Anaesthesia for major abdominal and urological surgery

There is good evidence that epidural analgesia provides slightly better analgesia when compared with intravenous (IV) opioid regimens; incisional local anaesthetic infiltration has minimal analgesic effectiveness; supplemental IV fluids improve patient comfort, but a restrictive fluid regimen promotes return of gastrointestinal (GI) function; normothermia prevents shivering and wound infection, prophylactic antibiotics prevent infections; heparin and graduated compression stockings reduce thromboembolism; nasogastric drainage has no benefit, but early enteral feeding reduces postoperative infection and hospital stay, and may have other benefits after abdominal surgery. There is inconclusive evidence that supplemental IV fluids improve postoperative nausea and vomiting (PONV), headache and pain; a restrictive fluid regimen reduces postoperative complications and hospital stay; choice of IV fluid has any clinically important effects; optimisation of tissue oxygen delivery with inotrope therapy improves outcome; supplemental oxygen reduces serious complications; nitrous oxide reduces wound infection and pneumonia; and whether or not beta-blockers reduce cardiac mortality. Major abdominal surgery includes many types of GI, as well as hepatobiliary, aortic, renal, and prostatic surgery. Naturally there are specific anaesthetic considerations inherent in each of these procedures, and some institutions will have unique issues for the anaesthetist to consider, such as innovative surgical techniques or the extent of hospital resources available for the perioperative care of the patient.