Fast-track is more than physiological anaesthesia

Heart, Lung and Vessels. 2014, Vol. 6 The role of the anaesthesiologist, nowadays, is not just limited to patient care in the operating room but also plays a key role in the ERAS (Enhanced Recovery After Surgery) protocol, including management of perioperative analgesia, infusion therapy, nutrition and efficient rehabilitation in order to obtain the shortest hospitalization with the lowest rate of adverse complications for patients undergoing surgery. The fast-track protocol was first designed for patients undergoing major abdominal surgery, but its principles were soon extended to other surgical specialities, including orthopaedic and vascular surgery. As the most advanced technical equipment and drugs are often insufficient to successfully manage serious conditions, their synergic use and mutual purposeful coordination are even more important. Cooperation of the whole team (in particular of the anaesthesiologist and the surgeon) is necessary, as demonstrated by the workgroup of Evidence Based Medicine in Surgery of the Canadian Association of General Surgeons and the American College of Surgeons. Nutritional support. Nutritional status, fluid intake before surgery, special nutritional products and intestinal preparation play a crucial role in the perioperative period (1). Perioperative nutritional care should focus particularly on detection of any preoperative malnutrition and potential nutrition problems in the postoperative period, compensation of perioperative hyperglycaemia and management of insulin resistance through preoperative administration of appropriate carbohydrate solutions, early enteral nutrition and special nutritional immunomodulative products to support the gastrointestinal tract. Randomized clinical studies have shown that adE di to ri al Fast-track is more than physiological anaesthesia