Users Online: 227 Home Print this page Email this page Small font sizeDefault font sizeIncrease font size  
Home | About us | Editorial board | Search | Ahead of print | Current issue | Archives | Submit article | Instructions | Subscribe | Contacts | Login 
 

 
Table of Contents
REVIEW ARTICLE
Year : 2012  |  Volume : 28  |  Issue : 2  |  Page : 162-171

Anesthesia and perioperative management of colorectal surgical patients - A clinical review (Part 1)


1 Department of Anaesthesia, Consultant Anaesthetist, The Pennine Acute Hospitals NHS Trust, Rochdale, United Kingdom
2 Consultant Anaesthetist, Blackpool Victoria Hospital, Blackpool, United Kingdom
3 Consultant Anaesthetist, Central Manchester University Hospitals NHS Foundation Trust, United Kingdom

Date of Web Publication11-Apr-2012

Correspondence Address:
Santosh Patel
School of Biomedicine The University of Manchester Manchester Academic Health Science Centre The Pennine Acute NHS Trust, Rochdale Infirmary OL12 0NB
United Kingdom
Login to access the Email id

Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0970-9185.94831

Rights and Permissions
  Abstract 

Colorectal surgery is commonly performed for colorectal cancer and other pathology such as diverticular and inflammatory bowel disease. Despite significant advances, such as laparoscopic techniques and multidisciplinary recovery programs, morbidity and mortality remain high and vary among surgical centers. The use of scoring systems and assessment of functional capacity may help in identifying high-risk patients and predicting complications. An understanding of perioperative factors affecting colon blood flow and oxygenation, suppression of stress response, optimal fluid therapy, and multimodal pain management are essential. These fundamental principles are more important than any specific choice of anesthetic agents. Anesthesiologists can significantly contribute to enhance recovery and improve the quality of perioperative care.

Keywords: Analgesia, anesthesia, colorectal, intestinal, perioperative


How to cite this article:
Patel S, Lutz JM, Panchagnula U, Bansal S. Anesthesia and perioperative management of colorectal surgical patients - A clinical review (Part 1). J Anaesthesiol Clin Pharmacol 2012;28:162-71

How to cite this URL:
Patel S, Lutz JM, Panchagnula U, Bansal S. Anesthesia and perioperative management of colorectal surgical patients - A clinical review (Part 1). J Anaesthesiol Clin Pharmacol [serial online] 2012 [cited 2017 Sep 20];28:162-71. Available from: http://www.joacp.org/text.asp?2012/28/2/162/94831


  Introduction Top


Colorectal (CR) surgery for cancer, diverticular, or inflammatory diseases is a high-risk surgery. Other indications for CR surgery include ischemic colitis, iatrogenic perforation or injury, and volvulus. For the successful anesthetic management and a favorable perioperative outcome, an understanding of basic sciences specific for CR surgery [e.g., colon blood flow (CBF) and stress response], preoperative assessment, and fluid and pain management is required. In addition, evidence-based principles of enhanced recovery and multidisciplinary team efforts can significantly help minimizing the incidence of complications [Figure 1]. A detailed and comprehensive review of anesthetic management and perioperative care of CR surgery is lacking in literature. Major anesthesia textbooks contain either no or only minimal specific educational material relating to these patient. This review focuses on anesthesia practice, techniques, postoperative care pathways, and care including pain relief.
Figure 1: Role of anesthesiologist in perioperative care of colorectal surgical patients

Click here to view


Colon blood flow and oxygenation

Perioperative factors affecting CBF are not well studied in humans. Preoperative medical conditions which may predispose colonic tissue to hypoxia include smoking, atherosclerosis, cardiac failure, and sickle cell anemia. During the perioperative period, CBF is affected by blood gas composition, [1] volume status, [2] intra-abdominal pressure, [3] intraluminal pressure, [4] type and volume of fluid therapy, [5] anesthetic agents and anesthetic techniques, [6],[7] and critical conditions such as hemorrhage [8] and sepsis. [9] It would be difficult to predict changes in CBF when many of these factors coexist during surgery or the postoperative period.

Regional anesthetic techniques increase CBF by causing sympatholysis. This has been shown with both spinal [7] and epidural techniques. In a canine model, high spinal anesthesia increased CBF by 22% and decreased vascular resistance by 44%, while the oxygen consumption of the colon was reduced significantly. [7] In human patients, epidural block with local anesthetic has a favorable effect on colonic blood flow and oxygenation. [10]

Preoperative assessment


Significant number of patients aged over 75 years present with rectal cancer . Kingston et al. found that the general fitness of a patient is a better predictor for outcome after surgery for CR cancer than chronological age. [11]

Anemia, electrolyte imbalance, nutritional deficiency (e.g., hypoalbuminemia), and weight loss should be identified and corrected. In elective cases for noncancer surgery, a detailed evaluation and treatment of medical problems are possible. However, in patients requiring cancer or urgent surgery (e.g., for obstruction or perforation), time may be limited. During emergency surgery, the main goals are to identify deteriorating vital physiological end organ functions and their causes, e.g., sepsis and hypovolemia. History, clinical examination, a review of monitored parameters, and laboratory investigations (e.g., arterial blood gas analysis and serum electrolytes) are vital to judge the severity of problems (e.g., fluid deficit). Cardiac and respiratory diseases are commonly present among the patients undergoing major CR surgery. One third of the patients may have significant cardiac or pulmonary problems during the preoperative period. [12] Cardiopulmonary exercise testing (CPET) has been suggested as an integrated objective measurement of functional reserve and is useful in predicting complications and outcome. The results of CPET have a high predictive value for patients at risk of developing cardiopulmonary complications in the postoperative period. [13] In a study by Snowden, the anaerobic threshold (AT) was lower in the group with more than one complication (11.9 vs. 9.1 ml/ kg/ min; P=0.001). [14] Wilson et al. studied the predictive value of AT and ventilatory equivalent for carbon dioxide (VE/VCO 2 ) using CPET for patients undergoing high-risk surgery. They demonstrated a VE/VCO 2 > 34 and an AT ≤ 10.9 ml/kg/min were significant predictors of all-cause hospital and 90 days mortality. They also found that CPET was more useful in predicting the risk of death in patients with no history of ischemic heart disease or risk factors for it. [15]

Scoring systems

Various risk indices and scoring systems have been used to stratify risk for patients undergoing gastrointestinal surgery. [16] Clinical risk indices are derived from history, functional capacity, physical examination, serum markers, and variables specific to surgery such as the urgency of surgery. The Physiological and Operative Severity Score for the Enumeration of Mortality and Morbidity (POSSUM) and Portsmouth-POSSUM (P-POSSUM) were developed in 1991 and 1996, respectively. The POSSUM-based scoring system predicts complications and outcome. [17] The specialty-specific CR POSSUM (CR-POSSUM), which uses 10 measures (6 physiological and 4 operative), was developed in 2004 and is easier to use, more accurate, and has been validated. [18] Ferjani et al. compared POSSUM-based scoring systems to the ACPGSI (Association of Coloproctology of Great Britain and Ireland) score. They found that the ACPGBI and the CR-POSSUM were significantly better predictors of overall 30 day mortality for CR cancer than POSSUM and P-POSSUM. [19] In the US, the National Surgical Quality Improvement Programme (NSQIP) has been applied to provide risk adjusted 30-day outcome data, but its application to other health care providers is limited.

