Improving perioperative care

The concept of perioperative medicine has shifted the focus to what an anesthesiologist can do to improve not only intraoperative management but also the overarching surgical process and its outcome. This thesis is a compilation of investigations concerning the improvement of perioperative care for patients undergoing anesthesia for surgery. Notably we focused our research on four perioperative medicine aspects: pain and airway management, mechanical ventilation, and perioperative clinical outcomes.
We found that performing an interfascial serratus plane block reduces opioid requirements and is associated with a lower need for rescue analgesia in the first 24 hours, in patients undergoing breast surgery. As for airway management, a dynamic guide during videolaryngoscopy improves the chance of first pass intubation in patients with a predicted difficult airway. During intraoperative mechanical ventilation, PEEP can counterbalance the intraabdominal pressure related rise in transpulmonary pressure during laparoscopic surgery and that during abdominal surgery intraoperative driving pressure is associated with occurrence of postoperative pulmonary complications with stronger associations in laparoscopic surgery. Furthermore, we observed that an individualized pneumoperitoneum strategy was associated with faster recovery in laparoscopic colorectal surgery and that postoperative complications occurrence is associated with worse long–term disease free survival. As for anaesthesia associated prognosis markers, μ type I receptor expression was not associated with shorter disease–free nor overall survival.
In conclusion, several aspects of anesthesia-related intraoperative management can improve early and late postoperative outcomes. Great effort should be placed in further enhance anesthesia contribution to better perioperative care.