Saudi Journal of Anaesthesia

REVIEW ARTICLE
Year
: 2021  |  Volume : 15  |  Issue : 3  |  Page : 264--271

How can we minimize the risks by optimizing patient's condition shortly before thoracic surgery?


Christoph Ellenberger1, Raoul Schorer2, Benoit Bedat3, Andres Hagerman2, Frederic Triponez4, Wolfram Karenovics3, Marc Licker1 
1 Department of Anesthesiology, Pharmacology, Intensive Care and Emergency Medicine, University Hospital of Geneva; Faculty of Medicine, Rue Michel-Servet 1, 1206 Genève, Geneva, Switzerland
2 Department of Anesthesiology, Pharmacology, Intensive Care and Emergency Medicine, University Hospital of Geneva, Geneva, Switzerland
3 Division of Thoracic and Endocrine Surgery , University Hospital of Geneva, Geneva, Switzerland
4 Faculty of Medicine, Rue Michel-Servet 1, 1206 Genève; Division of Thoracic and Endocrine Surgery , University Hospital of Geneva, Geneva, Switzerland

Correspondence Address:
Marc Licker
Department of Anesthesiology, Pharmacology, Intensive Care and Emergency Medicine, University Hospital of Geneva, Rue Gabrielle-Perret-Gentil 4, Geneva - CH-1211
Switzerland

The “moderate-to-high-risk” surgical patient is typically older, frail, malnourished, suffering from multiple comorbidities and presenting with unhealthy life style such as smoking, hazardous drinking and sedentarity. Poor aerobic fitness, sarcopenia and “toxic” behaviors are modifiable risk factors for major postoperative complications. The physiological challenge of lung cancer surgery has been likened to running a marathon. Therefore, preoperative patient optimization or “ prehabilitation “ should become a key component of improved recovery pathways to enhance general health and physiological reserve prior to surgery. During the short preoperative period, the patients are more receptive and motivated to adhere to behavioral interventions (e.g., smoking cessation, weaning from alcohol, balanced food intake and active mobilization) and to follow a structured exercise training program. Sufficient protein intake should be ensured (1.5–2 g/kg/day) and nutritional defects should be corrected to restore muscle mass and strength. Currently, there is strong evidence supporting the effectiveness of various modalities of physical training (endurance training and/or respiratory muscle training) to enhance aerobic fitness and to mitigate the risk of pulmonary complications while reducing the hospital length of stay. Multimodal interventions should be individualized to the patient's condition. These bundle of care are more effective than single or sequential intervention owing to synergistic benefits of education, nutritional support and physical training. An effective prehabilitation program is necessarily patient-centred and coordinated among health care professionals (nurses, primary care physician, physiotherapists, nutritionists) to help the patient regain some control over the disease process and improve the physiological reserve to sustain surgical stress.


How to cite this article:
Ellenberger C, Schorer R, Bedat B, Hagerman A, Triponez F, Karenovics W, Licker M. How can we minimize the risks by optimizing patient's condition shortly before thoracic surgery?.Saudi J Anaesth 2021;15:264-271


How to cite this URL:
Ellenberger C, Schorer R, Bedat B, Hagerman A, Triponez F, Karenovics W, Licker M. How can we minimize the risks by optimizing patient's condition shortly before thoracic surgery?. Saudi J Anaesth [serial online] 2021 [cited 2022 Jun 28 ];15:264-271
Available from: https://www.saudija.org/article.asp?issn=1658-354X;year=2021;volume=15;issue=3;spage=264;epage=271;aulast=Ellenberger;type=0