[The role of anesthesiology in fast track concepts in colonic surgery].
In the present study the "fast-track rehabilitation" protocol of the Charité university hospital for patients undergoing elective colonic resection is described. The underlying principles, clinical pathways and outcome data from 208 patients are shown. Particularly anesthesiological aspects of this multimodal approach, such as modified preoperative and postoperative fluid management, changed guidelines for preoperative fasting, effective analgetic therapy using epidural analgesia and avoiding high systemic doses of opioids, use of short-acting anesthetic agents, and maintenance of normothermia as well as normovolemia are presented and discussed. In comparison to outcome data before "fast-track rehabilitation" was established, the duration of postoperative hospital stay has been reduced from 12 to 5 days, the number of general complications (pneumonia, duodenal ulcer bleeding, urinary tract infection, cerebral, cardiac and renal dysfunction) decreased from 20% to 7%, whereas surgical complications remained constant at 17% (8% wound infections, 3% anastomotic insufficiency).
Hensel
M
M
Klinik für Anästhesiologie und operative Intensivmedizin, Campus Charité Mitte, Universitätsmedizin, Berlin. mario.hensel@charite.de
Schwenk
W
W
Bloch
A
A
Raue
W
W
Stracke
S
S
Volk
T
T
von Heymann
C
C
Müller
J M
JM
Kox
W J
WJ
Spies
C
C
D015360:Analgesia, Epidural; D000700:Analgesics / Q000627:therapeutic use; D000758:Anesthesia; D001831:Body Temperature / Q000502:physiology; D003106:Colon / Q000601:surgery*; D013505:Digestive System Surgical Procedures; D006801:Humans; D007902:Length of Stay; D016343:Monitoring, Intraoperative; D011183:Postoperative Complications / Q000453:epidemiology / Q000517:prevention & control / Q000628:therapy; D012189:Retrospective Studies; D016896:Treatment Outcome
D000700:Analgesics