Anaesthetic Problems of Intestinal Obstruction in Adults

Abstract

The problems of anaesthetizing ill patients with intestinal obstruction arise from the possibility of aspirating stomach contents, and from attempts to produce adequate abdominal muscular relaxation. The hazards and mechanisms of both vomiting and regurgitation are discussed in detail. On this basis, the rationale of preventing aspiration is described. For the production of adequate abdominal relaxation, the muscle relaxants appear to be the method of choice, despite occasional abnormal responses in these patients. The nature of these responses and methods of rendering them even less common are discussed in detail. PRE-OPERATIVE PROBLEMS Fluid and electrolyte loss. Normally, about 8 litres of digestive juices are secreted every 24 hours, most of which is reabsorbed in the colon. If there is an obstruction proximal to the colon, large volumes of gas (mainly nitrogen) and fluid accumulate above it. Small bowel obstruction presents a more urgent problem than large bowel obstruction because the

Bag-Mask Ventilation during Tracheal Intubation of Critically Ill Adults

“…11,12,29,30 However, previous studies that have evaluated aspiration during bag-mask ventilation have been limited to the examination of anesthetized healthy volunteers, have used epigastric auscultation to detect gastric insufflation as a surrogate for aspiration, and have reported conflicting results. 14,31–36 Given the low incidence of operator-reported aspiration during tracheal intubation of critically ill adults, 7,37,38 determining whether bag-mask ventilation increases the relative risk of aspiration by 50% would require a trial enrolling approximately 4000 patients. However, our trial provides some reassurance, since the incidence of operator-reported aspiration was numerically lower in the bag-mask ventilation group than in the no-ventilation group.…”

The Anaesthetic Management of a Patient with a Broncho-Pleural Fistula and Intestinal Obstruction

“…Normally this hazard is prevented by preoxygenation, rapid intravenous induction with a barbiturate and intubation during cricoid pressure. 2 In the circumstances we judged that rapid induction with a barbiturate in the semirecumbent position would have resulted in postural hypotension. 3 Whilst this could have been avoided by the use of intravenous ketamine, two other problems would have remained.…”

Emergency tracheal intubation in patients with COVID-19: is it any different? Comment on Br J Anaesth 2020; 125: e28–e37

“…4,5 Wylie 6 proposed the concept of 'not inflating' the patient's lungs with oxygen until tracheal intubation had been accomplished in 1963. This view was subsequently reinforced by Stevens 7 in 1964. Both these authors hypothesised that positive pressure ventilation before intubation increases the risk of gastric inflation and the potential for regurgitation.…”

“…Both these authors hypothesised that positive pressure ventilation before intubation increases the risk of gastric inflation and the potential for regurgitation. 6,7 Incorporation of these changes into practice led to the origin of the concept of 'modified' RSI. Thus, we believe that the authors performed 'traditional' RSI and not the 'modified' RSI technique.…”