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AMBULATORY ANESTHESIA

The Role of the Anesthesiologist in Fast-Track Surgery: From Multimodal Analgesia to Perioperative Medical Care

Paul F. White, PhD, MD^*, Henrik Kehlet, MD, PhD, Joseph M. Neal, MD, Thomas Schricker, MD, PhD, Daniel B. Carr, MD^||¶, Franco Carli, MD, MPhil, and the Fast-Track Surgery Study Group

From the *Department of Anesthesiology and Pain Management, University of Texas Southwestern Medical Center at Dallas, Texas; Section for Surgical Pathophysiology, The Juliane Marie Centre, Rigshospitalet, Copenhagen, Denmark; Department of Anesthesia, Virginia Mason Medical Centre, Seattle, Washington; Department of Anesthesia, McGill University Health Centre, Montreal, Canada; ||Department of Anesthesia, Tufts-New England Medical Center, Boston, Massachusetts; and ¶Javelin Pharmaceuticals, Cambridge, Massachusetts.

Address correspondence and reprint requests to Paul F. White, PhD, MD, Department of Anesthesiology and Pain Management, University of Texas Southwestern Medical Center at Dallas, Texas. Address e-mail to paul.white{at}utsouthwestern.edu.

BACKGROUND: Improving perioperative efficiency and throughput has become increasingly important in the modern practice of anesthesiology. Fast-track surgery represents a multidisciplinary approach to improving perioperative efficiency by facilitating recovery after both minor (i.e., outpatient) and major (inpatient) surgery procedures. In this article we focus on the expanding role of the anesthesiologist in fast-track surgery.

METHODS: A multidisciplinary group of clinical investigators met at McGill University in the Fall of 2005 to discuss current anesthetic and surgical practices directed at improving the postoperative recovery process. A subgroup of the attendees at this conference was assigned the task of reviewing the peer-reviewed literature on this topic as it related to the role of the anesthesiologist as a perioperative physician.

RESULTS: Anesthesiologists as perioperative physicians play a key role in fast-track surgery through their choice of preoperative medication, anesthetics and techniques, use of prophylactic drugs to minimize side effects (e.g., pain, nausea and vomiting, dizziness), as well as the administration of adjunctive drugs to maintain major organ system function during and after surgery.

CONCLUSION: The decisions of the anesthesiologist as a key perioperative physician are of critical importance to the surgical care team in developing a successful fast-track surgery program.

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