Colorectal Surgery: What does the anesthesia provider need to know?
Educational content from recorded physician discussions — not medical advice. Talk to your (or your child's) care team about your situation.
Podcast
Cloaca Management with Dr. Marc Levitt & Dr. Aaron Garrison
43 min · Published Dec 2016
Podcast
Anorectal Malformations Complications
Marc Levitt · 48 min · Published Feb 2016
Video
Error Traps and Culture of Safety in Hirschsprung Disease
CCHMC Pediatric Surgery · Published Oct 2019
Podcast
Anorectal Malformations Complications
Marc Levitt · 48 min · Published Feb 2016
Video
Hirschsprung Disease: Surgical Procedures
128 min · Published Feb 2015
Podcast
Update Course Rewind: Pediatric Colorectal Consortium 2021
14 min · Published Apr 2022
Video
Posterior Rectal Advancement Anoplasty (PRAA) in a male with an anorectal malformation and rectoperineal fistula
9 min · Published Mar 2026
Video
Sphincter Reconstruction in a patient who suffered from Fournier’s gangrene
5 min · Published Mar 2026
Video
Total colonic Hirschsprung disease: Ileostomy take down and ileoanal pull-through
9 min · Published Mar 2026
Podcast
Colorectal Quiz: Episode 50 - 16th Annual European Pediatric Colorectal and Pelvic Reconstruction Conference, Stockholm, Sweden, October 2025 - What did we learn?
24 min · Published Mar 2026
Video
Turnbull Stoma
4 min · Published Feb 2026
Video
Rectal Atresia - a Unique Anorectal Malformation
4 min · Published Oct 2025
What the experts said
Associated malformations in colorectal patients affect airway and cardiac systems, relevant to anesthesia choices
Electrical stimulation is used to identify the ideal sphincteric ellipse for anus placement
Neuromuscular blockade prevents visualization of muscle contractions during sphincter mapping
Neuromuscular blockade should be avoided at the beginning of cases requiring sphincter mapping
Neuromuscular blockade can be administered after sphincter marking is complete
Patients with existing anus (Hirschsprung's, fecal incontinence with Malone) do not require sphincter mapping, so neuromuscular blockade is acceptable
Prone position provides better access to the pelvis for colorectal surgery
Alberto Pena introduced the posterior sagittal approach to the rectum in 1980
Prone positioning allows three surgeons to visualize the field well, compared to one in supine perineal approach
Lower extremity IV access is acceptable with sterile tubing across the drape
Baseline hematocrit is important for long cases to monitor for blood loss
Transfusion is rare in colorectal cases, occurring approximately once or twice per year
Hyperviscosity should be avoided because reconstructed tissues are based on single blood vessels
Some colorectal reconstructions are analogous to free flap cases, with tissue moved based on a single vessel
Bowel prep causes dehydration requiring fluid catch-up
When the bladder is open during surgery, urine output cannot be monitored for approximately 6 hours
Cloaca repair can range from 3 to 8 hours depending on complexity
Regional pain management has significantly reduced ICU utilization at this institution
Rapid responses for pain and respiratory issues at night were common at previous institution but are rare at current institution
Leaving patients intubated overnight can prevent midnight pain crises on the floor
Dopamine is less vasoconstrictive than norepinephrine
Vasoconstrictive medications can cause loss of pedicled grafts
Transverse incisions are more painful than vertical incisions
Oral narcotics should be delayed until patient is on regular diet to avoid diagnostic confusion from nausea
Many colorectal patients have single kidneys but normal renal function
NSAIDs are effective for pain management and avoid narcotics
Norepinephrine and epinephrine are associated with vasoconstriction of small vessels in pedicled tissue situations
At previous institution, cases longer than 6 hours routinely went to ICU
In the last 6 months, only 1-2 patients required ICU admission
A 16-hour case required ICU admission for both pain and fluid management
Joint cases with urology and robotic cases can take 8-10 hours
Better regional care is the major factor in reduced ICU utilization
Pain management is the main issue determining ICU need, not blood pressure
Patient referral to surgery typically takes 3-4 months for paperwork, insurance, and planning
Colorectal reconstructions are not urgent because patients are safe with diverting ostomies
Reconstruction can take place anytime within the first year of life as long as colostomy and urinary drainage are functioning
Ideal timeline is newborn colostomy, reconstruction at 2-6 months, colostomy closure thereafter, all completed by 1 year
Two years after reconstruction allows time for potty training assessment before nursery school
Overhydration causes dilated bowel that is difficult to close
Current institution has not experienced bowel edema from overhydration