Major abdominal surgery and complications: is air gastric tonometry predictive of outcome?

Introduction

Gut mucosal ischemia can initiate a systemic inflammatory response sometimes leading to multiple organ failure. The adequacy of splanchnic perfusion during major abdominal surgery can be evaluated by an easy, non invasive, new method: gastric air tonometry. Air tonometry is an important technical advance which eliminates errors involved in saline tonometry.

The aim of our study was to investigate wether there was a relationship between a perioperative tonometric parameter and clinical outcome.

Methods

27 patients, ASA 1–3, admitted for major abdominal surgery (hepatectomy, pancreatoduodenectomy, colorectal resection) were prospectively studied between March 98 and October 98. After induction of anesthesia, intramucosal PCO₂ (PrCO₂) was measured by a gastric tonometer placed in the stomach and then connected to a TONOCAP^® (Tonometrics-Datex-Engstrom). PCO₂ gap was measured immediately after tracheal intubation and until discharge of the SICU at H24 postoperatively. Post operative complications were recorded during the entire hospital stay. Statistical analysis used FISCHER's Exact Test.

Results

19 out of 27 patients suffered complications (bleeding, SIRS, sepsis, MOF, pancreatitis, wound infection, hepatic failure, anastomotic leakage) leading to death for two of them. Fifteen out of these 19 patients had a PCO gap >15 mmHg during surgery. The FISCHER's Exact Test (P < 0.002) was conclusive for both group. According to these results, PCO₂ gap can predict complications with a sensibility of 78.5% and a specificity of 88%.

Conclusion

During abdominal surgery, the assessment of splanchnic perfusion can he easily achieved with air tometry; a PCO₂ gap >15 mmHg seems to be predictive of postoperative complications.

Table 1 Statistical analysis used FISCHER’s Exact Test