Preoperative preparation

To improve recovery after CR surgery, traditional clinical measures such as mechanical bowel preparation (MBP) and routine insertion of nasogastric tubes have been challenged. It does not prevent any abdominal infectious complications but may increase cardiac complications. [20] It is also associated with a poor patient experience. One recent meta-analysis [21] and guideline [22] suggest that the routine use of MBP should be omitted in elective CR surgery. Routine insertion of nasogastric tubes is not recommended as their use is associated with a delayed return of bowel function and an increase in pulmonary complications. [23]

Antibiotic prophylaxis

Nelson et al., in a review comprising more than 30000 patients in 182 trials, concluded that the antimicrobial prophylaxis with aerobic and anaerobic coverage reduces surgical site infection by 75%. [24]

Preoperative nutrition and carbohydrate loading

Hypoalbuminemia, anemia, and weight loss are common in CR patients. Some patients, e.g., those with Crohn's disease, may not tolerate an enteral diet. Enteral intake with high-energy drinks and parenteral nutrition if enteral feeding is not tolerated should then be commenced. [25] Poor nutritional status, particularly hypoalbuminemia, has been associated with increased postoperative complications such as infections [26] and increased length of hospital stay. [27] Preoperative oral carbohydrate loading has been shown to reduce preoperative patient discomfort, postoperative insulin resistance, [28] loss of muscle mass, [28] postoperative nausea and vomiting (PONV) [29] and to improve muscle strength [28] Preoperative carbohydrates are also beneficial for enhanced recovery and reduce length of stay. [30] A thorough nutritional assessment and nutrition management guidelines (with support from nutritional units) reduce the unnecessary use of total parenteral nutrition, time spent "nil by mouth," and hospital stay. [31] There are conflicting reports regarding benefits of preoperative immunonutrition on requirement of total parental nutrition or reduced infection rates. [32]

Chewing gum

Gum chewing mimics feeding and promotes peristalsis via neural and hormonal mechanisms which increases the secretion of gastrointestinal juices and bowel motility and reduces postoperative paralytic ileus. It is a safe, effective, and economical means to reduce time to feeding and hospital stay. [33]

Stress and immune responses

Preoperative nutritional support, [34] presence or absence of peritonitis, intraoperative use of anesthetic agents and anesthetic technique employed, [35] perioperative use of adjuvants such as beta-blockers [36] or alpha-agonists, [37] postoperative analgesia, and patient pathway [38] (e.g., conventional or enhanced recovery program) may modify the stress response. Surgical factors which influence the stress response during CR surgery are duration of open surgery, [39] urgency of surgery, [40] open vs. laparoscopy techniques, [41] and amount of blood loss and blood transfusion. [42] An exaggerated stress response has been associated with postoperative bowel dysfunction, fatigue, delayed wound healing, infectious complications such as wound infection, anastomotic leak and cardiopulmonary complications. It may delay recovery, increase susceptibility for metastasis in cancer patients, [43] and have long-term side effects such as the formation of adhesions. [44] The recovery of a suppressed immune function is faster in laparoscopic surgery and this may influence recurrence in cancer surgical patients. [45]

Modification of stress response

Several strategies to counteract the catabolic stress response have been suggested. Shortened fasting periods, use of nutritional support and glycemic control, [46] laparoscopic surgery, and epidural analgesia [47] have all been shown to be beneficial. Tylman et al. found no differences in inflammatory response among CR cancer surgery patients receiving either total intravenous anesthesia with propofol and remifentanil or inhalational anesthesia with sevoflurane and fentanyl, except raised IL-17levels and hyperglycemia. [48] With the use of intraoperative thoracic epidural anesthesia, plasma concentrations of epinephrine and cortisol were significantly lower and lymphocyte numbers and T-helper cells were significantly higher in a study by Ahler et al. [49] Systemic lidocaine used during CR surgery also has anti-inflammatory actions and is a useful alternative to suppress the stress response in patients who are not suitable for epidural analgesia. [50] Methyl prednisolone administered preoperatively in colon cancer patients modified the stress response and was found to improve both pulmonary function and postoperative pain, as well as to reduce length of stay regardless of the surgical technique used. [51] During open surgery, the administration of 8 mg dexamethasone was associated with significantly lower peritoneal interleukin (IL) 6 and IL-13 concentrations on day 1 and significantly reduced early postoperative fatigue. [52] Nonsteroidal anti-inflammatory drugs ((NSAID) like parecoxib and flubiprofen [53],[54],[55] and pentoxiphylline [56] may also be useful. There is increasing evidence that a multimodal approach to perioperative care markedly reduces surgical stress and enhances recovery after major CR surgery. [36],[38]

Intraoperative anesthetic management


The goals of perioperative anesthetic management for CR surgical patients are minimizing stress and immune responses, maintaining systemic and colonic blood flow and oxygenation, meticulous fluid and electrolyte therapy, multimodal analgesia, and prevention of postoperative gut dysfunction [Figure 1].

The perioperative use of ß-blockers and α2-agonists may be useful, particularly for high-risk patients. However, their routine use is not recommended until large studies showing clinical benefits in this specific surgical population are available. Antiemetics should be considered to prevent PONV. Other factors can also influence the incidence of PONV. In comparison to 30% oxygen, supplemental oxygen at 80% has been found to reduce the incidence of PONV two- to five-fold after CR surgery, possibly due to decreased serotonin levels in plasma. [57]

Maintaining perioperative normothermia reduces postoperative cardiac and coagulation complications and should be standard care during colon surgery. Hypothermia causes several undesirable systemic changes, including an exaggerated stress response [58] and suppression of the immune function [59] in patients undergoing CR surgery. Active thermoregulation should be carried out both during open and laparoscopic CR surgery, as the reduced bowel exposure during the latter does not compensate for the marked effects of anesthesia on temperature regulation. [60] During laparoscopic surgery, systemic physiological changes due to pneumoperitoneum may cause cardiorespiratory problems. Patients should be carefully positioned and their positioning carefully maintained to prevent Trendelenburg position-related complications. Brachial plexus injury [61] and lower limb compartment syndromes [62],[63] have been reported with laparoscopic large bowel surgery.

