Randomized clinical trial to evaluate the effects of perioperative supplemental oxygen administration on the colorectal anastomosis

• Published in: British journal of surgery Vol. 93; no. 6; pp. 698 - 706
• Main Authors: García-Botello, S. A., García-Granero, E., Lillo, R., López-Mozos, F., Millán, M., Lledó, S.
• Format: Journal Article
• Language: English
• Published: Chichester, UK John Wiley & Sons, Ltd 01.06.2006; Wiley
• Subjects: Adult; Aged; Aged, 80 and over; Anastomosis, Surgical - methods; Biological and medical sciences; Blood Gas Monitoring, Transcutaneous; Colorectal Neoplasms - surgery; Female; General aspects; Humans; Hydrogen-Ion Concentration - drug effects; Male; Medical sciences; Middle Aged; Oxygen Inhalation Therapy - methods; Perioperative Care - methods; Prospective Studies; Stomach, duodenum, intestine, rectum, anus; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Surgery of the digestive system; Treatment Outcome; Wound Healing - drug effects; Medicine; Perioperative; Oxygen; Randomization; Treatment; Colorectal anastomosis; Surgery; Clinical trial; Supplementation
• ISSN: 0007-1323; 1365-2168
• DOI: 10.1002/bjs.5370

Background: Perioperative supplemental oxygen therapy may have beneficial effects on wound healing following colorectal surgery. The aim of this study was to evaluate the effects of such therapy on colorectal anastomotic pH and partial pressure of carbon dioxide (PCO2) gap. Methods: Forty‐five patients undergoing anterior resection for rectal or sigmoid cancer were randomized to receive 30 or 80 per cent perioperative oxygen. Administration was commenced after induction of anaesthesia and maintained for 6 h after surgery. Intragastric and anastomotic tonometric catheters were placed in each patient and intramucosal pH (pHi) was measured immediately after operation, and 6 and 24 h later. Gastric and anastomotic pHi and PCO2 gap in each group were compared. Results: There was a significantly lower anastomotic pHi and wider PCO2 gap for gastric readings in the 30 per cent O2 group, both 30 min (pHi, P = 0·006; PCO2 gap, P = 0·006) and 6 h (pHi, P = 0·024; PCO2 gap, P = 0·036) after surgery. There were no differences 24 h after surgery while breathing room air (pHi, P = 0·131; PCO2 gap P = 0·139). No difference was found between gastric and anastomotic readings at any time point in the 80 per cent O2 group. Conclusion: Perioperative administration of 80 per cent O2 both during surgery and for 6 hours afterwards is associated with an improvement in relative anastomotic hypoperfusion as assessed by the measurement of pHi and PCO2 gap. Copyright © 2006 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd. Perioperative supplemental oxygen has benefits