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Questions and Answers
What is the effect of high sympathetic stimulation on GI tract activity?
What is the effect of high sympathetic stimulation on GI tract activity?
- It is still unknown
- It inhibits GI tract activity (correct)
- It increases GI tract activity
- It has no effect on GI tract activity
Why are patients often given premedication with a benzodiazepine, such as midazolam, before surgery?
Why are patients often given premedication with a benzodiazepine, such as midazolam, before surgery?
- To reduce anxiety and enhance the effect of GABA on GABA-A receptors (correct)
- To increase sympathetic stimulation
- To inhibit the effect of GABA on GABA-A receptors
- To enhance the effect of norepinephrine
What is the effect of midazolam on the migrating motor complex (MMC) in the duodenum?
What is the effect of midazolam on the migrating motor complex (MMC) in the duodenum?
- It eliminates the MMC
- It increases the duration of phase III of the MMC
- It decreases the duration of phase III of the MMC
- shortened the MMC (correct)
What is the relationship between anxiety and GI tract activity?
What is the relationship between anxiety and GI tract activity?
What is one possible explanation for the change in MMC activity caused by midazolam?
What is one possible explanation for the change in MMC activity caused by midazolam?
What is the consequence of reduced anxiety on GI tract activity?
What is the consequence of reduced anxiety on GI tract activity?
What is the order of recovery of bowel function after administration of volatile anesthetics?
What is the order of recovery of bowel function after administration of volatile anesthetics?
Which of the following volatile anesthetics is associated with greater sympathetic activation during rapid increases in concentration?
Which of the following volatile anesthetics is associated with greater sympathetic activation during rapid increases in concentration?
What is the effect of volatiles on splanchnic circulation and oxygenation?
What is the effect of volatiles on splanchnic circulation and oxygenation?
What is the duration of the effect of rapid increases in desflurane concentration on sympathetic and renin-angiotensin system activity?
What is the duration of the effect of rapid increases in desflurane concentration on sympathetic and renin-angiotensin system activity?
What is the primary mechanism by which volatile anesthetics affect bowel function?
What is the primary mechanism by which volatile anesthetics affect bowel function?
What is the comparison between desflurane and isoflurane in terms of effects on sympathetic and renin-angiotensin system activity?
What is the comparison between desflurane and isoflurane in terms of effects on sympathetic and renin-angiotensin system activity?
What is the effect of volatile anesthetics on spontaneous activity?
What is the effect of volatile anesthetics on spontaneous activity?
Which of the following is true about the effects of desflurane, isoflurane, and sevoflurane on bowel function?
Which of the following is true about the effects of desflurane, isoflurane, and sevoflurane on bowel function?
What is the relationship between adverse GI effects and the use of volatile anesthetics?
What is the relationship between adverse GI effects and the use of volatile anesthetics?
during periods of ischemia for resection and anastomosis, reactive hyperemia was better preserved in the patients given?
during periods of ischemia for resection and anastomosis, reactive hyperemia was better preserved in the patients given?
What is the effect of TIVA on intestinal motility as compared to sevoflurane-remifentanil?
What is the effect of TIVA on intestinal motility as compared to sevoflurane-remifentanil?
What was the outcome of a study comparing bowel recovery after open procedures using different anesthetics?
What was the outcome of a study comparing bowel recovery after open procedures using different anesthetics?
What was the difference in inflammatory response among patients receiving TIVA or inhalational anesthesia with sevoflurane and fentanyl in colorectal cancer patients?
What was the difference in inflammatory response among patients receiving TIVA or inhalational anesthesia with sevoflurane and fentanyl in colorectal cancer patients?
What was the outcome of using TIVA (propofol-remifentanil) compared to sevoflurane-remifentanil in terms of surgeon satisfaction?
What was the outcome of using TIVA (propofol-remifentanil) compared to sevoflurane-remifentanil in terms of surgeon satisfaction?
What is the primary reason nitrous oxide causes bowel distention?
What is the primary reason nitrous oxide causes bowel distention?
What is the correlation between gut distention and the use of nitrous oxide?
What is the correlation between gut distention and the use of nitrous oxide?
What is the recommended approach when performing lengthy abdominal surgeries?
What is the recommended approach when performing lengthy abdominal surgeries?
What was the outcome of the ENIGMA trial regarding the use of nitrous oxide?
What was the outcome of the ENIGMA trial regarding the use of nitrous oxide?
What is the primary reason for avoiding nitrous oxide in certain surgeries?
What is the primary reason for avoiding nitrous oxide in certain surgeries?
What is the potential consequence of the increased intragastric pressure caused by succinylcholine?
What is the potential consequence of the increased intragastric pressure caused by succinylcholine?
What factors should be considered when assessing the risk of aspiration with succinylcholine?
What factors should be considered when assessing the risk of aspiration with succinylcholine?
What is the effect of neuromuscular blocking drugs on GI motility?
What is the effect of neuromuscular blocking drugs on GI motility?
What is the effect of neostigmine on bowel anastomoses?
What is the effect of neostigmine on bowel anastomoses?
Why is sugammadex a more prudent choice for reversal in situations of tenuous bowel anastomoses?
Why is sugammadex a more prudent choice for reversal in situations of tenuous bowel anastomoses?
What is the goal of anesthetic care in surgical procedures on the GI tract?
What is the goal of anesthetic care in surgical procedures on the GI tract?
What is the potential benefit of using neostigmine in treating postoperative ileus?
What is the potential benefit of using neostigmine in treating postoperative ileus?
What is the purpose of administering anticholinergic medications, such as glycopyrrolate or atropine, with neostigmine?
