title: Intra-operative oxygen delivery in infusion volume-optimized patients undergoing laparoscopic colorectal surgery within an enhanced recovery programme: the effect of different analgesic modalities.
abstract: OBJECTIVE
  Patients undergoing major open surgery who have an indexed oxygen delivery (DO(2) I) > 600 ml/min/m(2) have been shown to have a lower incidence of morbidity and mortality compared with those whose DO(2) I is below this level. Laparoscopy and Trendelenburg positioning cause a reduction in DO(2) I. We aimed to quantify the effect of the type of analgesia on DO(2) I and to correlate the DO(2) I achieved with the incidence of anastomotic leakage in patients undergoing laparoscopic surgery.
  
  
  METHODS
  Following ethical approval, patients were randomized to receive spinal anaesthesia (Group S), epidural analgesia (Group E) or intravenous morphine (Group P) followed by postoperative patient-controlled analgesia (PCA). In addition to standard monitoring, oesophageal Doppler monitoring of the stroke volume allowed directed intravenous fluid therapy. The mean DO(2) I was compared with the anastomotic leakage rate.
  
  
  RESULTS
  Seventy-five patients were recruited (Group S, 27; Group E, 23; Group P, 25). The mean (range) DO(2) I for all patients was 490 (230-750) ml/min/m(2) . The analgesic modality had no effect on DO(2) I. Of the 18 patients with a DO(2) I of < 400 ml/min/m(2) , four (22%) developed anastomotic leakage compared with one (%) of the 57 patients with a DO(2) I of > 400 ml/min/m(2) (P = 0.01).
  
  
  CONCLUSIONS
  The analgesic modality used had no effect on the DO(2) I achieved. Anastomotic leakage was significantly higher in patients with a DO(2) I of < 400 ml/min/m(2) . A further study assessing the outcome after raising the DO(2) I with inotropes is required.
authors: Department of Surgery, Institution: Minimal Access Therapy Training Unit, Post Graduate Medical School, University of Surrey, Manor Park, Guildford, Surrey, UK. brucelevy22@hotmail.com
authors: B F
authors: BF
authors: Levy
authors: W J
authors: WJ
authors: Fawcett
authors: M J P
authors: MJ
authors: Scott
authors: T A
authors: TA
authors: Rockall
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015360:Analgesia, Epidural; D000701:Analgesics, Opioid / Q000008:administration & dosage*; D000704:Analysis of Variance; D057868:Anastomotic Leak / Q000209:etiology; D000775:Anesthesia, Spinal; D002045:Bupivacaine; D003082:Colectomy / Q000009:adverse effects; D005283:Fentanyl; D005440:Fluid Therapy; D003932:Heroin; D006801:Humans; D007262:Infusions, Intravenous; D007430:Intraoperative Care; D010535:Laparoscopy / Q000009:adverse effects; D008875:Middle Aged; D009020:Morphine / Q000008:administration & dosage*; D010100:Oxygen / Q000008:administration & dosage* / Q000493:pharmacokinetics*; D013318:Stroke Volume
chemical_list: D000701:Analgesics, Opioid; D003932:Heroin; D009020:Morphine; D010100:Oxygen; D005283:Fentanyl; D002045:Bupivacaine