Anesthesia Management and Recovery after Laparoscopic Colorectal Surgery

Open abdominal procedures are associated with high levels of postoperative surgical stress that can impede recovery of physiological functions. Trauma resulting from aggressive manipulation of organs, and especially the intestine, can increase postoperative complications and result in delay in normal recovery. In an attempt to minimize complications and overall duration of hospital stay, fast track strategies, called “early recovery after surgery” (ERAS) protocols, have been adopted. Laparoscopic surgery has recently been identified as a major component of rapid recovery. One of the key differences between the open and the laparoscopic approach is the use of pneumoperitoneum for organ exposure during laparoscopy. Prolonged increase in abdominal pressure in addition to patient positioning can have a profound effect on hemodynamic parameters such as central venous pressure (CVP), cardiac output and intracranial pressure. Modifications in fluid administration, the choice of anesthetic agent and the depth of neuromuscular blockade are indicated to accommodate to the conditions imposed by pneumoperitoneum. Postoperatively, laparoscopic surgery is usually associated with less aggressive analgesia management. Based on ERAS protocols, patients are encouraged to initiate early oral feeding and to resume physical activity as soon as possible after abdominal surgery. While laparoscopic abdominal surgery is associated with reduced needs for pain medication, there appear to be no significant differences in early enteral feeding and mobilization between laparoscopic procedures and open surgery. When all factors are taken into consideration, however, laparoscopic colorectal surgery is associated with significant reduction in the duration of the total hospital stay, and is therefore recommended whenever feasible.