A Novel Mechanistic Model for Future Research in the Elements of the ERAS Program in Patients With Sickle Cell Disease-A Novel Mechanistic Model for Future Research in the Elements of the ERAS Program in Patients With Sickle Cell Disease

A Novel Mechanistic Model for Future Research in the Elements of the ERAS Program in Patients With Sickle Cell Disease

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The AANA Journal article discusses the development of Enhanced Recovery After Surgery (ERAS) protocols tailored for patients with sickle cell disease (SCD). ERAS is a multidisciplinary, evidence-based approach to reducing surgical stress and optimizing recovery, traditionally not specific to SCD patients. Research has identified a novel mechanistic model suggesting ERAS protocols need adaptation for SCD patients due to their distinct physiological responses.<br /><br />Currently, ERAS protocols include preoperative strategies like carbohydrate loading 2 hours before surgery to reduce postoperative insulin resistance and muscle loss. However, this standard practice might not suit SCD patients, as emerging research indicates they respond adversely to varying serum glucose and cation levels—conditions that could trigger vaso-occlusive crises. The novel model highlights a role for actin, a structural protein, in these crises, proposing that increased glucose levels may abnormally polymerize actin in red blood cells, exacerbating sickle cell complications.<br /><br />The article advocates further research and carefully managed perioperative protocols to prevent hyperglycemic and hypertonic states in SCD patients. Adjustments might involve personalized carbohydrate intake and intravenous fluids that consider their unique needs. The objective is to minimize perioperative risks such as painful crises, acute chest syndrome, and cardiovascular complications.<br /><br />In essence, this study calls for ERAS protocol customizations for SCD patients, considering their responsiveness to metabolic changes, to improve surgical outcomes and mitigate risks. This requires coordinated efforts from healthcare providers to develop tailored perioperative management strategies across the spectrum of surgical care.

Keywords

Enhanced Recovery After Surgery

ERAS protocols

sickle cell disease

perioperative management

surgical stress

vaso-occlusive crises

actin polymerization

hyperglycemic states

personalized carbohydrate intake

cardiovascular complications