General anesthetic agents and technique

At present, there is no evidence to recommend specific anesthetic or analgesic agents for CR surgical patients. However, short acting agents are useful if patients are for fast track CR surgery. During prolonged laparoscopic-assisted surgery, sevoflurane-based anesthesia was associated with earlier eye opening and tracheal extubation in comparison to propofol-based anesthesia. In the latter group, the incidence of postoperative colon dysfunction (POCD) on day 2 and day 3 was higher. [64] For open surgery, Jenesen et al. [65] studied three different anesthetic techniques (isoflurane/nitrous oxide, propofol/air, or propofol/nitrous oxide), with fentanyl and vecuronium. There were no significant differences in overall recovery, bowel function (passage of flatus and oral intake), postoperative hospital stay, and complications. Volatile agents differ in their effects on CBF and oxygenation. Muller et al. [66] studied the effects of desflurane and isoflurane on intestinal tissue oxygen pressure during open CR surgery. On completion of the anastomosis, mean tissue oxygen pressure was higher in the isoflurane group than in the desflurane group. This may be due to preservation of reactive hyperemia by isoflurane. No difference between groups could be observed with regards to splanchnic hemodynamics and global oxygenation. Intraoperative use of xenon decreased superior mesenteric artery blood flow, but had no detrimental effect on colon oxygenation. [67] During CR surgery, diffusion of nitrous oxide (N 2 O) into the bowel lumen may cause distention and might therefore affect surgical handling and bowel recovery. Scheilein et al. [68] found an earlier return of bowel function with air in comparison to N 2 O during isoflurane anesthesia. In contrast, Krough et al. [69] found no differences between air and N 2 O in terms of postoperative bowel function and recovery. The use of N 2 O is not associated with a recurrence of CR cancer. [70] Use of neostigmine has been suggested to be hazardous during the use of bowel surgery. Doses as little as 0.5 mg were associated with violent bowel contractions with intraluminal pressures increasing markedly up to 70 mm of Hg. [71] In addition, it decreased CBF up to 50% in some animals, which was attributed to a decrease in cardiac output and/or contractility. Fortunately, effects are less severe if an anticholinergic is used simultaneously. [71]

Use of regional analgesia and anesthesia

Epidural analgesia is recommended for open CR surgery. [72] In the case of laparoscopic surgery, an epidural may be beneficial if the patient has significant preoperative respiratory disease. It may be beneficial to insert an epidural catheter if conversion to open surgery is likely. Sole regional anesthesia, e.g., combined spinal-epidural technique, is possible for low anterior resections of the rectum. [73] The use of intraoperative thoracic epidural anesthesia and analgesia has been associated with an increase in colonic blood flow [10],[74] and better gastrointestinal recovery. Pain control with epidural analgesia does not, however, affect the incidence of CR cancer recurrence. [75] Spinal with light general anesthesia has also been found to be beneficial. [76],[77] Recently, Kumar et al. reported continuous spinal anesthesia using microcatheter for high-risk patients. [78] A wide variety of CR surgical procedures were performed with anesthetic block height T6-T7. After establishing spinal anesthesia with heavy 0.5% bupivacaine and fentanyl, 0.5% isobaric bupivacaine was used to extend spinal anesthesia. However, the microcatheter was removed at the end of surgery.

Optimization of hemodynamics

Several studies have demonstrated that, for patients undergoing CR surgery, goal-directed hemodynamic management reduces postoperative gastrointestinal complications. [79] Fluids alone or fluids and inotropes are used to achieve defined end points. Flow-, pressure-, or volume-based goals have been used. [79] Interestingly, intraoperative [80] or postoperative [81] changes in central venous oxygen saturation (ScvO 2 ) have been found to predict complications. Intraoperative maintenance of ScvO 2 > 73% may prevent complications. [80] The perioperative use of dopexamine to improve the splanchnic circulation is controversial. Davies et al. studied high-risk patients (anaerobic threshold T of <11 ml/kg/min or an AT of 11-14 ml/kg/min with a history of ischemic heart disease). Low-dose dopexamine (0.5 mcg/ kg/min) was administered with goal-directed fluid therapy. It was associated with earlier enteral diet tolerance, but there were no differences in complications or length of stay. [82] Stroke volume guided fluid and low-dose dopexamine therapy may improve global oxygen delivery, microvascular flow, and tissue oxygenation.

Postoperative care

Recovery after open CR surgery can be hastened by adopting perioperative evidence-based practices. This approach is described as "enhanced" or "fast track" or "accelerated" recovery after surgery. [83]

Recovery - conventional or enhanced

Recovery pathways, enhanced or conventional, should be managed by multidisciplinary teams involving anesthesiologists, surgeons, nursing staff, nutritional experts, acute pain team, pharmacists, and physiotherapists. In comparison with conventional postoperative management, enhanced recovery pathway (ERP) is associated with a reduced postoperative morbidity (14.8% vs. 33.6%, respectively; P<0.01). However, it does not reduce mortality. [83] ERP is recommended to reduce length of in-hospital stay. [84] The aim is to reduce perioperative stress-related bowel and other organ dysfunction by incorporating a multimodal approach in perioperative care. [85] ERP has not been widely implemented around the world yet, [86] but even partial compliance with the components of ERP has shown to reduce hospital stays and improve patient satisfaction. [87] Concerns about high readmission rates have been unfounded, and early discharge as a result of ERP does not lead to increased needs for home care, social care, or visits to general practitioners. [88]

Fluid therapy and nutrition

Postoperative fluid therapy should take into consideration maintenance requirements, losses (insensible and sensible), and pathophysiological changes associated with major bowel surgery. There is no magic formula and an individualized approach is necessary. Restrictive fluid therapy during the postoperative period has been shown to be beneficial. There is no doubt that excessive fluid prescription to correct epidural or other systemic vasodilator-related hypotension is not justified and associated with more risks than benefits. There is no scientific basis for the traditional strategy to keep patients "nil by mouth" until flatus has been passed or bowel sounds heard, and there is no specific advantage to withhold early feeding within 24 h after CR surgery. [89] Early enteral nutrition has several advantages, such as improved healing of intestinal anastomoses, [90],[91] preservation of gut barrier functions, a positive nitrogen balance, improved calorie intake, a reduced incidence of infectious complications, [92],[93] and reduced hyperglycemia and insulin resistance. [94] Furthermore, septic complications and length of hospital stay were reduced in patients receiving early enteral feeding. [92],[95] Enteral nutrition along with epidural analgesia and forced mobilization improved nutrition uptake after CR surgery. [96] Enteral nutrition is safe and more cost effective than parenteral nutrition (TPN), which requires a central line. It is also a care component of enhanced recovery.

Pain management

Postoperative pain relief after CR surgery has been reviewed in the literature. For open surgery, thoracic epidural analgesia is recommended. Other pain relief methods used for postoperative pain relief are patient-controlled analgesia (PCA), intrathecal (IT) analgesia, systemic lidocaine infusions, wound infusions, wound infiltration, and transversus abdominis plane (TAP) block. Opioids have significant side effects on the gastrointestinal tract, such as nausea, vomiting, inhibition of bowel motility, and constipation. Their use may delay the return of bowel function and oral intake. Peripheral opioid antagonists, such as avlimopan, have been shown to reduce the duration of paralytic ileus after colon surgery. [97] In addition, NSAID and acetaminophen are commonly used to achieve multimodal analgesia. There is a concern about increased risk of anastomotic leaks with the use of cyclooxygenase 2 inhibitors. [98] However, NSAIDs are widely used, and in our practice are routinely used as part of multimodal analgesia. The usefulness of other analgesics such as tramadol, gabapentin, and ketamine has not been studied for CR surgical patients, and they are not routinely recommended.

