Perioperative splanchnic perfusion variation around colorectal surgery using both indocyanine green spectrophotometry and fluorescence angiography - Scorecard - MDSpire
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Perioperative splanchnic perfusion variation around colorectal surgery using both indocyanine green spectrophotometry and fluorescence angiography
Clinical Scorecard: Variability of Splanchnic Blood Flow During Colorectal Surgery Assessed by Indocyanine Green Spectrophotometry and Fluorescence Angiography
At a Glance
Category
Detail
Condition
Impaired splanchnic and intestinal perfusion during colorectal surgery
Key Mechanisms
Splanchnic shunting, anesthesia effects, sepsis, and pneumoperitoneum affecting gut blood flow; assessment via ICG pharmacokinetics and fluorescence
Target Population
Adult patients undergoing elective colorectal surgery
Care Setting
Perioperative surgical setting including intraoperative and postoperative monitoring
Key Highlights
Splanchnic perfusion variability occurs even with normal systemic blood pressure due to physiological adaptations.
Indocyanine green (ICG) based technologies—peripheral pulse spectrophotometry (PPS) and fluorescence angiography (ICGFA)—enable quantitative and qualitative assessment of splanchnic and intestinal perfusion.
Use of ICGFA intraoperatively is associated with improved anastomotic leakage rates in colorectal surgery.
Guideline-Based Recommendations
Diagnosis
Use ICG-PPS to quantitatively assess hepatosplanchnic perfusion perioperatively via plasma disappearance rate (PDR) and ICG retention at 15 minutes (ICGR15).
Apply ICG fluorescence angiography (ICGFA) intraoperatively for real-time qualitative assessment of intestinal tissue perfusion.
Management
Consider intraoperative ICGFA to guide surgical decisions on intestinal perfusion and potentially reduce anastomotic leakage.
Maintain consistent anesthetic protocols to minimize variability in splanchnic perfusion.
Monitoring & Follow-up
Perform baseline ICG-PPS measurement preoperatively (awake, fasting), intraoperatively after vessel ligation, and postoperatively (day 4) to monitor perfusion changes.
Use simultaneous ICGFA during surgery to visually assess perfusion adequacy.
Risks
Impaired splanchnic perfusion is linked to increased risk of anastomotic leakage and postoperative complications.
Physiological factors such as anesthesia, sepsis, and pneumoperitoneum may unpredictably reduce gut perfusion despite normal systemic blood pressure.
Patient & Prescribing Data
Adults undergoing elective colorectal surgery with major resections classified as proximal or distal based on vessel ligation.
ICG administered intravenously at 0.25 mg/kg for perfusion assessment; repeated dosing allowed pre- and postoperatively but limited intraoperatively to avoid prolonging surgery.
Clinical Best Practices
Standardize anesthetic protocols to reduce variability in splanchnic perfusion assessments.
Use ICG-PPS and ICGFA complementarily to obtain both quantitative and qualitative perfusion data.
Perform intraoperative ICGFA with pneumoperitoneum desufflated and patient in level position for accurate assessment.
Monitor postoperative perfusion changes to identify patients at risk for complications.
Classify surgical resections by vessel ligation site to tailor perfusion assessment and risk stratification.
