Anesthesia in GI Patients Flashcards
anticholinergic drugs
atropine
glycopyrrolate
indications for anticholinergics
- sinus bradycardia
- vagally mediated 1st and 2nd degree AV block
GI side effects of anticholinergics
reduced secretions
decreased GI motility
decreased LES tone
increased gastric pH
H2 blocker drugs
famotidine
indications for H2 blockers
used with H1 blockers in patients with MCTs
GI side effects of H2 blockers
decrease gastric acid secretion
increase gastric pH
proton pump inhibitor drugs
pantoprazole
omeprazole
indications for PPI
prevent esophagitis in patients at risk of GER or regurgitation
decrease severity of aspiration pneumonia
GI side effects of PPIs
decrease gastric acid secretion
increase gastric pH
what antiemetic drug is used most commonly with anesthesia
maropitant
reduces opioid induced emesis
indications for opioids
sedation - premed
analgesia
GI effects of opioids
decreased GI motility
initial vomiting followed by antiemetic properties
decreased LES tone
increased risk of regurg
GI effects of acepromazine
antiemetic
delays gastric emptying
decreased GI motility
decreased LES tone
increased risk of regurg
GI effects of dexmedetomidine
vomiting (cats)
decreased LES tone
increased risk of regurg
decreased GI motility
GI effects of benzodiazepines
MINIMAL GI EFFECTS
decrease LES tone
increased risk of regurg
GI effects of propofol
antiemetic
decreased gastric empting/GI motility
GI effects of alfaxalone
decreased LES tone
GI effects of ketamine
MINIMAL GI EFFECTS
decreases GI motility
GI effects of inhalants
decreased LES tone
increased risk of regurg
decreased GI motility
3 anesthetic considerations for vomiting patients
- head position down
- suction mouth prior to intubation
- rapid induction
3 anesthetic considerations for regurgitating patients
- head position upward
- suction mouth prior to intubation and extubation
- rapid induction
where do refluxed contents go in patients with gastroesophageal reflux
nose
esp. brachycephalics
what are risk factors for GER during surgery
- age (older > younger)
- abdominal procedures
- long pre-op fasting period
- drugs - phenothiazines, atropine, morphine
do position and type of inhalant used affect GER
NO
what medications can be used to reduce the risk of GER
high dose metoclopramide CRI
OR
cisapride
what drugs should not be used for induction when a rapid induction is required
inhalants or opioids
what complications can occur from vomiting, regurgitation, or reflux under anesthesia
esophagitis
aspiration pneumonia
how to prevent esophagitis under anesthesia
suction frequently
lavage esophagus with high volume saline
can add bicarbonate to lavage fluid
what factors increase risk of developing aspiration pneumonia
- hydromorphone
- history of regurgitation
- surgery type
- megaesophagus
- history of neuro or respiratory disease
what is the goal in order to prevent postoperative ileus
maintain intestinal oxygenation and blood flow
steps of ileus prevention
- perioperative analgesia - limit opioid use while still providing good analgesia
- surgical technique - minimize handling of intestines
- postoperative care - get patient eating and walking quickly, use laxatives, peripheral opioid antagonists, prokinetics
components of an anesthesia anticipated problem list
- anesthesia related problems
- procedure related problems
- disease related problems
anesthesia related problems
hypotension
hypoventilation
hypothermia
+/- bradycardia
procedure related problems
pain
bleeding
stomach distention
esophagitis
disease related problems
vomiting
regurgitation
electrolyte imbalances
esophageal perforation
