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Continuing Education in Anaesthesia, Critical Care & Pain Advance Access originally published online on March 4, 2009
Continuing Education in Anaesthesia, Critical Care & Pain 2009 9(2):39-43; doi:10.1093/bjaceaccp/mkp006
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© The Author [2009]. Published by Oxford University Press on behalf of The Board of Directors of the British Journal of Anaesthesia. All rights reserved. For Permissions, please email: journals.permissions@oxfordjournal.org

Fast-track surgery and anaesthesia

Andrew J. Kitching, FRCA
Consultant Anaesthetist
Royal Berkshire NHS Foundation Trust
London Road
Reading RG1 5AN
UK

Sarah S. O'Neill, FRCA
Specialist Registrar in Anaesthesia
Oxford Radcliffe Hospitals
Oxford
UK
Tel: +44 118 322 7065 Fax: +44 118 322 7067 E-mail: andrewjkitch@btinternet.com

The first 150 words of the full text of this article appear below.


Key points

Enhanced recovery after surgery (fast-track surgery) entails a multidisciplinary approach to perioperative care to permit earlier discharge from hospital.
Patient education and motivation, early feeding and mobilization, and a multimodal analgesic regime are all essential.
A corporate approach should be developed; education of surgical, anaesthetic, nursing, and physiotherapy staff is vital.
A significant reduction in length of hospital stay may be achieved without any increase in perioperative morbidity.

 

Major surgery induces profound physiological responses; frequent sequelae include pain, nausea, ileus, increased cardiac demands, and impaired pulmonary function. These complications can lead to delayed mobilization, prolonged hospital stay, and significant postoperative complications.

‘Fast-track’ surgery was pioneered by Professor Henrik Kehlet in Denmark in the early 1990s.1,2 The term refers to a multimodal package of techniques which aim to decrease post-surgical organ dysfunction and complications, and hence to improve postoperative recovery. The centres that have pioneered this approach have achieved . . . [Full Text of this Article]


   Preoperative management
 
Preoperative assessment

Premedication

Preoperative hydration status


   Intraoperative management
 
Surgical technique

Avoidance of routine nasogastric tubes and drains

Anaesthetic technique

Fluid management

Prevention of postoperative nausea and vomiting

Temperature control


   Postoperative management
 
Balanced analgesia

Early enteral nutrition

Early mobilization


   Outcomes and implementation of fast-track programmes
 

   Conclusion
 

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