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This review article discusses the central role of the anesthesiologist in Enhanced Recovery After Surgery (ERAS) protocols, highlighting their contributions to preoperative patient optimization, intraoperative management (including goal-directed fluid therapy, normothermia, and opioid-sparing analgesia), and postoperative care. The review emphasizes the anesthesiologist's role in multidisciplinary coordination, protocol development, and quality improvement to improve patient outcomes and reduce complications.
Anesthesiologists are critical for the successful implementation of ERAS protocols, leading to improved patient recovery, safety, and overall surgical outcomes through active perioperative management and multidisciplinary coordination.
Background: Enhanced Recovery After Surgery (ERAS) is an evidence-based, multidisciplinary perioperative care pathway designed to reduce surgical stress, maintain physiological function, and accelerate postoperative recovery. Since its introduction by the ERAS Society, ERAS protocols have demonstrated significant reductions in postoperative complications, hospital length of stay, opioid consumption, and healthcare costs while improving patient satisfaction and functional outcomes. The anesthesiologist plays a central and pivotal role in the successful implementation of ERAS programs. Preoperatively, the anesthesiologist contributes to patient optimization through risk stratification, comorbidity management, anemia correction, prehabilitation support, patient education, and appropriate fasting and carbohydrate loading strategies. Intraoperatively, the anesthesiologist ensures goal-directed fluid therapy, maintenance of normothermia, multimodal opioid-sparing analgesia, prevention of postoperative nausea and vomiting, and use of short-acting anesthetic agents to facilitate early recovery and mobilization. Regional anesthesia techniques and ultrasound-guided nerve blocks further enhance analgesia while minimizing systemic opioid requirements. Postoperatively, anesthesiologists support early extubation, effective pain control, early enteral nutrition, glycemic control, and thromboprophylaxis in collaboration with surgeons, nurses, and physiotherapists. Their leadership in protocol development, audit, and quality improvement initiatives ensures adherence to ERAS guidelines and continuous outcome monitoring. Conclusion: the anesthesiologist is integral to the success of ERAS pathways, functioning not only as a perioperative physician but also as a coordinator of multidisciplinary care. Active anesthetic management within ERAS protocols significantly enhances patient recovery, safety, and overall surgical outcomes.
