European Surgery

, Volume 42, Issue 2, pp 83–90

Fast-track surgery for colonic and rectal resections in Austria – Results from a survey on the perioperative anaesthesia management

  • T. Hasenberg
  • B. Reibenwein
  • F. Längle
  • K. Schindler
  • S. Post
  • C. Spies
  • W. Schwenk
  • E. Shang
Original Scientific Paper
  • 73 Downloads

Summary

BACKGROUND: "Fast-track" rehabilitation can accelerate recovery, reduce general morbidity and decrease hospital stay after elective colorectal surgery. Despite this evidence, there is no information on the acceptance and utilization of these concepts amongst Austrian anaesthesiologist. In addition to that differences between colonic and rectal resections have not been addressed yet. METHODS: A questionnaire concerning perioperative routines in elective, open colonic and rectal resection was sent to the senior anaesthesiologist in 120 Austrian digestive surgical centres. RESULTS: The response rate was 63% (76 centres). Prophylactic measures for postoperative nausea and vomiting (PONV) were administered in 32% of clinics. Epidural analgesia is in use in three-quarters both of the institutions, regardless of the procedure. Short-acting anaesthetics were used for colonic as well as rectal resections. Normothermia is provided by the majority of anaesthetists. CONCLUSIONS: In Austria the anaesthesiological routine after elective colonic and rectal surgery adheres broadly to the evidence-based recommendations for fast-track concepts.

Keywords

Austria Fast-track surgery Anaesthesia Colorectal surgery Evidence-based medicine 

"Fast-Track"-Chirurgie im Rahmen kolorektaler Resektionen in Österreich – Umfrage zum perioperativen anästhesiologischen Management

Zusammenfassung

GRUNDLAGEN: Die "Fast-Track"-Rehabilitation im Rahmen elektiver kolorektaler Resektionen ist ein multimodales, perioperatives Behandlungskonzept, das chirurgische und anästhesiologische Aspekte kombiniert. Dadurch wird die Rate allgemeiner Komplikationen vermindert und eine rasche Rekonvaleszenz ermöglicht. Die hier vorgestellte Umfrage untersucht die Verbreitung und die Anwendung dieses Konzeptes in Österreich. METHODIK: 120 anästhesiologische Abteilungen erhielten einen Fragebogen, in dem das übliche anästhesiologische Vorgehen am Beispiel einer elektiven, offenen Sigma- und Rektumresektion beschrieben werden sollte. ERGEBNISSE: Die Rücklaufrate betrug 76 (63 %). Eine Prophylaxe gegen postoperative Übelkeit und Erbrechen ("postoperative nausea and vomiting", PONV) führen 32% der Befragten durch. Es nutzen 75 % der anästhesiologischen Abteilungen epidurale Analgesien. Kurzwirksame Analgetika sind weit verbreitet. Maßnahmen zum Erhalt der Normothermie haben sich fest etabliert. SCHLUSSFOLGERUNGEN: In Österreich orientiert sich die anästhesiologische Versorgung im Rahmen elektiver kolorektaler Resektionen in weiten Teilen an den evidenzbasierten Empfehlungen zur "Fast-Track"-Chirurgie.

Schlüsselwörter

Österreich "Fast-Track"-Chirurgie Anästhesiologisches Vorgehen Kolorektale Chirurgie Evidenzbasierte Medizin 