For laparoscopic CR surgery, there is no sufficient evidence for any specific postoperative analgesic method. Epidural analgesia may not offer the same benefits as in open surgery. However, epidurals may be indicated if patients have preoperative pulmonary morbidities and also if the procedure is converted to open surgery. One recent randomized controlled trial has shown an earlier return of bowel function with IT analgesia, compared to epidural analgesia. [99] In contrast, Zingg et al. [100] reported faster recovery of gastrointestinal function with epidural analgesia after laparoscopic surgery. Both are single centre studies involving small number of patients. There is a need for larger studies comparing analgesic regimens for laparoscopic CR surgery.

Thoracic epidural analgesia provides several benefits for open CR surgery [Table 1] and there is a strong evidence for its recommendation. Other techniques such as wound infusion with ropivacaine and systemic lidocaine infusion [Table 1] have also been reported after open surgery. These techniques may be useful if epidural is technically not feasible or contraindicated.
Table 1: Clinical advantages and disadvantages of various pain relief methods specific to colorectal surgery

Click here to view


The choice of a specific technique or drug depends on its safety, efficacy, the patient's comorbidities, and overall gastrointestinal, systemic, and clinical advantages and disadvantages [Table 1]. Detailed expert guidelines for pain relief after open and laparoscopic CR surgery are available on the Internet (www.postoppain.org).


  Conclusion Top


CR surgery carries significant morbidity and mortality. Enhanced recovery programs, laparoscopic surgical approach, multidisciplinary team efforts, and integrated care pathways have improved the perioperative management for elective cases. There is a need for CR surgery specific education and research within our specialty. Such efforts should focus on basic and clinical sciences including CBF and oxygenation, preoperative objective assessment, reduction of risk factors, perioperative stress, and fluid and pain management.


  Acknowledgment Top


SP conceptualized the article. SP designed overall structure, figures and tables for part 1 and part 2. SP searched and collected literature for all sections. SP responded to reviewers' comments and was responsible for revisions and correspondence.

SP wrote CBF and stress response sections. SP and UP wrote preoperative assessment and intraoperative management. SB and SP wrote preoperative preparation and postoperative care. JB and SP organized references and contributed for revision. Authors contributed for revision of their sections and for final revision.[125]

 
  References Top

1.Gilmour DG, Douglas IH, Aitkenhead AR, Hothersall AP, Horton PW, Ledingham IM. Colon blood flow in the dog: Effects of changes in arterial carbon dioxide tension. Cardiovasc Res 1980;14:11-20.  Back to cited text no. 1
    
2.Gilmour DG, Aitkenhead AR, Hothersall AP, Ledingham IM. The effect of hypovolaemia on colonic blood flow in the dog. Br J Surg 1980;67:82-4.  Back to cited text no. 2
    
3.Diebel LN, Dulchavsky SA, Wilson RF. Effect of increased intra-abdominal pressure on mesenteric arterial and intestinal mucosal blood flow. J Trauma 1992;33:45-8.  Back to cited text no. 3
    
4.Ruf W, Suehiro GT, Suehiro A, Pressler V, McNamara JJ. Intestinal blood flow at various intraluminal pressures in the piglet with closed abdomen. Ann Surg 1980;191:157-63.  Back to cited text no. 4
    
5.Kimberger O, Arnberger M, Brandt S, Plock J, Sigurdsson GH, Kurz A, et al. Goal-directed colloid administration improves the microcirculation of healthy and perianastomotic colon. Anesthesiology 2009;110:496-504.  Back to cited text no. 5
    
6.Seyde WC, Longnecker DE. Anesthetic influences on regional hemodynamics in normal and hemorrhaged rats. Anesthesiology 1984;61:686-98.  Back to cited text no. 6
    
7.Aitkenhead AR, Gilmour DG, Hothersall AP, Ledingham IM. Effects of subarachnoid spinal nerve block and arterial PCO2 on colon blood flow in the dog. Br J Anaesth 1980;52:1071-7.  Back to cited text no. 7
    
8.Krejci V, Hiltebrand L, Banic A, Erni D, Wheatley AM, Sigurdsson GH. Continuous measurements of microcirculatory blood flow in gastrointestinal organs during acute haemorrhage. Br J Anaesth 2000;84:468-75.  Back to cited text no. 8
    
9.Hiltebrand LB, Krejci V, Banic A, Erni D, Wheatley AM, Sigurdsson GH. Dynamic study of the distribution of microcirculatory blood flow in multiple splanchnic organs in septic shock. Crit Care Med 2000;28:3233-41.  Back to cited text no. 9
    
10.Gould TH, Grace K, Thorne G, Thomas M. Effect of thoracic epidural anaesthesia on colonic blood flow. Br J Anaesth 2002;89:446-51.  Back to cited text no. 10
    
11.Kingston RD, Jeacock J, Walsh S, Keeling F. The outcome of surgery for colorectal cancer in the elderly: A 12-year review from the Trafford Database. Eur J Surg Oncol 1995;21:514-6.  Back to cited text no. 11
    
12.Alves A, Panis Y, Mathieu P, Mantion G, Kwiatkowski F, Slim K; Association Française de Chirurgie. Postoperative mortality and morbidity in French patients undergoing colorectal surgery: Results of a prospective multicenter study. Arch Surg 2005;140:278-83.  Back to cited text no. 12
    
13.Older P, Hall A, Hader R. Cardiopulmonary exercise testing as a in the elderly. Chest 1999;116:355-62.  Back to cited text no. 13
    
14.Snowden CP, Prentis JM, Anderson HL, Roberts DR, Randles D, Renton M, et al. Submaximal cardiopulmonary exercise testing predicts complications and hospital length of stay in patients undergoing major elective surgery. Ann Surg 2010;251:535-41.  Back to cited text no. 14
    
15.Wilson RJ, Davies S, Yates D, Redman J, Stone M. Impaired functional capacity is associated with all-cause mortality after major elective intra-abdominal surgery. Br J Anaesth 2010;105:297-303.  Back to cited text no. 15
    
16.Chandra A, Mangam S, Marzouk D. A review of risk scoring systems utilised in patients undergoing gastrointestinal surgery. J Gastrointest Surg 2009;13:1529-38.  Back to cited text no. 16
    
17.Richards CH, Leitch FE, Horgan PG, McMillan DC. A systematic review of POSSUM and its related models as predictors of post-operative mortality and morbidity in patients undergoing surgery for colorectal cancer. J Gastrointest Surg 2010;14:1511-20.  Back to cited text no. 17
    
18.Ramkumar T, Ng V, Fowler L, Farouk R. A comparison of POSSUM, P-POSSUM and colorectal POSSUM for the prediction of postoperative mortality in patients undergoing colorectal resection. Dis Colon Rectum 2006;49:330-5.  Back to cited text no. 18
    
19.Ferjani AM, Griffin D, Stallard N, Wong LS. A newly devised scoring system for prediction of mortality in patients with colorectal cancer: A prospective study. Lancet Oncol 2007;8:317-22.  Back to cited text no. 19
    
20.Gravante G, Caruso R, Andreani SM, Giordano P. Mechanical bowel preparation for colorectal surgery: A meta-analysis on abdominal and systemic complications on almost 5,000 patients. Int J Colorectal Dis 2008;23:1145-50.  Back to cited text no. 20
    
