The patients underwent open colorectal surgery such as anterior rectal resection, colectomy or rectal amputation. In 44 patients, the indication for operation
was rectal cancer, and four patients were operated on owing to inflammatory bowel disease, Crohns disease or ulcerative colitis. Two patients had both inflammatory bowel disease and colorectal cancer. The patients were randomised into two different groups by the use of sealed envelopes. Both groups. Before induction, 1 mg of midazolam (Dormicum®; Roche AB, Stockholm, Sweden) was given intravenously and an arterial line was inserted in the left radial artery for repeated blood analyses and continuous Rucaparib blood pressure monitoring. A thoracic epidural catheter was inserted in the Thoracic VII-XII interval. All patients also received 0.5 mg of atropine (Atropin Merck NM; Merck NM AB, Stockholm, Sweden) before induction of anaesthesia. Before endotracheal
intubation, fentanyl (Leptanal®; Janssen-Cilag AB, Sollentuna, Sweden) and rocuronium (Esmeron®; Organon AB, Göteborg, Sweden) were given in standard doses. A continuous epidural infusion was started during the operation with bupivacain 5 mg/ml (Marcain® adrenalin; AstraZeneca AB, Södertälje, Sweden) and adrenaline 5 μg/ml at an infusion rate selleck of 4–6 ml/h. At the end of the operation, patients were given 5–10 mg of ketobemidon (Ketogan®; Pfizer AB, Sollentuna, Sweden), which is equipotent to 7–15 mg of morphine. Group TIVA. Patients were anaesthetized with total intravenous technique; a combination of propofol (Diprivan®; AstraZeneca AB, Södertälje, Sweden) and remifentanil (Ultiva®; Glaxo Smith Kline AB, Solna, Sweden) was used. Propofol was administered intravenously
Etofibrate with Target-Controlled Infusion (Alaris Diprifusor® IVAC TCI and TIVA; Alaris Medical Systems Ltd, Hampshire, UK). The target concentration during induction was 3 μg/ml. The target concentration was decreased to 2 μg/ml during the operation. Remifentanil was administered as a continuous intravenous infusion. The infusion rate at induction was 0.25 μg/kg/min. The infusion rate was then lowered to 0.15 μg/kg/min during surgery. Group INHALATION. The patients received inhalation anaesthesia with sevoflurane/O2/air. Sevoflurane was used both as induction agent and for maintenance of anaesthesia (VIMA, Volatile Induction and Maintenance of Anaesthesia). Anaesthesia was induced by inhalation of a mixture of sevoflurane/O2/air (Sevorane®; Abbott Scandinavia AB, Solna, Sweden). For maintenance, the end-tidal sevoflurane concentration was kept at 1.4–2.8 vol%. Fentanyl, in repeated intravenous doses of 25–100 μg, was given at the discretion of the anaesthetist. Complement and cytokine measurements. Blood samples were drawn at four times before, during and after surgery. The first sample (T0) was drawn after insertion of the arterial line before induction of anaesthesia.