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Perioperative fluid therapy and associated outcomes of patients undergoing major elective open gastrointestinal surgery are poorly understood. This study measured perioperative fluid therapy, complication rates and outcomes for major elective open gastrointestinal surgery in a tertiary care hospital. We obtained demographic data, operative details, fluid prescription, complications and outcomes in 100 patients. Patients were elderly and had multiple comorbidities. Median delivered intraoperative fluid volume was 4.2 litres, followed by 6.3 litres over the subsequent 24 hours. Perioperative fluid prescription was associated with a positive fluid balance. Complications occurred in 57% of patients with 32% experiencing at least one major complication. Serious complications were substantially more frequent in patients having non-colorectal operations. The most common adverse events were pulmonary oedema (21%), ileus (18%), serious sepsis (17%), pneumonia (17%), arrhythmias (14%), delirium (14%) and wound healing problems (infections 13%, anastomotic leaks 12%). Mortality at 30 days was 2%. This study provides planning data for future interventional studies. [ABSTRACT FROM AUTHOR]

The use of extracorporeal membrane oxygenation (ECMO) for elective thoracic surgical procedures has been infrequently reported in the anaesthetic literature. We report the use of intraoperative veno-venous ECMO support for a patient with a previous left pneumonectomy who required a right-sided thoracotomy for repair of a tracheo-oesophageal fistula. To avoid traumatising or pressurising the fistula, a spontaneous ventilation technique was used prior to intubation with a single-lumen endotracheal tube positioned above the level of the fistula. The ECMO cannulas were inserted after induction and ECMO was instituted prior to transfer to the lateral position. Oxygenation during ECMO was augmented with apnoeic oxygen delivery via the breathing circuit. This was associated with an increase in the oxygen saturations from 80% to 99% without compromising surgical access. The use of apnoeic oxygenation via the breathing circuit significantly improved gas exchange in this case and should be considered as an adjunct to veno-venous ECMO. [ABSTRACT FROM AUTHOR]