Pharmacological interventions and concepts of fast-track perioperative medical care for enhanced recovery programs

Improving perioperative efficiency and tightly maintaining the patient's homeostasis in order to improve rehabilitation and well-being are key factors in the increasing popularity of fast-track recovery programs. Although the pharmacological contribution should not be overestimated, the use of up-to-date pharmacological agents with predictable duration of action and minimal side effects is mandatory to allow for a fast and gentle recovery process.

A literature review of about 160 peer-reviewed publications provides the basis for this review of pharmacological interventions for optimizing recovery following anesthesia.

The choice of anesthetic technique and pharmacological agents should be tailored to the needs of the patient as well as the type of procedure being performed as fast-track surgery. The universally applicable goals valid for every class of intervention are that they should be easy to use, have minimal side effects, maintain homeostasis, allow for a predictable on- and offset, and give minimal impairment of recovery and function.

The pivotal role played by the anesthesiologist in facilitating the recovery process following surgical procedures has assumed increased importance in the concept of enhanced recovery programs. Although the interdisciplinary approach common to all parties involved (surgeons, anesthesiologists, nurses, physiotherapists) is the true enabler of fast-track surgery, the choice of anesthetic drugs and concomitant medication can all influence the ability to fast-track patients after surgery and should therefore considered mandatory in fast-track programs.