Randomized controlled trial of regional tissue oxygenation following goal-directed fluid therapy during laparoscopic colorectal surgery.

Background: A randomized, double-blinded controlled trial was performed to evaluate how perioperative goal-directed fluid therapy (GDFT) influences tissue oxygenation in laparoscopic colorectal surgery.

Methods: A total of 74 patients undergoing elective laparoscopic colorectal surgery were treated with GDFT (G group) guided by stroke volume variation or conventional fluid therapy (C group). Forearm, crural, and cerebral tissue oxygen saturation (rSO) were simultaneously measured by near-infrared spectroscopy. Parameters of hemodynamics and rSO were obtained at seven time points including before induction of anesthesia (T1), 5 min after trachea cannula (T2), 5, 60, and 120 min after pneumoperitoneum in the Trendeleburg position (T3, T4 and T5, respectively), after desufflation in the Trendeleburg position (T6), and at the end of the operation in a supine position (T7). The postoperative outcomes were recorded.

Results: Compared to C group, intraoperatively, patients in the G group received more colloid (<0.05). The stroke volume variation in G group at T5, T6 and T7 was significantly lower than that in C group (<0.05). The cardiac index, forearm and crural rSO in G group at T4, T5, T6 and T7 were significantly higher than those in C group (<0.05). No significant differences were observed for the cerebral rSO between the two groups ( > 0.05). The postoperative hospital stay and complications also showed no differences between these two groups.

Conclusions: Although the implementation of GDFT cannot increase cerebral rSO, the forearm and crural rSO are improved during the laparoscopic colorectal surgery, which is helpful to reduce the risk of regional tissue hypoxia.