Due to the many aspects of perioperative care covered in the review a formal literature search was not done. We based the review on work published mostly within the past 5 years from the major anaesthesiological, surgical, and pain journals, and systematic and Cochrane Reviews where appropriate. Recent review articles that provided comprehensive overviews were included where appropriate instead of multiple references of original work.
SeriesAnaesthesia, surgery, and challenges in postoperative recovery
Section snippets
Preoperative assessment and optimisation
Postoperative morbidity is related to preoperative comorbidity, and the anaesthetist (together with the surgeon) has to assess the risks before the operation and institute treatment to optimise the patient's condition thereby reducing postoperative complications.3
Additionally, psychological preparation of patients undergoing surgery has been shown to shorten hospital stay and to reduce the need for postoperative analgesics.4 Carefully presented information from surgeons, anaesthetists, and
Recovery and morbidity from general anaesthetics
The introduction of short-acting volatile anaesthetics (desflurane and sevoflurane), intravenous anaesthetics (propofol), and opioids (remifentanil) permits earlier recovery from anaesthesia. Comparisons between short-acting volatile anaesthetics and total intravenous anaesthetic techniques have not shown major clinically relevant differences in recovery profiles.5, 6 However, the occurrence of postoperative nausea and vomiting (PONV) during the first 6 h after surgery is reduced with propofol
Prevention and treatment of pain
The alleviation of postoperative pain is central to the role of the anaesthetist, and can include interventional as well as pharmacological techniques—provided before, during, and after surgery. Pain treatment should also reduce anxiety and provide subjective comfort. Furthermore, effective analgesia might help to blunt autonomic and somatic reflex responses and thus restore organ functions and enable mobilisation and food intake, thereby helping to improve postoperative outcome.
In the past few
Fluid management
Replacement of appropriate amounts of fluid is obviously important when normal intake is prohibited, and also has a role in preoperative optimisation of cardiovascular function. Postoperative fluid management has varied from “wet” to “dry” regimens, but evidence-based procedure- specific regimens for fluid administration are not available.65 For minor procedures, preoperative and intraoperative administration of 1–1·5 L fluid is important to enhance recovery by compensating for preoperative
PONV and ileus
Anaesthetists can enhance recovery by administering effective anti-emetics such as serotonin antagonists, glucocorticoids, and droperidol,22, 61, 62, 63, 64, 65, 66, 67, 68, 69, 70 and combination therapy can further improve the effects. Additionally, provision of opioid-free or opioid-reduced anaesthesia and analgesia can facilitate recovery by reducing PONV.
Postoperative ileus is a paradoxical response to abdominal surgery, which can increase patients' discomfort and delay recovery and
Fatigue and convalescence
Major operations are commonly followed by fatigue and convalescence. The pathogenesis of early postoperative fatigue can include sleep disturbances induced by cytokines and opioids in the early period,1, 73 while the late fatigue persisting for up to several weeks can depend on loss of muscle tissue and function and deconditioning of cardiovascular response to exercise,1, 73 as well as level of preoperative fatigue.74 Strategies that can reduce postoperative fatigue include a combined
Future directions
The forthcoming years will, as before, pose several challenges for anaesthetists to improve perioperative care and to take part in the multidisciplinary collaboration of fast-track surgery (panel 2). Thus, the anaesthetist will have a major role in the improvement of postoperative outcome, thanks to the expertise within the specialty in anaesthesia and analgesia, pathophysiology of perioperative organ dysfunctions, respiratory care, fluid management, and other supportive treatment.113 It has
Search strategy
References (116)
- et al.
Preoperative assessment
Lancet
(2003) - et al.
Acute pain
Lancet
(1999) - et al.
Propofol anaesthesia and postoperative nausea and vomiting: quantitative systematic review of randomised controlled studies
Br J Anaesth
(1997) - et al.
Omitting nitrous oxide in general anaesthesia: meta-analysis of intraoperative awareness and postoperative emesis in randomized controlled trials
Br J Anaesth
(1996) - et al.
Effect of postoperative analgesia on surgical outcome
Br J Anaesth
(2001) - et al.
Epidural anaesthesia and analgesia and outcome of major surgery: a randomised trial
Lancet
(2002) - et al.
Catabolic response to stress and potential benefits of nutrition support
Nutrition
(2002) - et al.
Insuline resistance and elective surgery
Surgery
(2000) - et al.
Analgesic agents for the postoperative period. Opioids
Surg Clin N Am
(1999) - et al.
