193🚑 Periop. Care of Emergency Laparotomy Part 1: ERAS Pathway, Risk Evaluation and Pre-optimisation

🎯 This Special Topic lecture in anesthesiology and perioperative medicine takes a deep dive into the perioperative care of emergency laparotomy, based on the ERAS Society guidelines and NELA data. Part 1 focuses on the preoperative phase: pathway design, risk stratification and pre-optimisation. 🧠 Why emergency laparotomy? Emergency laparotomy is one of the highest-risk surgical procedures, with a 30-day mortality of about 10% that rises to roughly one in four among patients over 80. Because patients often arrive already septic and physiologically deranged, the approach must differ fundamentally from elective ERAS. 🔬 What this video covers Epidemiology of emergency laparotomy and the mortality improvement achieved through NELA How emergency ERAS differs from elective ERAS, with definitions and urgency classification The overall pathway structure spanning pre-, intra- and postoperative care The 12 preoperative elements of ERAS Part 1 and their levels of evidence Early warning scores, sepsis screening, the hour-1 bundle and lactate monitoring Time targets for source control in septic shock and sepsis, and the role of CT Frailty, cognitive assessment, delirium prevention and geriatrician co-management Reversal of anticoagulants and antiplatelets, VTE assessment, glucose and electrolyte management Comparison of risk prediction models including NELA, P-POSSUM, ACS-NSQIP and POTTER Practical pre-optimisation covering fluid resuscitation, medication management, nutrition and damage control surgery Consultant-led care, ICU admission thresholds, failure to rescue, the NoLap population and end-of-life discussions Audit, mortality review and strategies for implementing care bundles 💡 Key message Do not delay surgery for optimisation; resuscitate and optimise simultaneously on the way to theatre. Every emergency laparotomy patient should be considered high risk until proven otherwise, and decisions should be shared among the team, the patient and the family, guided by an objective risk score. 🏥 We hope this lecture is practically useful for every clinician involved in emergency surgical anesthesia, critical care and perioperative medicine. Part 2 will continue with intraoperative and postoperative management. 👍 If you found this video helpful, please subscribe, like, and share your hospital's emergency laparotomy pathway experience in the comments. #EmergencyLaparotomy #ERAS #EnhancedRecoveryAfterSurgery #NELA #RiskStratification #PreOptimisation #Sepsis #SourceControl #Frailty #Delirium #PerioperativeMedicine #EmergencyGeneralSurgery #AcuteCareSurgery #CriticalCare #Anesthesiology #FailureToRescue #SharedDecisionMaking #AnesthesiaEducation #MedicalEducation #Residency