Der Urologe. Ausg. A
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Der Urologe. Ausg. A · Sep 2011
Practice Guideline[Preoperative evaluation of adult patients prior to elective, non-cardiac surgery. Joint recommendations of German Society of Anesthesiology and Intensive Care Medicine, German Society of Surgery and German Society of Internal Medicine].
Evaluation of the patient's medical history and a physical examination are the cornerstones of risk assessment prior to elective surgery and may help to optimize the patient's preoperative medical condition and to guide perioperative management. Whether the performance of additional technical tests (e.g. blood chemistry, ECG, spirometry, chest-x-ray) can contribute to a reduction of perioperative risk is often not very well known or controversial. Similarly, there is considerable uncertainty among anesthesiologists, internists and surgeons with respect to the perioperative management of the patient's long-term medication. ⋯ These recommendations aim to ensure that surgical patients undergo a rational preoperative assessment and at the same time to avoid unnecessary, costly and potentially dangerous testing. The joint recommendations reflect the current state-of-the-art knowledge as well as expert opinions because scientific-based evidence is not always available. These recommendations will be subject to regular re-evaluation and updating when new validated evidence becomes available.
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The origins of the fast track concept in the field of elective colon surgery can be traced back to the beginning of the 1990s. The first studies performed by Kehlet et al. sparked interest in this new form of patient management among physicians and hospital administrators. Different fast track programs for patients undergoing radical cystectomy can be found in the current literature. The goal of the prevailing fast track concepts is to reduce the perioperative burden, optimize postoperative convalescence, decrease the postoperative need for analgesics, lower the postoperative morbidity rate, and shorten hospital stays.