[The anesthetist in perioperative care]

Abstract

Due to the recent development in operative medicine medical and organizational demands on perioperative patient care have changed significantly. Corresponding to the responsibility of the operative colleagues for therapy of the primary disease, anesthesiologists have to account for monitoring and treatment of vital functions throughout the perioperative period, starting from preoperative evaluation until postoperative care. The postanesthesia recovery unit has a key role in perioperative management. Beyond post-operative monitoring and stabilization of vital parameters it is increasingly used as a buffer and switch operating station, where patients are prepared and allocated to a normal ward, an observation or intensive care unit for subsequent postoperative care. The recovery unit has developed to a "multitasking" care center, which should be operational 24 h a day with an anesthesiologist present during working hours. The terminology should be changed in the future in order to better characterize the new task spectrum, e.g. in perioperative anaesthetic care unit (PACU) for medical and medicolegal reasons patient security must have absolute priority above economic aspects. Effective postoperative pain control using epidural or patient-controlled intravenous analgesia may increase patient comfort and reduce postoperative complications caused by sympathoadrenergic activation. Both method can be safely used on normal wards provided that close cooperation and training of ward personnel is guaranteed as well as continuous supervision by a specialized acute pain service.