Change of Post-anesthetic Recovery Time after Colorectal Surgery with N-acetyl-cysteine Infusion

Abstract

Background: The gut is an important area for inflammatory responses. Gut manipulation during open laparotomy compared with laparoscopic surgery, increases the inflammatory responses. Laparoscopic assisted colectomy (LC) with less bowel manipulation might minimize the inflammatory responses and oxidative stress, and offer a faster postanesthetic recovery than an open colectomy (OC). This study evaluated the effect of N-acetyl-cysteine (NAC), an antioxidant, on the recovery after colectomy. Methods: 116 colorectal tumor patients were reviewed retrospectively. The patients were divided into 3 groups; LC by surgeon A (A－L), OC by surgeon A (A－O) and OC by surgeon B (B－O). The postanesthetic recovery scores (PARS) were compared. In the prospective randomized controlled trial, the colorectal tumor patients were assigned to one of four groups; laparoscopic assisted colectomy (L － N) with NAC infusion (L + N), open colectomy (O-N) with NAC infusion (O + N). In the NAC groups, NAC (5 mg/kg/h) was infused after intubation to extubation. The PARS were compared. Results: In the retrospective study, the time to reach 10 points, which satisfies the discharge criteria in the PACU, was significantly lower in the A－L group than in the other groups. In the prospective study, the time to 10 points was shorter in the O + N group than in the O－N group. NAC offered no added benefits to the L + N and L－N groups. Conclusions: NAC offered faster recovery in the OC group but not in the LC group.