Newly Published
Clinical Focus Review  |   April 2020
Prehabilitation for the Anesthesiologist
Author Notes
  • From the Department of Anesthesia, McGill University Health Centre, Montreal General Hospital, Montreal, Quebec, Canada.
  • Submitted for publication January 17, 2020. Accepted for publication March 30, 2020.
    Submitted for publication January 17, 2020. Accepted for publication March 30, 2020.×
  • Correspondence: Address correspondence to Dr. Carli: Department of Anesthesia, McGill University Health Centre, Montreal General Hospital, 1650 Cedar Ave, Room E10.160, Montreal, Quebec, Canada H3G 1A4. franco.carli@mcgill.ca. Information on purchasing reprints may be found at www.anesthesiology.org or on the masthead page at the beginning of this issue. Anesthesiology’s articles are made freely accessible to all readers, for personal use only, 6 months from the cover date of the issue.
Article Information
Endocrine and Metabolic Systems / Geriatric Anesthesia / Quality Improvement / Clinical Focus Review
Clinical Focus Review   |   April 2020
Prehabilitation for the Anesthesiologist
Anesthesiology Newly Published on April 28, 2020. doi:https://doi.org/10.1097/ALN.0000000000003331
Anesthesiology Newly Published on April 28, 2020. doi:https://doi.org/10.1097/ALN.0000000000003331
The “fast-track” and the enhanced recovery after surgery programs proposed in the late 1990s demonstrated a significant effect on postoperative outcome. Intraoperative and immediate postoperative evidence-based interventions, such as minimally invasive surgery, multimodal analgesia, early mobilization, and early feeding, were among the most impactful elements producing shorter length of hospital stay and reduction in complications, hospital readmissions, and healthcare costs.1  In this context the anesthesiologist’s role evolved from being a physician providing primarily optimal surgical conditions and perioperative pain relief to that of a perioperative physician, working closely with surgeons and other health allied professions. The fast-track and enhanced recovery after surgery protocols emphasize the relevant effects of preoperative carbohydrate loading, beside the intraoperative and immediate postoperative interventions. The preoperative period represents an opportune time to prepare the patient for the stress of surgery by increasing his or her physiologic reserve. Besides medical management, preoperative optimization of cardiopulmonary functional capacity may be particularly important for the patients who are older, are frail, have cancer, are malnourished, and are experiencing social marginalization. In these populations a decline in functional capacity represents a significant surgical risk. Functional capacity is the term used to reflect the ability to perform activities of daily living and is determined by the integrity of the pulmonary, cardiovascular, and musculoskeletal systems.2  Low functional capacity before surgery has been associated with greater chance of dying within 30 days after surgery, longer postoperative hospital stay, and higher rate of surgical complications.3  The preoperative time should thus be valued as an opportunity to evaluate and stratify surgical risk and intervene. The optimum management of high-risk patients involves multidisciplinary collaborative decision making, and the anesthesiologist is an integral part of this process.