Department of Anaesthesiology and Pain Medicine, Inselspital, University Hospital Bern, CH 3010, Bern, Switzerland.
Department of Urology, Inselspital, University Hospital Bern, Bern, Switzerland.
World J Urol. 2020 Jun;38(6):1359-1368. doi: 10.1007/s00345-019-02839-y. Epub 2019 Jun 14.
The aim of this review is to present an anesthesiological overview on surgical safety for radical cystectomy implementing the cornerstones of today's rapidly evolving field of perioperative medicine.
This is a narrative review of current perioperative medicine and surgical safety concepts for major surgery in general with special focus on radical cystectomy.
The tendency for perioperative care and surgical safety is to consider it a continuous proactive pathway rather than a single surgical intervention. It starts at indication for surgery and lasts until full functional recovery. Preoperative optimization leads to superior outcome by mobilizing and/or increasing physiological reserve. Multidisciplinary teamwork involving all the relevant parties from the beginning of the pathway is crucial for outcome rather than an isolated specialist approach. This fact has gained importance in times of an ageing frail population and rising health care cost. We also present our 2019 Cystectomy Enhanced Recovery Approach for optimization of perioperative care for open radical cystectomy in a high caseload center.
With the implementation of in itself simple but crucial steps in perioperative medicine such as multimodal prehabilitation, safety checks, better perioperative monitoring and enhanced recovery concepts, even complex surgical procedures such as radical cystectomy can be performed safer. Emphasis has to be laid on a more global view of the patients' path through the perioperative process than on the surgical procedure alone.
本综述旨在介绍当今围手术期医学领域快速发展的基石在根治性膀胱切除术方面的麻醉学概述。
这是对一般大型手术的当前围手术期医学和外科安全概念的叙述性综述，特别关注根治性膀胱切除术。
围手术期护理和外科安全的趋势是将其视为一个连续的主动途径，而不仅仅是单次手术干预。它始于手术指征，并持续到完全功能恢复。术前优化通过动员和/或增加生理储备来获得更好的结果。从路径开始就涉及所有相关方的多学科团队合作对于结果至关重要，而不是孤立的专家方法。在人口老龄化和医疗保健成本上升的时代，这一事实变得更加重要。我们还介绍了我们 2019 年的膀胱切除术增强恢复方法，以优化高病例量中心开放性根治性膀胱切除术的围手术期护理。
通过在围手术期医学中实施本身简单但至关重要的步骤，如多模式术前康复、安全检查、更好的围手术期监测和增强恢复概念，即使是复杂的手术程序，如根治性膀胱切除术，也可以更安全地进行。重点必须放在患者在围手术期过程中的整体路径上，而不仅仅是手术程序本身。
