Anesth Analg 2008; 106:1250-1251
© 2008 International Anesthesia Research Society
doi: 10.1213/ane.0b013e318165e05e
GENERAL ARTICLE
Reengineering Fast-Track Anesthesia: The Expanding Role of Anesthesiologists in Perioperative Medical Care Meeting in Abano Terme, Padova, Italy, on June 19–20, 2007
Paul F. White, MD, PhD, FANZCA
From the Department of Anesthesiology and Pain Management, University Texas Southwestern Medical Center at Dallas, 5323 Harry Hines Boulevard, Dallas, Tx.
Address correspondence and reprint requests to MD, Professor & Holder of Margaret Milam McDermott Distinguished Chair, Department of Anesthesiology and Pain Management, University Texas Southwestern Medical Center at Dallas, 5323 Harry Hines Boulevard, Dallas, TX. Address e-mail to paul.white{at}utsouthwestern.edu.
Anesthesiologists are critically involved in patient care throughout the perioperative period. An intensive didactic and practical course was organized by Dr. Giovanni Pittoni (Director of Anesthesia and Intensive Care at Azienda Ospedaliera—Universita, Padova) and Dr. Giorgio Davia (Chief of Anesthesia & Intensive Care at Casa di Cura Abano Terme) in Padova, Italy, to discuss the optimal anesthetic techniques for facilitating postoperative recovery and early rehabilitation after ambulatory and inpatient surgical procedures. The formal lectures were supplemented by practical tutorials in the operating rooms with surgeons and nurses at Casa di Cura Hospital. Surgical cases being performed concurrently in the operating rooms at Casa di Cura were used to facilitate discussions between the faculty and the attendees regarding the advantages and disadvantages of various anesthetic and analgesic options for the surgical procedures.
The central role of anesthesiologists as perioperative physicians was discussed by Dr. Paul F. White (Professor & Holder of the Margaret Milam McDermott Distinguished Chair of Anesthesiology at the University of Texas Southwestern Medical Center in Dallas), who presented an evidence-based analysis of anesthetic and analgesic techniques for common surgical procedures and also discussed cost-effective approaches to minimizing common side effects after surgery (e.g., incisional pain, postoperative nausea and vomiting, drowsiness, fatigue, bowel and bladder dysfunction).1 Dr. Battista Borghi from Bologna University discussed the increasingly important role of regional anesthetic-analgesic techniques during and after surgery for facilitating the recovery process and minimizing postoperative side effects.
Professor Luca Dalla Paola and his colleagues from Padua University described a novel interdisciplinary team approach used at their center in the management of diabetic patients with ischemic and infected feet.2,3 The patients are admitted to a specialized unit for optimization of their glucose control and antibiotic therapy. Patients are then scheduled for placement of vascular stents to improve blood flow to the ischemic extremity under local anesthesia with sedation (i.e., monitored by anesthesia care). Before the start of the podiatric procedure, the anesthesiologists place a femoral-sciatic nerve catheter to administer local anesthetics during and after the operation. This technique increases blood flow to the foot and also provides effective postoperative analgesia. The foot is placed in an external fixation device to facilitate early ambulation after surgery. It has been reported that the use of continuous peripheral nerve blocks can improve postoperative pain control, reduce emetic sequelae, and facilitate an earlier discharge after foot and ankle procedures.4
The second annual international meeting on fast-track anesthesia and surgery techniques will be held on September 14–16, 2008 in Padova, Italy. The upcoming conference will focus on "in depth" discussions of multidisciplinary approaches for managing patients undergoing a wide variety of surgical procedures. The educational program is being organized by Drs. G. Pittoni, G. Davia, and P.F. White. The invited faculty will include Professors Henrik Kehlet (from the Juliane Marie Centre, Rigshospitalet, Copenhagen, Denmark), Franco Carli (from McGill University, Montreal, Canada), Admir Hadzic (from Roosevelt-St. Luke’s Hospital, New York City, NY), and Johan Raeder (from University of Oslo, Norway). Special pre- and post-meeting programs designed to facilitate one-on-one discussions with the distinguished faculty regarding future research opportunities related to the fast-track process will be organized in the Dolomites and Sicily, respectively, in cooperation with the White Mountain Institute, a not-for-profit private foundation dedicated to the advancement of novel approaches to improving health care and promoting a healthy lifestyle.
Information regarding the upcoming meetings in Italy can be obtained by contacting the co-Chairmen of the international program planning committee (Giovanni.pittoni{at}sanita.padova.it or paul.white{at}utsouthwestern.edu), or the local meeting organizers: Macrino Macri (Solaris) at mac{at}solaris-italy.com or Donatella Emmedi (MD Emmedi) at amos{at}mdemmedi.com.
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Footnotes
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Accepted for publication November 29, 2007.
Dr. Paul F. White, Section Editor for Special Projects, was recused from all editorial decisions related to this manuscript.
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REFERENCES
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- White PF, Kehlet H, Neal JM, Schricker T, Carr DB, Carli F. Fast-track surgery study group. The expanding role of anesthesiology in fast-track surgery: from multimodal analgesia to perioperative medical care. Anesth Analg 2007;104: 1380–96[Abstract/Free Full Text]
- Fusaro M, Dalla Paola L, Biondi-Zoccai G. Pedal-plantar loop technique for a challenging below-the-knee chronic total occlusion: a novel approach to percutaneous revascularization in critical lower limb ischemia. J Invasive Cardiol 2007;19: E34–E37[Medline]
- Dalla Paola L, Faglia E, Caminiti M, Clerici G, Ninkovic S, Deanesi V. Ulcer recurrence following first ray amputation in diabetic patients: a cohort prospective study. Diabetes Care 2003;26:1874–8[Abstract/Free Full Text]
- White PF, Issioui T, Skrivanek GD, Early JS, Rawal S, Ing C, Wakefield C. Use of a continuous popliteal sciatic nerve block for the management of pain after major podiatric surgery: does it improve quality of recovery? Anesth Analg 2003;97:1303–9[Abstract/Free Full Text]
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