient can improve the efficiency of therapy and prophylaxis for anaphylaxis.