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References

  1. Kehlet H, Wilmore DW. Evidence-based surgical care and the evolution of fast-track surgery. Ann Surg 2008;248(2):189–98CrossRefPubMedGoogle Scholar
  2. Gouvas N, Tan E, Windsor A, Xynos E, Tekkis PP. Fast-track vs standard care in colorectal surgery: a meta-analysis update. Int J Colorectal Dis 2009;24(10):1119–31CrossRefPubMedGoogle Scholar
  3. Wind J, Polle SW, Fung Kon Jin PH, Dejong CH, von Meyenfeldt MF, Ubbink DT, et al. Systematic review of enhanced recovery programmes in colonic surgery. Br J Surg 2006;93(7):800–9CrossRefPubMedGoogle Scholar
  4. Walter CJ, Collin J, Dumville JC, Drew PJ, Monson JR. Enhanced recovery in colorectal resections: a systematic review and meta-analysis. Colorectal Dis 2009;11(4):344–53CrossRefPubMedGoogle Scholar
  5. Hannemann P, Lassen K, Hausel J, Nimmo S, Ljungqvist O, Nygren J, et al. Patterns in current anaesthesiological peri-operative practice for colonic resections: a survey in five northern-European countries. Acta Anaesthesiol Scand 2006;50(9):1152–60CrossRefPubMedGoogle Scholar
  6. Hasenberg T, Niedergethmann M, Rittler P, Post S, Jauch KW, Senkal M, et al. Elective colon resection in Germany. A survey of the perioperative anesthesiological management. Anaesthesist 2007;56(12):1223–6, 8–30CrossRefPubMedGoogle Scholar
  7. Marusch F, Koch A, Schmidt U, Wenisch H, Ernst M, Manger T, et al. Early postoperative results of surgery for rectal carcinoma as a function of the distance of the tumor from the anal verge: results of a multicenter prospective evaluation. Langenbeck's archives of surgery/Deutsche Gesellschaft fur Chirurgie 2002;387(2):94–100PubMedGoogle Scholar
  8. Martling AL, Holm T, Rutqvist LE, Moran BJ, Heald RJ, Cedemark B. Effect of a surgical training programme on outcome of rectal cancer in the County of Stockholm. Stockholm Colorectal Cancer Study Group, Basingstoke Bowel Cancer Research Project. Lancet 2000;356(9224):93–6CrossRefPubMedGoogle Scholar
  9. Dowdall JF, Maguire D, McAnena OJ. Experience of surgery for rectal cancer with total mesorectal excision in a general surgical practice. Br J Surg 2002;89(8):1014–9CrossRefPubMedGoogle Scholar
  10. Schwandner O, Schiedeck TH, Killaitis C, Bruch HP. A case-control-study comparing laparoscopic versus open surgery for rectosigmoidal and rectal cancer. Int J Colorectal Dis 1999;14(3):158–63CrossRefPubMedGoogle Scholar
  11. Sauer R, Becker H, Hohenberger W, Rodel C, Wittekind C, Fietkau R, et al. Preoperative versus postoperative chemoradiotherapy for rectal cancer. N Engl J Med 2004;351(17):1731–40CrossRefPubMedGoogle Scholar
  12. Anthuber M, Fuerst A, Elser F, Berger R, Jauch KW. Outcome of laparoscopic surgery for rectal cancer in 101 patients. Dis Colon Rectum 2003;46(8):1047–53CrossRefPubMedGoogle Scholar
  13. Senagore AJ, Duepree HJ, Delaney CP, Brady KM, Fazio VW. Results of a standardized technique and postoperative care plan for laparoscopic sigmoid colectomy: a 30-month experience. Dis Colon Rectum 2003;46(4):503–9CrossRefPubMedGoogle Scholar
  14. Basse L, Hjort Jakobsen D, Billesbolle P, Werner M, Kehlet H. A clinical pathway to accelerate recovery after colonic resection. Ann Surg 2000;232(1):51–7CrossRefPubMedGoogle Scholar
  15. Bardram L, Funch-Jensen P, Kehlet H. Rapid rehabilitation in elderly patients after laparoscopic colonic resection. Br J Surg 2000;87(11):1540–5CrossRefPubMedGoogle Scholar
  16. Anderson AD, McNaught CE, MacFie J, Tring I, Barker P, Mitchell CJ. Randomized clinical trial of multimodal optimization and standard perioperative surgical care. Br J Surg 2003;90(12):1497–504CrossRefPubMedGoogle Scholar
