Fast track in thoracic anesthesia and surgery.

PURPOSE OF REVIEW: To provide an update on fast track thoracic anesthesia for patients undergoing lung resection.

RECENT FINDINGS: There are very few studies supporting the concept of fast-track approach in thoracic surgery. The concept of fast track can be applied if patients can be identified in the preoperative visit to subdivide those with good pulmonary reserve, if postoperative pulmonary complications are reduced, or if complications can be treated under fast-track guidelines. A high volume in thoracic surgery practice and a single thoracic surgeon can make a difference in the outcome with the concept of fast-track surgery either via video-assisted thoracic surgery or open thoracotomy. In addition, a multimodal approach and the use of thoracic epidural analgesia can contribute to facilitate the fast-track approach.

SUMMARY: Fast track in thoracic surgery and anesthesia has evolved quite slowly in contrast to other surgical specialties; further studies are needed to weigh the risks and benefits in thoracic surgical patients in order to determine who can benefit from the concept of fast track.