Making changes in surgical practice is often very slow and old routines prevail way beyond the last best for use day (Lassen K; Bmj 2005; 330:1420). Treatments such as preoperative fasting (Ljungqvist O; Br J Surg 2003; 90:400), large enemas for preoperative bowel cleansing (Slim K; Br J Surg 2004; 91:1125), unrestricted perioperative fluid treatments (Lobo DN; Lancet 2002; 359:1812), delayed food intake (Lewis SJ; Bmj 2001; 323:773)
are largely still in use. Even when these routines are challenged and
proven wrong and outdated, it still takes a long time to make changes in
daily practice. A typical example are the overnight fasting routines
that were shown over 20 years ago to be outdated but still remain in use
in most of Europe (Soreide E; Acta Anaesthesiol Scand 2005; 49:1041).
While many northern European Anesthesia and other expert societies
have made changes in accordance to current knowledge, the great
majority of countries have not and in these countries nil per os from
midnight still is the rule.
It is now 10 years ago that the pioneering work by Henrik Kehlet on fast track surgery was published (Kehlet H; Br J Surg 1999; 86:227). In this report he showed it possible to have more than half the patients undergoing segmental colonic resection fit to leave the hospital 2 days after the operation. For a long time, this was almost not believed, but in time others have shown similar outcomes using similar protocols.
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