The effect of anesthetic technique on early postoperative gastric emptying: comparison of propofol-remifentanil and opioid-free sevoflurane anesthesia

Walldén, Jakob; Thörn, Sven‐Egron; Lövqvist, Åsa; Wattwil, L.; Wattwil, Magnus

doi:10.1007/s00540-006-0436-3

Cited by 25 publications

(14 citation statements)

References 28 publications

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“…This was similar to the findings of W. Scott Jellish et al Jacob Wallden et al 18 who conducted a study on comparison of propofol-remifentanil and opioid free sevoflurane on early postoperative gastric emptying concluded that there were no major differences in early postoperative gastric emptying between the groups. Jan Wallenborn et al 19 who conducted a study on the impact of isoflurane, desflurane or sevoflurane on the PONV concluded that type of inhaled agent had no influence of PONV frequency or severity.…”

Section: Discussionsupporting

confidence: 78%

Comparison of Induction, Maintenance and Recovery Characteristics of Sevoflurane - N2o and Propofol - Sevoflurane - N 2o With Propofol - Isoflurane - N2o

M¹,

Shah²

2014

jemds

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BACKGROUND: Rapid redistribution of the intravenous induction agent could lead to lightening of the plane of anesthesia before adequate depth is attained with the inhalational agent. This has promoted the rediscovery of single agent anesthesia, which avoids problems associated with transition phase. The aim of the study was to compare induction, maintenance and recovery with sevoflurane anesthesia from propofol and isoflurane anesthesia when administered with nitrous oxide to patients undergoing laparoscopic surgeries. METHODS: Sixty consenting patients of ASA physical status I or II aged between 20-55yrs of either sex scheduled for elective laparoscopic surgeries were randomly assigned to receive either I propofol for induction of anesthesia and isoflurane-nitrous oxide for maintenance (control), II propofol for induction and sevoflurane-nitrous oxide for maintenance, or III sevoflurane-nitrous oxide for induction and maintenance of anesthesia. Induction, maintenance and recovery characteristics were noted and compared between groups. RESULTS: Inhalational induction with sevoflurane-nitrous oxide was relatively prolonged (106±14s) and smooth without any episodes of coughing or laryngospasm. There were no untoward hemodynamic changes. Post induction mean arterial pressure (MAP) values were less in the groups where propofol was used (77.83±5.29mmHg and 78.96±5.58mm Hg in groups I and II respectively) as compared to the group in which sevoflurane-nitrous oxide was used for induction (83.16±4.70mmHg). Recovery time in the isoflurane-nitrous oxide group was much longer (7:47±0:47minutes) compared to the sevoflurane-nitrous oxide groups (4:41±0:26minutes and 4:37±0:26minutes in groups II and III respectively). STATISTICAL ANALYSIS: Data are expressed as mean ± standard deviation. Data were analyzed using analysis of variance and chi-square test. CONCLUSION: Induction of anesthesia with sevoflurane-nitrous oxide was relatively prolonged without any side effects. Patients were hemodynamically stable throughout in all groups. Emergence and recovery after maintenance with sevoflurane-nitrous oxide was significantly faster than after isoflurane-nitrous oxide anesthesia.

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Section: Discussionsupporting

confidence: 78%

Comparison of Induction, Maintenance and Recovery Characteristics of Sevoflurane - N2o and Propofol - Sevoflurane - N 2o With Propofol - Isoflurane - N2o

M¹,

Shah²

2014

jemds

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“…Irrespective of the use of narcotics, gastric motility is deranged under GA, more so after open cholecystectomy. [1213] This bradygastria and large-volume reflux of noxious bilious duodenal contents can both increase the gastric volume as well as irritability leading to increased incidence of post-operative nausea and vomiting. Further studies estimating the incidence of post operative nausea and vomiting following cholecystectomy and finding out its correlation with gastric pH changes are required to establish this assumption.…”