21.Slim K, Vicaut E, Launay-Savary MV, Contant C, Chipponi J. Updated systematic review and meta-analysis of randomized clinical trials on the role of mechanical bowel preparation before colorectal surgery. Ann Surg 2009;249:203-9.  Back to cited text no. 21
    
22.Eskicioglu C, Forbes SS, Fenech DS, McLeod RS. Best practice in general surgery committee: Preoperative bowel preparation for patients undergoing elective colorectal surgery: A clinical practice guideline endorsed by the Canadian Society of Colon and Rectal Surgeons. Can J Surg 2010;53:385-95.  Back to cited text no. 22
    
23.Nelson R, Edwards S, Tse B. Prophylactic nasogastric decompression after abdominal surgery. Cochrane Database Syst Rev 2007;18: CD004929.  Back to cited text no. 23
    
24.Nelson RL, Glenny AM, Song F. Antimicrobial prophylaxis for colorectal surgery. Cochrane Database Syst Rev 2009;21: CD001181.  Back to cited text no. 24
    
25.Alves A, Panis Y, Bouhnik Y, Pocard M, Vicaut E, Valleur P. Risk factors for intra-abdominal septic complications after a first ileocecal resection for Crohn's disease: A multivariate analysis in 161 consecutive patients. Dis Colon Rectum 2007;50:331-6.  Back to cited text no. 25
    
26.Yamamoto T, Allan RN, Keighley MR. Risk factors for intra-abdominal sepsis after surgery in Crohn's disease. Dis Colon Rectum 2000;43:1141-5.  Back to cited text no. 26
    
27.Garth AK, Newsome CM, Simmance N, Crowe TC. Nutritional status, nutrition practices and post-operative complications in patients with gastrointestinal cancer. J Hum Nutr Diet 2010;23:393-401.  Back to cited text no. 27
    
28.Noblett SE, Watson DS, Huong H, Davison B, Hainsworth PJ, Horgan AF. Pre-operative oral carbohydrate loading in colorectal surgery: A randomized controlled trial. Colorectal Dis 2006;8:563- 9.  Back to cited text no. 28
    
29.Henriksen MG, Hessov I, Dela F, Hansen HV, Haraldsted V, Rodt SA. Effects of preoperative oral carbohydrates and peptides on postoperative endocrine response, mobilization, nutrition and muscle function in abdominal surgery. Acta Anaesthesiol Scand 2003;47:191-9.  Back to cited text no. 29
    
30.Fearon KC, Ljungqvist O, Von Meyenfeldt M, Revhaug A, Dejong CH, Lassen K, et al. Enhanced recovery after surgery: A consensus review of clinical care for patients undergoing colonic resection. Clin Nutr 2005;24:466-77.  Back to cited text no. 30
    
31.Planas M, Peñalva A, Burgos R, Puiggrós C, Pérez-Portabella C, Espín E, et al. Guidelines for colorectal cancer: Effects on nutritional intervention. Clin Nutr 2007;26:691-7.  Back to cited text no. 31
    
32.Horie H, Okada M, Kojima M, Nagai H. Favorable effects of preoperative enteral immunonutrition on a surgical site infection in patients with colorectal cancer without malnutrition. Surg Today 2006;36:1063-8.  Back to cited text no. 32
    
33.Chan MK, Law WL. Use of chewing gum in reducing postoperative ileus after elective colorectal resection: A systematic review.Dis Colon Rectum 2007;50:2149-57.  Back to cited text no. 33
    
34.Lin MT, Saito H, Fukushima R, Inaba T, Fukatsu K, Inoue T, et al. Preoperative total parenteral nutrition influences postoperative systemic cytokine responses after colorectal surgery. Nutrition 1997;13:8-12.  Back to cited text no. 34
    
35.Yeager MP, Glass DD, Neff RK, Brinck-Johnsen T. Epidural anesthesia and analgesia in high-risk surgical patients. Anesthesiology 1987;66:729-36.  Back to cited text no. 35
    
36.Kehlet H, Dahl JB. Anaesthesia, surgery, and challenges in postoperative recovery. Lancet 2003;362:1921-8.  Back to cited text no. 36
    
37.Wu CT, Jao SW, Borel CO, Yeh CC, Li CY, Lu CH, et al. The effect of epidural clonidine on perioperative cytokine response, postoperative pain, and bowel function in patients undergoing colorectal surgery. Anesth Analg 2004;99:502-9.  Back to cited text no. 37
    
38.Wilmore DW, Kehlet H. Management of patients in fast track surgery. BMJ 2001;322:473-6.  Back to cited text no. 38
    
39.Norman JG, Fink GW. The effects of epidural anesthesia on the neuroendocrine response to major surgical stress: A randomized prospective trial. Am Surg 1997;63:75-80.  Back to cited text no. 39
    
40.Catena F, Ansaloni L, Avanzolini A, Di Saverio S, D'Alessandro L, Maldini Casadei M, et al. Systemic cytokine response after emergency and elective surgery for colorectal carcinoma. Int J Colorectal Dis 2009;24:803-9.  Back to cited text no. 40
    
41.Delgado S, Lacy AM, Filella X. Acute phase response in laparoscopic and open colectomy in colon cancer: Randomized study. Dis Colon Rectum 2001;44:638-46.  Back to cited text no. 41
    
42.Miki C, Hiro J, Ojima E, Inoue Y, Mohri Y, Kusunoki M. Perioperative allogeneic blood transfusion, the related cytokine response and long-term survival after potentially curative resection of colorectal cancer. Clin Oncol (R Coll Radiol) 2006;18:60-6.  Back to cited text no. 42
    
43.Koda K, Saito N, Takiguchi N, Oda K, Nunomura M, Nakajima N. Preoperative natural killer cell activity: Correlation with distant metastases in curatively research colorectal carcinomas. Int Surg 1997;82:190-3.  Back to cited text no. 43
    
44.Cahill RA, Redmond HP. Cytokine orchestration in post-operative peritoneal adhesion formation. World J Gastroenterol 2008;14:4861-6.  Back to cited text no. 44
    
45.Evans C, Galustian C, Kumar D, Hagger R, Melville DM, Bodman-Smith M, et al. Impact of surgery on immunologic function: Comparison between minimally invasive techniques and conventional laparotomy for surgical resection ofcolorectal tumors. Am J Surg 2009;197: 238-45.  Back to cited text no. 45
    
46.Schricker T, Lattermann R. Strategies to attenuate catabolic stress response to surgery and improve perioperative outcomes. Can J Anaesth 2007;54:414-9.  Back to cited text no. 46
    
47.Lugli AK, Donatelli F, Schricker T, Kindler C, Wykes L, Carli F. Protein balance in nondiabetic versus diabetic patients undergoing colon surgery: Effect of epidural analgesia and amino acids. Reg Anesth Pain Med 2010;35:355-60.  Back to cited text no. 47
    
48.Tylman M, Sarbinowski R, Bengtson JP, Kvarnström A, Bengtsson A. Inflammatory response in patients undergoing colorectal cancer surgery: The effect of two different anesthetic techniques. Minerva Anestesiol 2011;77:275-82.  Back to cited text no. 48
    
