The Safety and Efficacy of the Enhanced Recovery After Surgery(ERAS)Applied on Cardiac Surgery With Cardiopulmonary Bypass

Intravenous infusion of flucloxacillin sodium 1g an hour before operation

"1. No routine bowel preparation;~2. Normal eating 1 days before the operation;~3. No drinking 2h and solid food 6h before the operation;~4. Drink 10% glucose 250ml 3h before operation ;~5. Gastric mucosal protective agent was given 3 days before operation(Esomeprazole Magnesium Enteric-coated tablets 40mg/d);"

Emphasize the preoperative psychological preparation for patients.

Received subcutaneous recombinant human erythropoietin (rhEPO)150（international unit/kg） once very two days from 2 days after hospital admission to 5 days postoperatively；

No scopolamine and morphine before surgery; No midazolam; No anti - choline drugs;

Solu-Medrol®:5mg/kg intravenous infusion during the surgery;

"1. Apply Transesophageal Echocardiography（TEE）after anesthesia induction;~2. Goal-directed fluid management."

"1. Infusion of Human Albumin Grifol®20% 50ml;~2. Ultrafiltration(TERUMO CARDIOVASCULAR SYSTEMS (TERUMO®));~3. Shorten the Cardio-pulmonary Bypass line；~4. Continuous near infrared spectrum monitoring of cerebral oxygen saturation(MNIR-P100（chongqingmingxi®）)"

Monitor urine volume closely, over 0.5ml/kg·h.

Protective ventilation strategy：Low tidal volume about 6\~8ml/kg and positive end expiratory pressure（PEEP） combined with lung recruitment maneuver

"1. Bilateral thoracic paravertebral block before induction of anesthesia;~2. Fast channel anesthesia:~ * Induction use Sufentanil 0.5\~1ug/kg, Vecuronium for Injection 0.15mg/kg and Etomidate 0.2\~0.6mg/kg; ②. Maintain use Remifentanil Hydrochloride for Injection 0.1\~0.4ug/kg·min, Propofol Injection 2\~6mg/kg·h, Sevoflurane 0.5\~1.5（minimum alveolar concentration） and Infusing Dexmedetomidine which load dose 0.5μg/kg in 10min then changed into 0.5-1.0μg/kg·h,Vecuronium 0.06\~0.12mg/kg·h; ③. Intravenous hydromorphone Hydrochloride Injection 0.15mg/kg before surgery over."

"1. Drink water after 6h, 200ml once, 2\~3 times / day，~2. early ambulation，mobilization within 48 h,~3. Intravenous the conventional antiemetic drugs Tropisetron hydrochloride Injection 12mg qd；~4. Intravenous the lansoprazole 30mg q12h."

Routine preoperative psychological preparation for patients.

After operation use Ropivacaine 100mg infiltrating intercostal wound and self-controlled intravenous analgesia pump is applicable(Sufentanil 0.05ug/kg·h combine with Ketamine 40ug/kg·h).

"1. Routine bowel preparation;~2. Liquid food eating 2 days before the operation;"

Intramuscular injection of scopolamine 0.3mg combined with morphine 10mg before surgery;

"1. Induction use Sufentanil 0.5\~1ug/kg, Vecuronium 0.15mg/kg and Etomidate 0.2\~0.6mg/kg,Midazolam0.05\~0.1mg/kg ;~2. Maintain use Sufentanil 1\~2ug/kg·h, Propofol 4\~12mg/kg·h, Sevoflurane 1\~3(minimal alveolar concentration)， Vecuronium 0.06\~0.12mg/kg·h;"

Use self-controlled intravenous analgesia pump containing Sufentanil 0.07ug/kg·h

Intravenous infusion of dexamethasone 20mg during the surgery

Intravenous infusion of flucloxacillin sodium 1g before the operation