Section: Discussionmentioning

confidence: 99%

Intra-operative change of gastric pH during laparotomic cholecystectomy under general anaesthesia: A prospective case-control study

et al. 2012

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Background:Gastric decompression by suctioning often shows greenish/greenish-yellow-coloured gastric aspirates following cholecystectomy under general anaesthesia (GA). Possible intraoperative regurgitation of duodenal contents into stomach because of surgical manipulation may be the reason for such alteration in colour of the gastric secretions.Aim:We conducted this study to determine whether there were any pH changes of gastric secretions during laparotomic cholecystectomy operation to confirm our hypothesis of regurgitation of duodenal contents into the stomach.Settings and Designs:Prospective observational controlled study in the Department of Anaesthesiology and Critical Care in a tertiary care university teaching hospital.Methods:Fifty adult ASA I and II patients scheduled for open cholecystectomy operation under GA were included in the study group and another 50 non-abdominal surgical patients without any gall bladder disease were taken as controls. Three to five milliliters of gastric secretions were aspirated just after intubation and also before reversal of residual neuromuscular blockade for analysis of pH.Statistical Analysis:Analysis of variance test and Chi-square test with Fisher's exact correction were used for statistical analysis. Differences were significant when the P value was <0.05.Results:Post-operative values of pH in the study group were significantly higher than their pre-operative values (2.40±1.10 vs. 4.04±1.6, P≤0.001). Forty-nine patients (98%) in the study group had altered coloured post-operative gastric aspirations, while no patient in the control group had such changes (P<0.001).Conclusions:A significant change in gastric pH takes place during laparotomic cholecystectomy due to reflux of duodenal content into the stomach.

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“…All types of anaesthesia may cause delayed gastric emptying and alteration of bowel motility, 16 which has also been separately shown for TIVA with propofol and remifentanil in humans. 17 This may lead to a delayed absorption of orally administered medications and an alteration of their bioavailability. 16,17 The major limitation of our study is, thus, its retrospective character and the relatively small sample size, which hampers the assessment of the impact of the perioperative procedures (surgery, anaesthesia, postoperative medication) on the serum levels of LTG.…”

Section: Discussionmentioning

confidence: 99%

“…17 This may lead to a delayed absorption of orally administered medications and an alteration of their bioavailability. 16,17 The major limitation of our study is, thus, its retrospective character and the relatively small sample size, which hampers the assessment of the impact of the perioperative procedures (surgery, anaesthesia, postoperative medication) on the serum levels of LTG. However, as our knowledge of perioperative fluctuations in AED serum levels is exiguous, this work alerts us to the relevance of decreased AED serum levels as a factor contributing to early postoperative seizures.…”

Section: Discussionmentioning

confidence: 99%

Perioperative fluctuations of lamotrigine serum levels in patients undergoing epilepsy surgery

Paul

Veauthier

Fritz

et al. 2007

Seizure

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Reductions in LTG serum levels are a relevant contributing factor for early postoperative seizures. Postoperative alteration of the gastrointestinal motility and transient time leading to delayed absorption and reduced bioavailability of AED may be a major risk factor. Therefore, close monitoring of postoperative LTG serum levels is necessary and should lead to a temporary dose augmentation and/or anticonvulsant co-medication with benzodiazepines in case of a pronounced reduction of serum levels.

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The effect of anesthetic technique on early postoperative gastric emptying: comparison of propofol-remifentanil and opioid-free sevoflurane anesthesia

Cited by 25 publications

References 28 publications

Comparison of Induction, Maintenance and Recovery Characteristics of Sevoflurane - N2o and Propofol - Sevoflurane - N 2o With Propofol - Isoflurane - N2o

Comparison of Induction, Maintenance and Recovery Characteristics of Sevoflurane - N2o and Propofol - Sevoflurane - N 2o With Propofol - Isoflurane - N2o

Intra-operative change of gastric pH during laparotomic cholecystectomy under general anaesthesia: A prospective case-control study

Perioperative fluctuations of lamotrigine serum levels in patients undergoing epilepsy surgery

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