Anesthetic Routines: The Anesthesiologist's Role in GI Recovery and Postoperative Ileus

Abstract

All patients undergoing bowel resection experience postoperative ileus, a transient cessation of bowel motility that prevents effective transit of intestinal contents or tolerance of oral intake, to varying degrees. An anesthesiologist plays a critical role, not only in the initiation of surgical anesthesia, but also with the selection and transition to effective postoperative analgesia regimens. Attempts to reduce the duration of postoperative ileus have prompted the study of various preoperative, perioperative, and postoperative regimens to facilitate gastrointestinal recovery. These include modifiable variables such as epidural anesthesia and analgesia, opioid-sparing anesthesia and analgesia, fluid restriction, colloid versus crystalloid combinations, prokinetic drugs, and use of the new peripherally acting mu-opioid receptor (PAM-OR) antagonists. Review and appropriate adaptation of these multiple modifiable interventions by anesthesiologists and their surgical colleagues will facilitate implementation of a best-practice management routine for bowel resection procedures that will benefit the patient and the healthcare system.

Effect of bed exercises and gum chewing on abdominal sounds, flatulence and early discharge in the early period after caesarean section

“…It is indicated in literature that the type of anaesthesia used during the operation is effective in the recovery time of intestine functions and the duration of hospital discharge. Compared to general anaesthesia, patients who undergo operations with local anaesthesia are observed to have intestine functions starting earlier and be discharged from hospital sooner after operation (Leslie et al 2010). Results of this study support this finding.…”

“…Compared to general anaesthesia, patients who undergo operations with local anaesthesia are observed to have intestine functions starting earlier and be discharged from hospital sooner after operation (Leslie et al . ). Results of this study support this finding.…”

Analgesic Opioid Dose Is an Important Indicator of Postoperative Ileus Following Radical Cystectomy with Ileal Conduit: Experience in the Robotic Surgery Era

“…The etiology of POI is complex. It is primarily associated with surgical stress, as it is an acute inflammatory response to manipulation of the bowel during surgery wherein endogenous opioids are secreted through the gastrointestinal (GI) tract in response to surgical trauma 7. Recent advancements in anaesthetic and surgical techniques have led to substantial reductions in convalescence and LOS after major GI surgeries.…”

“…Opioid-based analgesia is currently the standard of care for the management of perioperative pain after major bowel surgeries due to their strong analgesic effect. At the same time, however, opioids act on peripheral µ-opioid receptors in the GI tract, resulting in disruptions of the migrating motor complex and propulsive motor activity associated with GI motility, thereby exacerbating POI 2,7. The exacerbation of bowel dysfunction is one of the most distressing side effects of opioids, which restricts their use.…”

The Efficacy of Peripheral Opioid Antagonists in Opioid-Induced Constipation and Postoperative Ileus

“…A standard POI definition does not exist in the literature, but the authors of 1 review suggest that it is "an abnormal pattern of gastrointestinal motility, most frequently occurring after abdominal surgery" and encompasses the "interval from surgery until passage of flatus/stool and tolerance of an oral diet." 5 Postoperative ileus has a multifactorial etiology that is shared with OIC, including the surgical stress response, 6,7 the inflammatory response that accompanies bowel manipulation, [6][7][8] and opioids that are both endogenously released by the gastrointestinal (GI) tract 7 and given by clinicians for intraoperative and postoperative analgesia. 9 Most importantly, POI can be a driver of poor patient satisfaction, increase hospital length of stay, and increase overall hospital costs.…”