Intraoperative anaesthesia, postoperative analgesia and postoperative prevention of nausea and vomiting in case of acute bowel obstruction (clinical lecture)
Keywords:acute bowel obstruction, anaesthetic management, postoperative anaesthesia, balanced crystalloids, nasojejunal and nasogastric tube, drugs that inhibit the regulation of the vomit reflex, prokinetics
The main efforts during anaesthesia for acute bowel obstruction surgery should be aimed at stabilizing the patient’s haemodynamics and compensation of electrolyte disorders that often occur in the preoperative period. Modern devices for monitoring hemodynamics, temperature, respiratory mechanics and gas exchange function should be used extensively. Effective monitoring of these functions and early use of medium doses of vasopressors in arterial hypotension allow stabilizing hemodynamics and limi-ting the volume of intraoperative fluid infusion. The choice of infusion solutions should be goal-directed and selected according to the type of electrolyte disturbances, but balanced crystalloids solutions should be the choice for baseline infusion. The choice for the anaesthetic drugs should be based on the possibility to promptly awake the patient soon after anaesthesia and for early mobilisation. If possible, general anaesthetic techniques should be complemen-ted by regional anaesthesia. The issue of avoiding intraoperative intestinal intubation, as well as early removal of nasojejunal and/or nasogastric tubes in the postoperative period should be discussed together with surgeons. Such a tactic often helps reduce the seve-rity of nausea and accelerate postoperative patients’ rehabilitation. For effective postoperative control of nausea and vomiting in case of bowel obstruction, it is often necessary to use a combination of drugs that reduce gastrointestinal secretion with drugs that inhibit the central regulation of the vomiting reflex in the central nervous system, as well as with prokinetics that improve the evacuation of gastric contents.
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