Intra-operative oxygen delivery in infusion volume-optimized patients undergoing laparoscopic colorectal surgery within an enhanced recovery programme: the effect of different analgesic modalities

Aim Patients undergoing major open surgery who have an indexed oxygen delivery (DO2I) > 600 ml/min/m2 have been shown to have a lower incidence of morbidity and mortality compared with those whose DO2I is below this level. Laparoscopy and Trendelenburg positioning cause a reduction in DO2I. We aimed to quantify the effect of the type of analgesia on DO2I and to correlate the DO2I achieved with the incidence of anastomotic leakage in patients undergoing laparoscopic surgery. Method 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 DO2I 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) DO2I for all patients was 490 (230-750) ml/min/m2. The analgesic modality had no effect on DO2I. Of the 18 patients with a DO2I of < 400 ml/min/m2, four (22%) developed anastomotic leakage compared with one (%) of the 57 patients with a DO2I of > 400 ml/min/m2 (P = 0.01). Conclusion The analgesic modality used had no effect on the DO2I achieved. Anastomotic leakage was significantly higher in patients with a DO2I of < 400 ml/min/m2. A further study assessing the outcome after raising the DO2I with inotropes is required.