Whether this translates into an effect on length of hospital stay requires further study.īowel preparation is traditionally administered to all patients before colorectal surgery. There is a reduction in perioperative insulin resistance, and a small reduction in perioperative muscle catabolism. They reduce the sensations of thirst and hunger, and in smaller trials have been shown to reduce anxiety levels. Clear carbohydrate fluids given before operation may also have a role. Clear fluids taken orally up to 2 h before surgery have been shown to have no effect on gastric volume and pH, and therefore no effect on aspiration risk. There is evidence that avoidance of preoperative dehydration can reduce postoperative pain and nausea.
Traditionally, patients for elective surgery are fasted overnight to reduce aspiration risk, which may lead to significant dehydration. and epidurally, can shorten the duration of ileus and improve pain control after colorectal procedures. Furthermore, clonidine, when given both i.v. There is also evidence that they reduce perioperative myocardial ischaemia, intraoperative blood loss, and postoperative nausea and vomiting (PONV). α 2-Agonists such as clonidine and dexmedetomidine can have opioid-sparing effects when used as premedication. They also have analgesic-sparing and anticatabolic properties, which may facilitate recovery from surgery.
β-Blockers suppress the surgically induced increase in circulating catecholamines and can therefore reduce perioperative cardiovascular morbidity. In this respect, there is increasing interest in both α 2-agonists and β-blockers. In the fast-track surgical setting, premedication is aimed at reducing the surgical stress response. PremedicationĬonsideration should be given to appropriate premedication.
Several studies have demonstrated that such information can reduce anxiety, analgesic requirements, and length of hospital stay. In fast-track programmes, patients are given information about their anticipated postoperative course, analgesia, mobilization programme, and discharge. Preoperative assessment also provides an opportunity for patient education. Preoperative assessment allows estimation of risk and an opportunity to stabilize co-existing disease and optimize organ function before surgery. Postoperative organ dysfunction and complications are related to preoperative co-morbidity. Preoperative management Preoperative assessment Well-organized prospective audit is an important part of the process. For this to be a success, the multidisciplinary team involved should be fully informed and educated about their roles within the programme. Each aspect uses evidence gleaned from the literature on perioperative medicine, and attempts to integrate these ideas into a seamless programme of clinical care. The core principles of fast-track surgery (or enhanced recovery) programmes, as applied to major abdominal surgery, are reviewed here. The centres that have pioneered this approach have achieved impressive reductions in hospital stay and surgical morbidity. 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. ‘Fast-track’ surgery was pioneered by Professor Henrik Kehlet in Denmark in the early 1990s. These complications can lead to delayed mobilization, prolonged hospital stay, and significant postoperative complications. Major surgery induces profound physiological responses frequent sequelae include pain, nausea, ileus, increased cardiac demands, and impaired pulmonary function. Patient education and motivation, early feeding and mobilization, and a multimodal analgesic regime are all essential.Ī corporate approach should be developed education of surgical, anaesthetic, nursing, and physiotherapy staff is vital.Ī significant reduction in length of hospital stay may be achieved without any increase in perioperative morbidity. Enhanced recovery after surgery (fast-track surgery) entails a multidisciplinary approach to perioperative care to permit earlier discharge from hospital.
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