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Anesthetic Management and the Role of the Anesthesiologist in Reducing Surgical Stress and Improving Recovery

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Enhanced Recovery After Surgery

Abstract

The stress response is viewed as the central physiological upset following major surgery, and reducing its various components is key to the rapid return to normal function. The stress response drives many of the pathophysiological changes in the early postoperative period, such as muscle weakness, insulin resistance and hyperglycemia, organ dysfunction, malaise, and psychological upset. Modification of this stress response is at the heart of ERAS programs and is a multidisciplinary perioperative approach.

In addition, as the role of the anesthesiologist expands to encompass perioperative medicine, there are a number of preoperative and postoperative interventions that can affect the stress response too. This chapter reviews how anesthetic practice can modify the response. Much of it centers around what might just be considered consistent high-quality anesthesia from protocolized pathways. The two major areas viewed as the sole control of the anesthesiologist are fluid administration and analgesia. When undertaken correctly these can revolutionize the patients’ perioperative pathway; but when poorly delivered, the effects can be disastrous and can result in a delayed recovery, with increased length of stay, complications, and cost. Both fluid administration and analgesia require a procedure-specific and patient-specific approach, balancing the anesthesiologist’s choice with potential side effects.

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Authors and Affiliations

  1. Department of Anaesthesia, Royal Surrey County Hospital NHS Foundation Trust, Guildford, Surrey, UK

    William J. Fawcett

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  1. William J. Fawcett
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Correspondence to William J. Fawcett .

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Editors and Affiliations

  1. Department of Surgery, Örebro University Hospital, Örebro, Sweden

    Olle Ljungqvist

  2. Yeovil District Hospital NHS Foundation Trust Higher Kingston, Yeovil, Somerset, UK

    Nader K. Francis

  3. Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women’s, Hospital Harvard Medical School, Boston, MA, USA

    Richard D. Urman

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Fawcett, W.J. (2020). Anesthetic Management and the Role of the Anesthesiologist in Reducing Surgical Stress and Improving Recovery. In: Ljungqvist, O., Francis, N., Urman, R. (eds) Enhanced Recovery After Surgery. Springer, Cham. https://doi.org/10.1007/978-3-030-33443-7_14

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  • DOI: https://doi.org/10.1007/978-3-030-33443-7_14

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  • Online ISBN: 978-3-030-33443-7

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