Learning Track:	8. Perioperative Medicine
Title:	The anesthetic role in implementing a fast-track oncogynecologist surgery protocol. Preliminary results from a 3-year randomized clinical trial
Author(s):	García Martínez I., Suárez Edo E., Alonso Mendoza V., Suescun López M.C., Conesa Marieges A., Manrique Muñoz S.
Institute(s):	Vall d'Hebron University Hospital. Universitat Autonoma de Barcelona, Dept of Anaesthesiology, Barcelona, Spain
Text:	Background and Goal of Study: Fast-track surgery programs are based on a multimodal approach to patients undergoing major abdominal surgery; the main objective is to improve the postoperative period based on a quick oral tolerance and stimulation of early mobilization; it´s possible due to a specific anaesthetic protocol in which multimodal analgesia has a main role. We present data of preliminary stage of a planned 3-year study , 100 patients randomised clinical trial comparing fast-track protocol with conventional management. Main objective: compare the average stay between groups. Secondary objectives: determine cost per patient, postoperative morbidity and the applicability of a fast-track program in the management of advanced ovarian cancer in a tertiary hospital in our midst.
Materials and methods: During 14 months, 24 women undergoing oncogynecologic major surgery were randomized to either fast-track protocol (fast-track group) or conventional management (conventional group). Fast-track group received preoperatively: no colonic preparation, no anxiolytics; carbohydrate solution 3h before surgery. No nasogastric tube or drains. Multimodal analgesia and guided-fluid therapy by monitoring noninvasively cardiac output. Combined general-epidural anaesthesia. Early discharge from recovery room was provided in postoperative period, based on a strict pain control avoiding opiate drugs. Combined intravenous-peridural analgesia with elastomeric ropivacaine 0.2% infusion bomb was performed to facilitate an early mobilization and respiratory rehabilitation. Conventional group received colonic preparation, anxiolytics, 8 hours-fasting. General balanced anaesthesia with nasogastric tube and drains. Postoperative opiates. 
Results and discussion: Data analysed for 24 patients (12 fast-track group, 12 conventional group) with advanced ovarian cancer. Mean age: 61 years, mean weight: 67 kg. The average stay fell 33,3% in the fast-track group (8 days) regarding to conventional group (12 days). 72 hours post-surgery, 91% of fast-track group patients were initiated oral tolerance and mobilization. Reported postoperative complications: 1 suture dehiscence, 3 surgical wound infections, 1 paralytic ileum, 1 suboclussion. None of the patients died in the 28 days following the surgery. 
Conclusion: Through a fast-track protocol the average hospital stay decreases, as well as the postoperative period recovery in patients subjected to major advanced oncogynecologist surgery.
Ethical Research Declaration:	5. Any study involving randomization
Preferred Presentation Type:	Clinical or experimental study