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Fast-track anaesthesia and patient selection
- Wolfgang Lederer (21 September 2009)
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Fast-track surgery, what about patient’s selection?
- Hany Shawkat, Amr Hawary, Urology Specialist Registrar, Severn Deanery,UK (18 August 2009)
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Wolfgang Lederer Innsbruck Medical University
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Thanks to Drs. Shawkat and Hawary for their valuable comments. It was one of our intentions to emphasize on the importance of preoperative selection and counselling of surgical patients. Flynn et al. suggested patient selection according to high risk-assessment, scheduling, anaesthetic regimen designed to facilitate early tracheal extubation, postoperative analgesia and adjusted postoperative care with reduced nurse: patient ratio, among others. There is no doubt, that anaesthetic considerations are important in the multidisciplinary approach of fast- track surgery but it is the patient who will usually contact the surgeon first. When there is a surgical solution to the health problem of the patient and both, the patient and the surgeon agree on the possibility of fast-track surgery the final decision should depend on the preoperative evaluation of the anaesthetist. Flynn M, Reddy S, Shepherd W, Holmes C, Armstrong D, Lunn C, Khan K, Kendall S. Fast-tracking revisited: routine cardiac surgical patients need minimal intenisve care. Eur J Cardiothorac Surg 2004;25:116-22. Conflict of Interest:None declared |
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Hany Shawkat, Anaesthetic Specialist Registrar North Western Deanery, UK, Amr Hawary, Urology Specialist Registrar, Severn Deanery,UK
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We read with great interest the paper published recently by Dr Wetsch and colleagues on preoperative stress and anxiety in day-care patients and inpatients undergoing fast-track surgery. The article raised the many valid and important points. One of the important issues raised was the need for both proper physiological and psychological assessment of patients undergoing fast track surgery, the authors recommended that the stress and anxiety profile of patients suitable for day-care are to be assessed preoperatively by the surgeon. Since its start in Denmark (1), Fast-track surgery has been taken up world wide with a variety of elements contributing to it, one of them being proper patient’s selection and counselling preoperatively. But who should be responsible for this? Is it the surgeon or the Anaesthetist or is it a shared responsibility? The whole concept of Fast-track surgery is based on a multidisciplinary approach to perioperative management of the patient to ensure a quick and safe postoperative return to home. Those parties include the surgeon, anaesthetist, nursing staff, physiotherapist and even the patient. It is agreed upon in literature that anaesthetic decisions in the preoperative period are pivotal and of critical importance to the surgical care team in developing a successful fast-track surgery program(2). In contemporary practice Fast-track surgery is becoming more and more popular with different institutions and specialities taking it on board because of its benefits to patients and its cost effectiveness for health trusts. Those patients would undoubtedly need special preoperative and anaesthetic consideration which is no less important than the surgical one. We hereby raise the question, is it time to re look at the process of patient’s selection for Fast-track surgery and redefine the anaesthetic role in this process? References 1- Bardram L, Funch-Jensen P, Jensen P, Crawford ME, Kehlet H. Recovery after laparoscopic colonic surgery with epidural analgesia, and early oral nutrition and mobilisation. Lancet 1995;345:763-4 2- White PF, Kehlet H, Neal JM, Schricker T, Carr D. The role of the anesthesiologist in fast-track surgery: from multimodal analgesia to perioperative medical care. Anesth Analgesia 2007; 104: 1380-96. Conflict of Interest:None declared |
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