Analgesic agents for the postoperative period. Non-opioids
Surg Clin N Am
(1999)
Comparative effects of paracetamol, NSAIDs or their combination in postoperative pain management: a qualitative review
Br J Anaesth
Upper Gl-mucosal effects of parecoxib sodium in healthy elderly subjects
Am J Gastroenterol
Safety and efficacy of postoperative epidural analgesia
Br J Anaesth
A qualitative systematic review of incisional local anaesthesia for postoperative pain after abdominal operations
Br J Anaesth
Randomization is important in studies with pain outcomes: systematic review of transcutaneous electrical nerve stimulation in acute postoperative pain
Br J Anaesth
No pain, no gain clinical excellence and scientific rigour-lessons learned from IA morphine
Pain
Meta-analysis of the efficacy of extradural clonidine to relieve postoperative pain: an impossible task
Br J Anaesth
Use and efficacy of low-dose ketamine in the management of acute postoperative pain: a review of current techniques and outcomes
Pain
Multimodal analgesia for postoperative pain control
J Clin Anesth
Pathophysiology and clinical implications of perioperative fluid excess
Br J Anaesth
Effect of salt and water balance on recovery of gastrointestinal function after elective colonic resection: a randomised controlled trial
Lancet
Epidural anesthesia-analgesia shortens length of stay after laparoscopic segmental colostomy for benign pathology
Surgery
Subjective and objective comparison of critical care pathways for open donor nephrectomy
J Urol
Infrarenal aortic surgery with a 3-day hospital stay: a report on success with a clinical pathway
J Vase Surg
Multimodal strategies to improve surgical outcome
Am J Surg
Fast-track surgery
A review of recovery from sevoflurane anaesthesia: comparisons with isoflurane and propofol including meta-analysis
Acta Anaesthesiol Scand
Comparisons between desflurane and isoflurane or propofol on time to following commands and time to discharge
Anesthesiology
A meta-analysis of nausea and vomiting following maintainance of anaesthesia with propofol or inhalation agents
Eur J Anaesthesiol
Omission of nitrous oxide during anesthesia reduces the incidence of postoperative nausea and vomiting. A meta-analysis
Anesthesiology
Twenty-four of twenty-seven studies show a greater incidence of emesis associated with nitrous oxide than with alternative anesthetics
Anesth Analg
Eliminating intensive postoperative care in same day surgery patients using short-acting anesthetics
Anesthesiology
From Cuthbertson to fast-track surgery: 70 years of progress in reducing stress in surgical patients
Ann Surg
Mild perioperative hypothermia
N Engl J Med
Supplemental perioperative oxygen to reduce the incidence of surgical-wound infection
N Engl J Med
Modification of responses to surgery by neural blockade: clinical implications
Reduction of postoperative mortality and morbidity with epidural or spinal anaesthesia: results from an overview of randomised trials
BMJ
Effect of epidural anesthesia and analgesia on perioperative outcome: a randomised controlled Veterans Affairs cooperative study
Ann Surg
Double-masked randomised trial comparing alternate combinations of intraoperative anesthesia and postoperative analgesia in abdominal aortic surgery
Anesthesiology
Perioperative single-dose glucocorticoid administration - pathophysiological effects in clinical implications
J Am Coll Surg
Beta-blockers and reduction of cardiac events in non-cardiac surgery
JAMA
Beta-blockade and growth hormone after burn
Ann Surg
Surgical stress response: does endoscopic surgery confer an advantage?
World J Surg
Effect of laparoscopy on immune function
Br J Surg
Vertical compared with transverse incisions in abdominal surgery
Eur J Surg
A qualitative and quantitative systematic review of preemptive analgesia for postoperative pain relief—the role of timing of analgesia
Anesthesiology
Efficacy and safety of patient-controlled opioid analgesia for acute postoperative pain. A quantitative systematic review
Acta Anaesthesiol Scand
Rectal and parenteral paracetamol, and paracetamol in combination with NSAIDs for postoperative analgesia
Br J Anaesth
Single dose oral ibuprofen and diclofenac for postoperative pain (Cochrane Review)
The Cochrane Library, Issue 4
Single-dose rofecoxib for acute postoperative pain in adults: a quantitative systematic review
BMC Anesthesiol
Cited by (1121)
Influence of laparoscopic surgery on the outcomes of radical cystectomy within a multimodal rehabilitation protocol
2024, Actas Urologicas EspanolasComparison of the effects of vitamin D and nasal calcitonin spray with nasal calcitonin spray on postoperative abdominal pain: A randomised controlled trial
2023, International Journal of Surgery OpenImpact of ERAS in breast reconstruction with a latissimus dorsi flap, compared to conventional management
2023, Journal of Plastic, Reconstructive and Aesthetic Surgery