Fast track in thoracic surgery and anaesthesia: update of concepts

Update of key elements on enhanced recovery after thoracic anaesthesia and surgery.

Pathways to enhance recovery after thoracic surgery ('fast-track') aim to improve response to lung surgery, reduction of postoperative pulmonary complications, and restore patient's vital function. Uncomplicated recovery after lung surgery reduces morbidity, hospital stay, and costs. Video-assisted thoracoscopic surgery is a major part of enhanced recovery minimizing tissue injury and stress response. Maintaining patient's physiology throughout perioperative processes by optimized anaesthesiological management and effective pain control present a crucial role in improving outcome.

The concept of enhanced recovery ('fast-track') after thoracic surgery and anaesthesia was developed in recent years making allowance to the increased number of video-assisted parenchymal lung resections in managing primary lung cancer. Current studies promote the benefit in thoracic surgical patients, if an established departmental protocol-based algorithm is implemented.