49.Ahlers O, Nachtigall I, Lenze J, Goldmann A, Schulte E, Höhne C, et al. Intraoperative thoracic epidural anaesthesia attenuates stress-induced immunosuppression in patients undergoing major abdominal surgery. Br J Anaesth 2008;101:781-7.  Back to cited text no. 49
    
50.Herroeder S, Pecher S, Schönherr ME, Kaulitz G, Hahnenkamp K, Friess H, et al. Systemic lidocaine shortens length of hospital stay after colorectal surgery: A double-blinded, randomized, placebo-controlled trial. Ann Surg 2007;246:192-200.  Back to cited text no. 50
    
51.Vignali A, Di Palo S, Orsenigo E, Ghirardelli L, Radaelli G, Staudacher C. Effect of prednisolone on local and systemic response in laparoscopic vs. open colon surgery: A randomized, double-blind, placebo-controlled trial. Dis Colon Rectum 2009;52:1080-8.  Back to cited text no. 51
    
52.Zargar-Shoshtari K, Sammour T, Kahokehr A, Connolly AB, Hill AG. Randomized clinical trial of the effect of glucocorticoids on peritoneal inflammation and postoperative recovery after colectomy. Br J Surg 2009;96:1253-61.  Back to cited text no. 52
    
53.Pandazi A, Kapota E, Matsota P, Paraskevopoulou P, Dervenis C, Kostopanagiotou G. Preincisional versus postincisional administration of parecoxib in colorectal surgery: Effect on postoperative pain control and cytokine response. A randomized clinical trial. World J Surg 2010;34:2463-9.  Back to cited text no. 53
    
54.Velickovic I, Yan J, Gross JA. Modifying the neuroendocrine stress response. Semin Anaesth Perioper Med Pain 2002;21:16-25.  Back to cited text no. 54
    
55.Xu Y, Tan Z, Chen J, Lou F, Chen W. Intravenous flurbiprofen axetil accelerates restoration of bowel function after colorectal surgery. Can J Anaesth 2008;55:414-22.  Back to cited text no. 55
    
56.Lu CH, Chao PC, Borel CO, Yang CP, Yeh CC, Wong CS, et al. Preincisional intravenous pentoxifylline attenuating perioperative cytokine response, reducing morphine consumption, and improving recovery of bowel function in patients undergoing colorectal cancer surgery. Anesth Analg 2004;99:1465-71.  Back to cited text no. 56
    
57.Ochmann C, Tuschy B, Beschmann R, Hamm F, Röhm KD, Piper SN. Supplemental oxygen reduces serotonin levels in plasma and platelets during colorectal surgery and reduces postoperative nausea and vomiting. Eur J Anaesthesiol 2010;27:1036-43.  Back to cited text no. 57
    
58.Frank SM, Higgins MS, Breslow MJ, Fleisher LA, Gorman RB, Sitzmann JV, et al. The catecholamine, cortisol, and hemodynamic responses to mild perioperative hypothermia. A randomized clinical trial. Anesthesiology 1995;82:83-93.  Back to cited text no. 58
    
59.Beilin B, Shavit Y, Razumovsky J, Wolloch Y, Zeidel A, Bessler H. Effects of mild perioperative hypothermia on cellular immune responses. Anesthesiology 1998;89:1133-40.  Back to cited text no. 59
    
60.Danelli G, Berti M, Perotti V, Albertin A, Baccari P, Deni F, et al. Temperature control and recovery of bowel function after laparoscopic or laparotomic colorectal surgery in patients receiving combined epidural/general anesthesia and postoperative epidural analgesia. Anesth Analg 2002;95:467-71.  Back to cited text no. 60
    
61.Brill S, Walfisch S. Brachial plexus injury as a complication after colorectal surgery. Tech Coloproctol 2005;9:139-41, 127.  Back to cited text no. 61
    
62.Beraldo S, Dodds SR. Lower limb acute compartment syndrome after colorectal surgery in prolonged lithotomy position. Dis Colon Rectum 2006;49:1772-80.  Back to cited text no. 62
    
63.Rao MM, Jayne D. Lower Limb Compartment Syndrome following Laparoscopic Colorectal Surgery: A Review. Colorectal Dis 2011;13:494-9.  Back to cited text no. 63
    
64.Nishikawa K, Nakayama M, Omote K, Namiki A. Recovery characteristics and post-operative delirium after long-duration laparoscope-assisted surgery in elderly patients: Propofol-based vs. sevoflurane-based anesthesia. Acta Anaesthesiol Scand 2004;48:162-8.  Back to cited text no. 64
    
65.Jensen AG, Kalman SH, Nyström PO, Eintrei C. Anaesthetic technique does not influence postoperative bowel function: A comparison of propofol, nitrous oxide and isoflurane. Can J Anaesth 1992;39:938-43.  Back to cited text no. 65
    
66.Müller M, Schindler E, Roth S, Schürholz A, Vollerthun M, Hempelmann G. Effects of desflurane and isoflurane on intestinal tissue oxygen pressure during colorectal surgery. Anaesthesia 2002;57:110-5.  Back to cited text no. 66
    
67.Vagts DA, Hecker K, Iber T, Roesner JP, Spee A, Otto B, et al. Effects of xenon anaesthesia on intestinal oxygenation in acutely instrumented pigs. Br J Anaesth 2004;93:833-41.  Back to cited text no. 67
    
68.Scheinin B, Lindgren L, Scheinin TM. Peroperative nitrous oxide delays bowel function after colonic surgery. Br J Anaesth 1990;64:154-8.  Back to cited text no. 68
    
69.Krogh B, Jørn Jensen P, Henneberg SW, Hole P, Kronborg O. Nitrous oxide does not influence operating conditions or postoperative course in colonic surgery. Br J Anaesth 1994;72:55-7.  Back to cited text no. 69
    
70.Fleischmann E, Marschalek C, Schlemitz K, Dalton JE, Gruenberger T, Herbst F, et al. Nitrous oxide may not increase the risk of cancer recurrence after colorectal surgery: A follow-up of a randomized controlled trial. BMC Anesthesiol 2009;9:1.  Back to cited text no. 70
    
71.Whitaker BL. Observations of the blood flow in the inferior mesenteric arterial system, and the healing of colonic anastomoses. Ann R Coll Surg Engl 1968;43:89-110.  Back to cited text no. 71
    
72.White PF, Kehlet H. Improving postoperative pain management: What are unresolved issues? Anesth Analg 2010;112:220-5.  Back to cited text no. 72
    
73.Imbelloni LE, Fornasari M, Fialho JC. Combined spinal epidural anesthesia during colon surgery in a high-risk patient: Case report. Rev Bras Anestesiol 2009;59:741-5.  Back to cited text no. 73
    
74.Johansson K, Ahn H, Lindhagen J, Tryselius U. Effect of epidural anaesthesia on intestinal blood flow. Br J Surg 1988;75:73-6.  Back to cited text no. 74
    
75.Gottschalk A, Ford JG, Regelin CC, You J, Mascha EJ, Sessler DI, et al. Association between epidural analgesia and cancer recurrence after colorectal cancer surgery. Anesthesiology 2010;113:27-34.  Back to cited text no. 75
    