  17. Khoo CK, Vickery CJ, Forsyth N, Vinall NS, Eyre-Brook IA. A prospective randomized controlled trial of multimodal perioperative management protocol in patients undergoing elective colorectal resection for cancer. Ann Surg 2007;245(6):867–2CrossRefPubMedGoogle Scholar
  18. Muller S, Zalunardo MP, Hubner M, Clavien PA, Demartines N. A fast-track program reduces complications and length of hospital stay after open colonic surgery. Gastroenterology 2009;136(3):842–7CrossRefPubMedGoogle Scholar
  19. Basse L, Jacobsen DH, Billesbolle P, Kehlet H. Colostomy closure after Hartmann's procedure with fast-track rehabilitation. Dis Colon Rectum 2002;45(12):1661–4CrossRefPubMedGoogle Scholar
  20. Delaney CP, Fazio VW, Senagore AJ, Robinson B, Halverson AL, Remzi FH. 'Fast track' postoperative management protocol for patients with high co-morbidity undergoing complex abdominal and pelvic colorectal surgery. Br J Surg 2001;88(11):1533–8CrossRefPubMedGoogle Scholar
  21. Schwenk W, Neudecker J, Raue W, Haase O, Muller JM. "Fast-track" rehabilitation after rectal cancer resection. Int J Colorectal Dis 2006;21(6):547–53CrossRefPubMedGoogle Scholar
  22. Kehlet H, Buchler MW, Beart RW, Jr, Billingham RP, Williamson R. Care after colonic operation – is it evidence-based? Results from a multinational survey in Europe and the United States. J Am Coll Surg 2006;202(1):45–54CrossRefPubMedGoogle Scholar
  23. Lassen K, Hannemann P, Ljungqvist O, Fearon K, Dejong CH, von Meyenfeldt MF, et al. Patterns in current perioperative practice: survey of colorectal surgeons in five northern European countries. BMJ 2005;330(7505):1420–1CrossRefPubMedGoogle Scholar
  24. Fearon KC, Ljungqvist O, Von Meyenfeldt M, Revhaug A, Dejong CH, Lassen K, et al. Enhanced recovery after surgery: a consensus review of clinical care for patients undergoing colonic resection. Clin Nutr 2005;24(3):466–77CrossRefPubMedGoogle Scholar
  25. Hasenberg T, Keese M, Langle F, Reibenwein B, Schindler K, Herold A, et al. 'Fast-track' colonic surgery in Austria and Germany – results from the survey on patterns in current perioperative practice. Colorectal Dis 2009;11(2):162–7CrossRefPubMedGoogle Scholar
  26. Apfel CC, Korttila K, Abdalla M, Kerger H, Turan A, Vedder I, et al. A factorial trial of six interventions for the prevention of postoperative nausea and vomiting. N Engl J Med 2004;350(24):2441–51CrossRefPubMedGoogle Scholar
  27. Golembiewski J, Chernin E, Chopra T. Prevention and treatment of postoperative nausea and vomiting. Am J Health Syst Pharm 2005;62(12):1247–60; quiz 61–2PubMedGoogle Scholar
  28. Gan TJ, Meyer T, Apfel CC, Chung F, Davis PJ, Eubanks S, et al. Consensus guidelines for managing postoperative nausea and vomiting. Anesth Analg 2003;97(1):62–71, table of contentsCrossRefPubMedGoogle Scholar
  29. Apfel CC, Stoecklein K, Lipfert P. PONV: a problem of inhalational anaesthesia? Best Pract Res Clin Anaesthesiol 2005;19(3):485–500CrossRefPubMedGoogle Scholar
  30. Hobbhahn J, Schwall B, Prasser C, Vogel H, Taeger K. Der Einfluß von Sevofluran und Desfluran auf die Einleitungs- und Aufwachphase – ein Vergleich mit den herkömmlichen Inhalationsanästhetika und Propofol. Anästhesiol Intensivmed 1997;12:607–15Google Scholar
  31. Beaussier M, Decorps A, Tilleul P, Balladur P, Lienhart A. An observational evaluation of the rate of awakening after isoflurane or desflurane used in daily clinical practice. J Clin Anesth 2000;12(8):586–91CrossRefPubMedGoogle Scholar
