Fast-track surgery—an update on physiological care principles to enhance recovery

Abstract

However, there are several possibilities for further improvement of most of the components of fast-track surgery, where surgical stress, fluid and pain management are key factors. There is an urgent need for better design of studies, especially in minimal invasive surgery to achieve maximal outcome effects when integrated into the fast-track methodology.

Protective effects of ginseng total saponins against hepatic ischemia/reperfusion injury in experimental obstructive jaundice rats

“…FTS (a simple intermittent portal triad clamping during operations and administration of fluid in the surgical setting) has been widely used in clinical practice to reduce complications. But this method has the frequent disadvantage of aggravating hepatic ischemia/ reperfusion injury (Kehlet & Wilmore, 2008;Kehlet, 2011). GS protects the liver by improving microcirculation through vasodilation, anti-platelet effects, inhibition of neutrophil activation, neutralization of toxic free radicals and anti-apoptotic effects (Langmead & Rampton, 2001).…”

Intrathecal morphine analgesia after cervical and thoracic spinal cord tumor surgery

“…Good pain control minimizes suffering and facilitates preservation of normal movement, early postoperative mobilization, and wound healing. 18 Based on our clinical experience of frequently insufficient pain control after spinal cord operations using traditional pain management with acetaminophen, metamizol, and morphine given intravenously by patient-controlled analgesia, we sought improvements to this regimen. Peridural local anesthetics would have required a catheter to remain in the epidural space, with some anesthetic-induced neurological dysfunction.…”

Fast Track Surgery—Minimizing Side Effects of Surgery

“…The complex interplay of somatic and autonomic wound-mediated inflammatory cascade has been in focus of scientist studying postoperative convalescence. This understanding has led to a three-decade-old hypothesis that a multimodal intervention to abort the cascade at different levels will lead to enhanced recovery from abdominal surgery [13]. Following this understanding, the concept of minimizing the side effects of surgery or surgical rehabilitation or postoperative convalescence or enhanced recovery after surgery has gained a nomenclature of Bfast track surgery^ [14].…”

“…These factors are involved in postoperative pain, postoperative orthostatic hemodynamics, postoperative nausea-vomiting complex, postoperative ileus, postoperative coagulation, postoperative fatigue, sleep disturbances, etc. [13]. Postoperative fatigue and sleep disturbances affect the patient's HrQoL for up to 3 month.…”

“…For its conceptualization for instituted practice, various components as enumerated in Table 3 have to be optimized [13,[24][25][26][27][28][29][30]. Based upon this holistic understanding, various guidelines have been formulated for abdominal surgery and especially targeted to colonic surgery, where the rewards of fast track protocols are most needed [31].…”