76.Aitkenhead AR, Wishart HY, Brown DA. High spinal nerve block for large bowel anastomosis. A retrospective study. Br J Anaesth 1978;50:177-83.  Back to cited text no. 76
    
77.Worsley MH, Wishart HY, Peebles Brown DA, Aitkenhead AR. High spinal nerve block for large bowel anastomosis. A prospective study. Br J Anaesth 1988;60:836-40.  Back to cited text no. 77
    
78.Kumar CM, Corbett WA, Wilson RG. Spinal anaesthesia with a micro-catheter in high-risk patients undergoing colorectal cancer and other major abdominal surgery. Surg Oncol 2008;17:73-9.  Back to cited text no. 78
    
79.Giglio MT, Marucci M, testini M, Brienza N. Goal-directed haemodynamic therapy and gastrointestinal complications in major surgery: A meta-analysis of randomized controlled trials. Br J Anaesth 2009;103:637-46.  Back to cited text no. 79
    
80.Collaborative Study Group on Perioperative ScvO2 Monitoring: Multicentre study on peri- and postoperative central venous oxygen saturation in high-risk surgical patients. Crit Care 2006;10: R158.  Back to cited text no. 80
    
81.Pearse R, Dawson D, Fawcett J, Rhodes A, Grounds RM, Bennett ed.Changes in central venous saturation after major surgery, and association with outcome. Crit Care 2005;9: R694-9.  Back to cited text no. 81
    
82.Davies SJ, Yates D, Wilson RJ. Dopexamine has no additional benefit in high-risk patients receiving goal-directed fluid therapy undergoing major abdominal surgery. Anesth Analg 2011;112:130- 8.  Back to cited text no. 82
    
83.Teeuwen PH, Bleichrodt RP, Strik C, Groenewoud JJ, Brinkert W, van Laarhoven CJ, et al. Enhanced recovery after surgery (ERAS) versus conventional postoperative care in colorectal surgery. J Gastrointest Surg 2010;14:88-95.  Back to cited text no. 83
    
84.Wind J, Polle SW, Fung Kon Jin PH, Dejong CH, von Meyenfeldt MF, Ubbink DT, et al.; Laparoscopy and/or Fast Track Multimodal Management Versus Standard Care (LAFA) Study Group. Enhanced Recovery after Surgery (ERAS) Group Systematic review of enhanced recovery programmes in colonic surgery. Br J Surg 2006;93:800-9.  Back to cited text no. 84
    
85.Kehlet H, Wilmore DW. Multimodal strategies to improve surgical outcome. Am J Surg 2002;183:630-41.  Back to cited text no. 85
    
86.Kehlet H, Büchler MW, Beart Jr RW, Billingham RP, Williamson R. Care after Colonic Operation-Is it Evidence-Based? Results from a Multinational Survey in Europe and the United States. J Am Coll Surg 2006;202:45-54.  Back to cited text no. 86
    
87.Polle SW, Wind J, Fuhring JW, Hofland J, Gouma DJ, Bemelman WA. Implementation of a fast-track perioperative care program: What are the difficulties? Dig Surg 2007;24:441-9.  Back to cited text no. 87
    
88.Jakobsen DH, Sonne E, Andreasen J, Kehlet H. Convalescence after colonic surgery with fast-track versus conventional care. Colorectal Dis 2006;8:683-7.  Back to cited text no. 88
    
89.Lewis SJ, Andersen HK, Thomas S. Early enteral nutrition within 24 h of intestinal surgery versus later commencement of feeding: A systematic review and meta-analysis. J Gastrointest Surg 2009;13:569-75.  Back to cited text no. 89
    
90.Demetriades H, Botsios D, Kazantzidou D, Sakkas L, Tsalis K, Manos K, et al. Effect of early postoperative enteral feeding on the healing of colonic anastomoses in rats. Comparison of three different enteral diets. Eur Surg Res 1999;31:57-63.  Back to cited text no. 90
    
91.Mazaki T, Ebisawa K. Enteral versus parenteral nutrition after gastrointestinal surgery: A systematic review and meta-analysis of randomized controlled trials in the English literature. J Gastrointest Surg 2008;12:739-55.  Back to cited text no. 91
    
92.Carr CS, Ling KD, Boulos P, Singer M. Randomised trial of safety and efficacy of immediate postoperative enteral feeding in patients undergoing gastrointestinal resection. BMJ 1996;312:869-71.  Back to cited text no. 92
    
93.Beier-Holgersen R, Boesby S. Influence of postoperative enteral nutrition on postsurgical infections. Gut 1996;39:833-5.  Back to cited text no. 93
    
94.Soop M, Carlson GL, Hopkinson J, Clarke S, Thorell A, Nygren J, et al. Randomized clinical trial of the effects of immediate enteral nutrition on metabolic responses to major colorectal surgery in an enhanced recovery protocol. Br J Surg 2004;91:1138-45.  Back to cited text no. 94
    
95.Lewis SJ, Egger M, Sylvester PA, Thomas S. Early enteral feeding versus "nil by mouth" after gastrointestinal surgery: Systematic review and meta-analysis of controlled trials. BMJ 2001;323:773-6.  Back to cited text no. 95
    
96.Henriksen MG, Hansen HV, Hessov I. Early oral nutrition after elective colorectal surgery: Influence of balanced analgesia and enforced mobilization. Nutrition 2002;18:263-7.  Back to cited text no. 96
    
97.Holzer P. Opioid antagonists for prevention and treatment of opioid-induced gastrointestinal effects. Curr Opin Anaesthesiol 2010;23:616-22.  Back to cited text no. 97
    
98.Holte K, Andersen J, Jakobsen DH, Kehlet H. Cyclo-oxygenase 2 inhibitors and the risk of anastomotic leakage after fast-track colonic surgery. Br J Surg 2009;96:650-4.  Back to cited text no. 98
    
99.Levy BF, Scott MJ, Fawcett W, Fry C, Rockall TA. Randomized clinical trial of epidural, spinal or patient-controlled analgesia for patients undergoing laparoscopic colorectal surgery. Br J Surg 2011;98:1068-78.  Back to cited text no. 99
    
100.Zingg U, Miscovic D, Hamel CT, Erni L, Oertli D, Metzqer U. Influence of thoracic epidural analgesia on postoperative pain relief and ileus after laparoscopic colorectal resection: Benefit with epidural analgesia. Surg Endosc 2009;23:276-82.  Back to cited text no. 100
    
101.Fotiadis RJ, Badvie S, Weston MD, Allen-Mersh TG. Epidural analgesia in gastrointestinal surgery. Br J Surg 2004;91:828-41.  Back to cited text no. 101
    
102.Clemente A, Carli F. The physiological effects of thoracic epidural anesthesia and analgesia on the cardiovascular, respiratory and gastrointestinal systems. Minerva Anestesiol 2008;74:549-63.  Back to cited text no. 102
    
103.Gendall KA, Kennedy RR, Watson AJ, Frizelle FA. The effect of epidural analgesia on postoperative outcome after colorectal surgery. Colorectal Dis 2007;9:584-98.  Back to cited text no. 103
    
