Principles of fast-track surgery：快速康复外科的原则.doc

Principles of fast-track surgery Henrik Kehlet, Prof., MD, PhD Section for Surgical Pathophysiology, 4074, Rigshospitalet Copenhagen University Telephone: +45 3545 4074 Fax: +45 3545 6543 Email: henrik.kehlet@rh.dk Short Title: Multimodal perioperative rehabilitation programmes Key words: fast-track surgery, pain, fluid therapy, perioperative care, minimal invasive surgery Abstract Recent evidence has documented that a combination of single-modality evidence-based care principles into a multimodal effort to enhance postoperative recovery (the fast-track methodology) has led to enhanced recovery with reduced medical morbidity, need for hospitalisation and convalescence. Nevertheless, general implementation of fast-track surgery has been relatively slow despite concomitant economic benefits. Further improvement in postoperative outcome may be obtained by developments within each care principle with a specific focus on minimal invasive surgery, effective multimodal, non-opioid analgesia and pharmacological stress reduction.  Despite progress in perioperative care over the last decade, surgical injury is still often followed by pain, nausea, vomiting, ileus, stress-induced organ dysfunction (pulmonary, cerebral, cardiovascular), fatigue and catabolism, all of which may contribute to morbidity, need for hospitalisation and prolonged convalescence. Since the postoperative recovery process includes multiple pathogenic mechanisms, an enhanced postoperative recovery programme (the fast-track methodology) has been developed as a stepwise multimodal effort by combining single-modality evidence-based interventions. The concept was introduced more than 10 years ago and subsequently been demonstrated to provide a powerful instrument to enhance recovery and reduce morbidity across almost all surgical procedures from simple day case procedures to more complex surgeries7, 10, 12, 14, 17. In the following, a short update on developments within specific perioperative interventions