  32. Gendall KA, Kennedy RR, Watson AJ, Frizelle FA. The effect of epidural analgesia on postoperative outcome after colorectal surgery. Colorectal Dis 2007;9(7):584–98; discussion 98–600CrossRefPubMedGoogle Scholar
  33. Marret E, Remy C, Bonnet F. Meta-analysis of epidural analgesia versus parenteral opioid analgesia after colorectal surgery. Br J Surg 2007;94(6):665–73CrossRefPubMedGoogle Scholar
  34. Popping DM, Elia N, Marret E, Remy C, Tramer MR. Protective effects of epidural analgesia on pulmonary complications after abdominal and thoracic surgery: a meta-analysis. Arch Surg 2008;143(10):990–9; discussion 1000CrossRefPubMedGoogle Scholar
  35. Jorgensen H, Wetterslev J, Moiniche S, Dahl JB. Epidural local anaesthetics versus opioid-based analgesic regimens on postoperative gastrointestinal paralysis, PONV and pain after abdominal surgery. Cochrane database of systematic reviews (Online) 2000(4):CD001893Google Scholar
  36. Roig JV, Garcia-Fadrique A, Redondo C, Villalba FL, Salvador A, Garcia-Armengol J. Perioperative care in colorectal surgery. Current practice patterns and opinions. Colorectal Dis 2009;11(9):976–83CrossRefPubMedGoogle Scholar
  37. Beers R, Camporesi E. Remifentanil update: clinical science and utility. CNS Drugs 2004;18(15):1085–104CrossRefPubMedGoogle Scholar
  38. Hensel M, Schwenk W, Bloch A, Raue W, Stracke S, Volk T, et al. [The role of anesthesiology in fast track concepts in colonic surgery]. Anaesthesist 2006;55(1):80–92CrossRefPubMedGoogle Scholar
  39. Beers RA, Calimlim JR, Uddoh E, Esposito BF, Camporesi EM. A comparison of the cost-effectiveness of remifentanil versus fentanyl as an adjuvant to general anesthesia for outpatient gynecologic surgery. Anesth Analg 2000;91(6):1420–5CrossRefPubMedGoogle Scholar
  40. Murphy GS, Szokol JW, Marymont JH, Vender JS, Avram MJ, Rosengart TK, et al. Recovery of neuromuscular function after cardiac surgery: pancuronium versus rocuronium. Anesth Analg 2003;96(5):1301–7, table of contentsCrossRefPubMedGoogle Scholar
  41. Grebe D, von Heymann C, Bloch A, Spies C. Moderne Anästhesiologie bei elektiven «Fast-track»- Kolonresektionen – Narkose, Körpertemperatur, Flüssigkeitstherapie. Chirurgische Gastroenterologie 2005;21(4):318–23CrossRefGoogle Scholar
  42. Basse L, Thorbol JE, Lossl K, Kehlet H. Colonic surgery with accelerated rehabilitation or conventional care. Dis Colon Rectum 2004;47(3):271–7; discussion 7–8CrossRefPubMedGoogle Scholar
  43. Brandstrup B, Tonnesen H, Beier-Holgersen R, Hjortso E, Ording H, Lindorff-Larsen K, et al. Effects of intravenous fluid restriction on postoperative complications: comparison of two perioperative fluid regimens: a randomized assessor-blinded multicenter trial. Ann Surg 2003;238(5):641–8CrossRefPubMedGoogle Scholar
  44. Nisanevich V, Felsenstein I, Almogy G, Weissman C, Einav S, Matot I. Effect of intraoperative fluid management on outcome after intraabdominal surgery. Anesthesiology 2005;103(1):25–32CrossRefPubMedGoogle Scholar
  45. Holte K, Foss NB, Andersen J, Valentiner L, Lund C, Bie P, et al. Liberal or restrictive fluid administration in fast-track colonic surgery: a randomized, double-blind study. Br J Anaesth 2007;99(4):500–8CrossRefPubMedGoogle Scholar
  46. Holte K, Klarskov B, Christensen DS, Lund C, Nielsen KG, Bie P, et al. Liberal versus restrictive fluid administration to improve recovery after laparoscopic cholecystectomy: a randomized, double-blind study. Ann Surg 2004;240(5):892–9CrossRefPubMedGoogle Scholar