104.Müller M, Schück R, Erkens U, Sticher J, Haase C, Hempelmann G. Effects of lumbar peridural anesthesia on tissue pO2 of the large intestine in man. Anasthesiol Intensivmed Notfallmed Schmerzther 1995;30:108-10.  Back to cited text no. 104
    
105.Carli F, Trudel JL, Belliveau P. The effect of intraoperative thoracic epidural anesthesia and postoperative analgesia on bowel function after colorectal surgery: A prospective, randomized trial. Dis Colon Rectum 2001;44:1083-9.  Back to cited text no. 105
    
106.Carli F, Mayo N, Klubien K, Schricker T, Trudel J, Belliveau P. Epidural analgesia enhances functional exercise capacity and health-related quality of life after colonic surgery: Results of a randomized trial. Anesthesiology 2002;97:540-9.  Back to cited text no. 106
    
107.Liu SS, Carpenter RL, Mackey DC, Thirlby RC, Rupp SM, Shine TS, et al. Effects of perioperative analgesic technique on rate of recovery after colon surgery. Anesthesiology 1995;83:757-65.  Back to cited text no. 107
    
108.Marret E, Remy C, Bonnet F. Meta-analysis of epidural analgesia versus parenteral opioid analgesia after colorectal surgery. Br J Surg 2007;94:665-73.  Back to cited text no. 108
    
109.Kehlet H, Rung GW, Callesen T. Postoperative opioid analgesia: Time for a reconsideration? J Clin Anesth 1996;8:441-5.  Back to cited text no. 109
    
110.Beaussier M, El'Ayoubi H, Schiffer E, Rollin M, Parc Y, Mazoit JX, et al. Continuous preperitoneal infusion of ropivacaine provides effective analgesia and accelerates recovery after colorectal surgery: A randomized, double-blind, placebo-controlled study. Anesthesiology 2007;107:461-8.  Back to cited text no. 110
    
111.Liu SS, Richman JM, Thirlby RC, Wu CL. Efficacy of continuous wound catheters delivering local anesthetic for postoperative analgesia: A quantitative and qualitative systematic review of randomized controlled trials. J Am Coll Surg 2006;203:914-32.  Back to cited text no. 111
    
112.Polglase AL, McMurrick PJ, Simpson PJ, Wale RJ, Carne PW, Johnson W, et al. Continuous wound infusion of local anesthetic for the control of pain after elective abdominal colorectal surgery. Dis Colon Rectum 2007;50:2158-67.  Back to cited text no. 112
    
113.Karthikesalingam A, Walsh SR, Markar SR, Sadat U, Tang TY, Malata CM. Continuous wound infusion of local anaesthetic agents following colorectal surgery: Systematic review and meta-analysis. World J Gastroenterol 2008;14:5301-5.  Back to cited text no. 113
    
114.Beaussier M, El'ayoubi H, Rollin M, Parc Y, Atchabahian A, Chanques G, et al. Parietal analgesia decreases postoperative diaphragm dysfunction induced by abdominal surgery: A physiologic study. Reg Anesth Pain Med. 2009t;34:393-7.  Back to cited text no. 114
    
115.Partridge BL, Stabile BE. The effects of incisional bupivacaine on postoperative narcotic requirements, oxygen saturation and length of stay in the postanesthesia care unit. Acta Anaesthesiol Scand 1990;34:486-91.  Back to cited text no. 115
    
116.Conaghan P, Maxwell-Armstrong C, Bedforth N, Gornall C, Baxendale B, Hong LL, et al. Efficacy of transversus abdominis plane blocks in laparoscopic colorectal resections. Surg Endosc 2010;24:2480-4.  Back to cited text no. 116
    
117.Beaussier M, Weickmans H, Parc Y, Delpierre E, Camus Y, Funck-Brentano C, et al. Postoperative analgesia and recovery course after major colorectal surgery in elderly patients: A randomized comparison between intrathecal morphine and intravenous PCA morphine. Reg Anesth Pain Med 2006;31:531-8.  Back to cited text no. 117
    
118.De Kock M, Lavand'homme P, Waterloos H. The short-lasting analgesia and long-term antihyperalgesic effect of intrathecal clonidine in patients undergoing colonic surgery. Anesth Analg 2005;101:566-72.  Back to cited text no. 118
    
119.Scott NB, James K, Murphy M, Kehlet H. Continuous thoracic epidural analgesia versus combined spinal/thoracic epidural analgesia on pain, pulmonary function and the metabolic response following colonic resection. Acta Anaesthesiol Scand 1996;40:691- 6.  Back to cited text no. 119
    
120.Virlos I, Clements D, Beynon J, Ratnalikar V, Khot U. Short-term outcomes with intrathecal versus epidural analgesia in laparoscopic colorectal surgery. Br J Surg 2010;97:1401-6.  Back to cited text no. 120
    
121.Levy BF, Tilney HS, Dowson HM, Rockall TA. A systematic review of postoperative analgesia following laparoscopic colorectal surgery. Colorectal Dis 2010;12:5-15.  Back to cited text no. 121
    
122.Marret E, Rolin M, Beaussier M, Bonnet F. Meta-analysis of intravenous lidocaine and postoperative recovery after abdominal surgery. Br J Surg 2008;95:1331-8.  Back to cited text no. 122
    
123.Chen JY, Wu GJ, Mok MS, Chou YH, Sun WZ, Chen PL, et al. Effect of adding ketorolac to intravenous morphine patient-controlled analgesia on bowel function in colorectal surgery patients-a prospective, randomized, double-blind study. Acta Anaesthesiol Scand 2005;49:546-51.  Back to cited text no. 123
    
124.Schlachta CM, Burpee SE, Fernandez C, Chan B, Mamazza J, Poulin EC. Optimizing recovery after laparoscopic colon surgery (ORAL-CS): Effect of intravenous ketorolac on length of hospital stay. Surg Endosc 2007;21:2212-9.  Back to cited text no. 124
    
125.Chen JY, Ko TL, Wen YR, Wu SC, Chou YH, Yien HW, et al. Opioid-sparing effects of ketorolac and its correlation with the recovery of postoperative bowel function in colorectal surgery patients: A prospective randomized double-blinded study. Clin J Pain 2009;25:485-9.  Back to cited text no. 125
    


    Figures

  [Figure 1]
 
 
    Tables

  [Table 1]


This article has been cited by
1 Anesthesia and perioperative management of colorectal surgical patients - Specific issues (part 2)
Patel, S. and Lutz, J. and Panchagnula, U. and Bansal, S.
Journal of Anaesthesiology Clinical Pharmacology. 2012; 28(3): 304-313
[Pubmed]



 

Top
 
  Search
 
    Similar in PUBMED
   Search Pubmed for
   Search in Google Scholar for
 Related articles
    Access Statistics
    Email Alert *
    Add to My List *
* Registration required (free)  

 
  In this article
   Abstract
  Introduction
  Conclusion
  Acknowledgment
   References
   Article Figures
   Article Tables

 Article Access Statistics
    Viewed33476    
    Printed267    
    Emailed23    
    PDF Downloaded4675    
    Comments [Add]    
    Cited by others 1    

Recommend this journal