Improvement of fluid balance in patients undergoing surgery of the colon and rectum.

58 consecutive patients undergoing elective colorectal surgery are divided into two groups. The control group will receive standard care. The intervention group will receive standard care plus hemodynamic optimization based on in- or decrease of cardiac output. Between group differences are measured primarily by Intestinal Fatty Acid Binding Protein (I-FABP) in plasma and urine, an accurate marker of intestinal damage. Secundary outcome variables are plasma levels of CRP, plasma and urinary levels of Liver Fatty Acid Binding Protein (L-FABP, another marker of intestinal damage), and CO2 pressure in the stomach lumen (reflecting intestinal perfusion). We hypothesize that the intervention group will have less intestinal damage, improved intestinal perfusion and improved postoperative recovery compared to the control group.

Hemodynamic optimization during and after colorectal surgery results in improved intestinal perfusion, sustained intestinal barrier and improved postoperative recovery.

1. Preoperative;

2. Every 15 minutes during surgery;

3. Every 60 minutes during the first 12 hours postoperatively;

4. Every 24 hours until discharge from hospital.

Fluid and/or noradrenaline administration based on cardiac output in/decrease and mean arterial pressure.

The control group will receive standard care. The intervention group will receive standard care plus hemodynamic optimization based on in- or decrease of cardiac output.