Anaesthesia has expanded outside of the operating theatre to encompass both intensive care medicine and pain medicine, but in addition over the last 10 years or so, the anaesthetist’s role has been redefined as a perioperative physician.

As a result, anaesthetists now have major input into preoperative assessment and preparation of patients for major surgery, optimizing medical conditions such as diabetes l and anaemia (including in iron therapy for the latter). Patients may also require referral to a high risk anaesthetic clinic (HRAC). Here they may also undergo risk stratification, so that the most appropriate surgery and care is provided including postoperative care. This may include preoperative cardiopulmonary exercise testing (CPET).

A major area of current interest is prehabilitation for some surgeries, and following chemotherapy. This involves improving preoperative aerobic fitness, nutrition and psychology to improve outcome.

Postoperatively, there is a focus not only the provision of oxygen therapy and fluids analgesia (with PONV prophylaxis), but also on thromboprophylaxis and appropriate antibiotics. In particular patients should be able to partake in early drinking, eating and mobilization, which itself requires avoidance of prolonged iv fluids, urinary catheters, NG tubes and surgical drains.

Finally early recognition and appropriate management of both surgical and medical complications is paramount.