ENHANCED RECOVERY AFTER CARDIAC SURGERY (ERACS) INTEGRATING CARDIAC ANAESTHESIA AND CARDIAC REHABILITATION

Enhanced Recovery After Cardiac Surgery (ERACS) is a coordinated, evidence-informed perioperative framework that combines preoperative risk optimization, contemporary cardiac anaesthesia, cardiopulmonary bypass management, postoperative critical care, and longitudinal cardiac rehabilitation. Its objective is not simply earlier discharge but safer restoration of organ function, functional independence, and patient-reported recovery. This expanded narrative review examines the biological basis of surgical stress,frailty and prehabilitation,perioperative patient blood management, opioid-sparing analgesia, haemodynamic and ventilatory strategies, delirium and acute kidney injury prevention, early extubation,respiratory physiotherapy, mobilization, and outpatient rehabilitation. The 2024 ERAS Cardiac expert recommendations, 2024 AHA/AACVPR rehabilitation statement, and 2026 AHA patient blood management statement inform the updated discussion. Clinical decision algorithms emphasize haemodynamic stability, bleeding control, oxygenation,cognition,and individualized progression. Digital rehabilitation and artificial intelligence offer promising tools but require validation, governance, and equitable access. ERACS should be implemented as a measurable multidisciplinary bundle with audit of both process adherence and patient-centred outcomes.