  47. von Heymann C, Grebe D, Schwenk W, Sander M, Hensel M, Muller JM, et al. The influence of intraoperative fluid therapy on the postoperative outcome in "fast track" colon surgery. Anasthesiol Intensivmed Notfallmed Schmerzther 2006;41(6):E1–7CrossRefPubMedGoogle Scholar
  48. Jonsson K, Jensen JA, Goodson WH, 3rd, West JM, Hunt TK. Assessment of perfusion in postoperative patients using tissue oxygen measurements. Br J Surg 1987;74(4):263–7CrossRefPubMedGoogle Scholar
  49. Arkilic CF, Taguchi A, Sharma N, Ratnaraj J, Sessler DI, Read TE, et al. Supplemental perioperative fluid administration increases tissue oxygen pressure. Surgery 2003;133(1):49–55CrossRefPubMedGoogle Scholar
  50. Lang K, Boldt J, Suttner S, Haisch G. Colloids versus crystalloids and tissue oxygen tension in patients undergoing major abdominal surgery. Anesth Analg 2001;93(2):405–9, 3rd contents pageCrossRefPubMedGoogle Scholar
  51. Kabon B, Akca O, Taguchi A, Nagele A, Jebadurai R, Arkilic CF, et al. Supplemental intravenous crystalloid administration does not reduce the risk of surgical wound infection. Anesth Analg 2005;101(5):1546–53CrossRefPubMedGoogle Scholar
  52. Perel P, Roberts I. Colloids versus crystalloids for fluid resuscitation in critically ill patients. Cochrane database of systematic reviews (Online). 2007(4):CD000567Google Scholar
  53. Kastrup M, Markewitz A, Spies C, Carl M, Erb J, Grosse J, et al. Current practice of hemodynamic monitoring and vasopressor and inotropic therapy in post-operative cardiac surgery patients in Germany: results from a postal survey. Acta Anaesthesiol Scand 2007;51(3):347–58CrossRefPubMedGoogle Scholar
  54. Abelha FJ, Castro MA, Neves AM, Landeiro NM, Santos CC. Hypothermia in a surgical intensive care unit. BMC Anesthesiol 2005;5:7CrossRefPubMedGoogle Scholar
  55. Kaudasch G, Schempp P, Skierski P, Turner E. The effect of convection warming during abdominal surgery on the early postoperative heat balance. Anaesthesist 1996;45(11):1075–81CrossRefPubMedGoogle Scholar
  56. Frank SM, Fleisher LA, Breslow MJ, Higgins MS, Olson KF, Kelly S, et al. Perioperative maintenance of normothermia reduces the incidence of morbid cardiac events. A randomized clinical trial. JAMA 1997;277(14):1127–34CrossRefPubMedGoogle Scholar
  57. Rajagopalan S, Mascha E, Na J, Sessler DI. The effects of mild perioperative hypothermia on blood loss and transfusion requirement. Anesthesiology 2008;108(1):71–7CrossRefPubMedGoogle Scholar
  58. Ng SF, Oo CS, Loh KH, Lim PY, Chan YH, Ong BC. A comparative study of three warming interventions to determine the most effective in maintaining perioperative normothermia. Anesth Analg 2003;96(1):171–6, table of contentsCrossRefPubMedGoogle Scholar
  59. Torossian A. Survey on intraoperative temperature management in Europe. Eur J Anaesthesiol 2007;24(8):668–75CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag 2010

Authors and Affiliations

  • T. Hasenberg
    • 1
  • B. Reibenwein
    • 2
  • F. Längle
    • 3
  • K. Schindler
    • 2
  • S. Post
    • 1
  • C. Spies
    • 4
  • W. Schwenk
    • 5
  • E. Shang
    • 1
  1. 1.Department of SurgeryUniversity Hospital Mannheim, Ruprecht Karls University HeidelbergMannheimGermany
  2. 2.The Austrian Society of Clinical NutritionViennaAustria
  3. 3.Department of General SurgeryUniversity of ViennaViennaAustria
  4. 4.Department of Anesthesiology and Intensive Care, Charité Campus Mitte and Charité Virchow KlinikumCharité UniversitätsmedizinBerlinGermany
  5. 5.Department for General and Visceral SurgeryAsklepios Clinic AltonaHamburgGermany

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