• Fast-track anaesthesia
• Multi-modal multidisciplinary package of measures aimed to decrease post-surgical organ dysfunction & complications
• Pre-op
• Patient education shown to decrease anxiety, analgesic requirements & hospital stay
• Premedication
• ? β-blocker, clonidine
• Avoid routine sedative pre-med
• Hydration
• Decreases PONV
• Clear fluids up to 2 hrs prior
• Carbohydrate drink (decreases peri-op insulin resistance)
• NO BOWEL PREP
• Post-op
• Balanced analgesia
• NSAID
• Paracetamol
• Gabapentin, clonidine ?
• Avoid opiates if possible
• Remove epidural at 48 hrs
• Acute pain team review
• Early mobilisation
• Physio
• Occupational therapy
• Early nutrition
• No effects shown on readmission
• Intra-op
• Aim to decrease the stress response & facilitate early feeding/mobilisation
• Surgical technique
• Consider minimally invasive
• Avoid routine ngt/drains
• Anaesthetic technique
• Short acting analgesics and agents used
• Consider TIVA
• Thoracic epidural (decreases ileus, earlier mobilisation, better pain relief, decreased post-op pulmonary complications)
• High FiO₂ used intra-op
• Fluid management
• Individually tailored goal-directed therapy
• Prevention of PONV
• Multimodal approach
• Temperature control
• BH
• FW
• Warm, humidified gases
• CEACCP
  Link:ceaccp.oxfordjournals.org/content/9/2/39.full.pdf