Advances in anesthesia during the last 4 decades have resulted in substantial
decreases in morbidity and mortality after surgery. Previously, anesthetists
focused mainly on the assessment of anesthetic-related complications and
traditional measures of postoperative morbidity. One of the challenges of
modern anesthesia is the necessity to contribute to postoperative recovery and
quality of life as part of a multidisciplinary team. The starting point for changing
perceptions and standardizing approaches to perioperative management lies in
improving communication within the team. For the anesthesiologist, this
involves attention to the patient’s wishes as well as to perioperative
management, ventilation strategies, postoperative pain management, and early
mobilization. Similarly, surgeons should be willing to discuss and vary the
operative technique according to patient physiology and characteristics.
Esophagectomy is a high-risk surgical procedure associated with tremendous
postoperative morbidity and mortality and provides a good example of a
complicated procedure in which a multidisciplinary approach is required. For
these patients, it is unlikely that a single intervention will show a benefit with
respect to outcome; an approach that addresses several factors and shows effects
on outcome or has promising benefits is necessary. A multimodal approach may
improve the infrastructure for management of these patients in high-volume
centers, resulting in earlier recognition and better treatment of complications.http://repub.eur.nl/res/pub/20865/100930_Buise%2C%20Marcus%20Paulus.pdf
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