Alisha Ebrahim

Enhanced Recovery After Surgery (ERAS) is an evidence-based, holistic perioperative recovery protocol intended to improve patient outcomes and decrease postoperative complication rates. While ERAS protocols were first introduced in 1997, specific guidelines for cardiac surgery were not established until 2019. Although the core principles of ERAS remain constant across surgical disciplines, ERAS guidelines for cardiac surgery have remained relatively understudied, likely due to the unique complexities posed by cardiac procedures. Within this comprehensive narrative review, we aimed to explore the current guidelines and evidence for ERAS in both cardiac and non-cardiac surgeries. In non-cardiac surgeries, ERAS has been shown to improve various outcomes, including ICU length of stay, patient satisfaction, and pain management. ERAS for cardiac surgery has also shown encouraging results, including shorter ICU and hospital stays, reduced postoperative opioid use, and faster recovery times. However, there is limited consensus across studies, particularly regarding its impact on morbidity and mortality, with mixed results reported. Furthermore, the limited data on the efficacy of ERAS in minimally invasive cardiac surgeries makes it difficult to establish well-supported guidelines for these procedures. Despite its limitations, the overall outcomes of ERAS for cardiac surgery remain promising. As our understanding and application of ERAS in cardiac surgery continue to evolve, these protocols have the potential to redefine cardiac surgical care standards.

The tubarial glands (TGs) are a collection of salivary glands (SGs) located within the nasopharynx, proximal to the eustachian tube. Currently, there is no quantitative characterization of the TGs. We investigated the histological architecture of the TGs and compared it with the major and minor SGs for categorization. Tubarial, parotid, submandibular, sublingual, buccal, labial, and lingual glands were excised from human donors (8 male and 3 female). Hematoxylin and eosin‐stained tissue sections were analyzed to measure the area of the largest lobule, number of ducts, number of mucinous acini, and mean mucinous acini area. Based on our observation, the TGs' histology resembles the minor SGs, while having some unique characteristics that distinguish them from both major and minor SGs. The area of the largest lobule in the TGs and minor SGs was smaller than the major SGs. TGs have a lower number of ducts than the major and minor SGs. TGs contain densely packed clusters of predominantly mucinous acini surrounded by loose connective tissue resembling minor SGs. This density may explain their previously observed high prostate‐specific membrane antigen uptake. In our cohort of donors, sex‐based differences were observed in the mean mucinous acini area between male and female TGs, submandibular and sublingual glands. Taken together, our findings suggest the histological characteristics of all SGs are better organized on a spectrum rather than discrete groups (major vs. minor) and provide information to open new avenues for research into the TGs' role in head and neck pathologies and sexual dimorphism of the SGs.