What is the purpose of administering anticholinergic medications, such as glycopyrrolate or atropine, with neostigmine?
What is the potential adverse effect of using neostigmine in treating postoperative ileus?
What is the potential adverse effect of using neostigmine in treating postoperative ileus?
What is the primary effect of opioids on the myenteric plexus in the GI tract?
What is the primary effect of opioids on the myenteric plexus in the GI tract?
What is the result of the decreased secretion of acetylcholine and increased release of nitrous oxide in the GI tract?
What is the result of the decreased secretion of acetylcholine and increased release of nitrous oxide in the GI tract?
What is the effect of opioid activation on the submucosal plexus?
What is the effect of opioid activation on the submucosal plexus?
What is the consequence of the combined effects of opioids on the myenteric and submucosal plexuses?
What is the consequence of the combined effects of opioids on the myenteric and submucosal plexuses?
What is the mechanism by which opioids reduce GI motility?
What is the mechanism by which opioids reduce GI motility?
What is the effect of opioids on the ileocecal valve and internal anal sphincters?
What is the effect of opioids on the ileocecal valve and internal anal sphincters?
What is the effect of naloxone on the gut motility inhibition caused by opioids?
What is the effect of naloxone on the gut motility inhibition caused by opioids?
What is the advantage of methylnaltrexone over naloxone?
What is the advantage of methylnaltrexone over naloxone?
What is the result of using metoclopramide, neostigmine, and other prokinetic agents in treating opioid-induced constipation?
What is the result of using metoclopramide, neostigmine, and other prokinetic agents in treating opioid-induced constipation?
What is the potential benefit of switching from one opioid to another in treating opioid-induced constipation?
What is the potential benefit of switching from one opioid to another in treating opioid-induced constipation?
What is the result of combining opioids with enteral opioid receptor antagonists in treating opioid-induced constipation?
What is the result of combining opioids with enteral opioid receptor antagonists in treating opioid-induced constipation?
What is the limitation of methylnaltrexone and alvimopan in treating opioid-induced constipation?
What is the limitation of methylnaltrexone and alvimopan in treating opioid-induced constipation?
What is the primary factor that initiates postoperative ileus?
What is the primary factor that initiates postoperative ileus?
What is the definition of postoperative ileus?
What is the definition of postoperative ileus?
What is the result of surgical manipulation of the bowel during open abdominal procedures?
What is the result of surgical manipulation of the bowel during open abdominal procedures?
What contributes to postoperative ileus in addition to manipulation of the intestines?
What contributes to postoperative ileus in addition to manipulation of the intestines?
What is the main effect of surgical procedure on GI physiology and function?
What is the main effect of surgical procedure on GI physiology and function?
What is the primary cause of the early neurogenic phase of postoperative ileus?
What is the primary cause of the early neurogenic phase of postoperative ileus?
What is the outcome of the inflammatory cascade in the gut after surgical manipulation?
What is the outcome of the inflammatory cascade in the gut after surgical manipulation?
How long does the late inflammatory phase of postoperative ileus typically last?
How long does the late inflammatory phase of postoperative ileus typically last?
What is the role of mast cells and neutrophils in the peritoneal cavity during postoperative ileus?
What is the role of mast cells and neutrophils in the peritoneal cavity during postoperative ileus?
What is the difference between open and laparoscopic procedures in terms of the early neurogenic phase of postoperative ileus?
What is the difference between open and laparoscopic procedures in terms of the early neurogenic phase of postoperative ileus?
When does the late inflammatory phase of postoperative ileus begin?
When does the late inflammatory phase of postoperative ileus begin?
of how long time does the early neurogenic phase last
of how long time does the early neurogenic phase last
late inflammatory phase, occurs about 3 hours after intestinal manipulation and continues to spread for the next ?
late inflammatory phase, occurs about 3 hours after intestinal manipulation and continues to spread for the next ?
What is the consequence of the bowel becoming necrotic in mesenteric ischemia?
What is the consequence of the bowel becoming necrotic in mesenteric ischemia?
What is the primary goal of treatment in mesenteric ischemia?
What is the primary goal of treatment in mesenteric ischemia?
What is the characteristic of the hyperactive stage of mesenteric ischemia?
What is the characteristic of the hyperactive stage of mesenteric ischemia?
What is the common etiology of mesenteric ischemia in patients with atrial fibrillation?
What is the common etiology of mesenteric ischemia in patients with atrial fibrillation?
What is the progression of mesenteric ischemia if left untreated?
What is the progression of mesenteric ischemia if left untreated?
What is the mortality rate of mesenteric ischemia if left untreated?
What is the mortality rate of mesenteric ischemia if left untreated?
What is the primary function of the jejunum in the GI system?
What is the primary function of the jejunum in the GI system?
What is the consequence of resecting more than 100 cm of the ileum?
What is the consequence of resecting more than 100 cm of the ileum?
What is the minimum percentage of the small intestine required to maintain its function?
What is the minimum percentage of the small intestine required to maintain its function?
What is the effect of small intestinal resection on gastric motility?
What is the effect of small intestinal resection on gastric motility?
What is the function of the ileum in the GI system?
What is the function of the ileum in the GI system?
What is the effect of resecting the terminal ileum and ileocecal valve?
What is the effect of resecting the terminal ileum and ileocecal valve?
What is the primary function of the colon in the gastrointestinal system?
What is the primary function of the colon in the gastrointestinal system?
What is the effect of resecting the small intestine on the gastrointestinal system?
What is the effect of resecting the small intestine on the gastrointestinal system?
What is the difference between the effects of colon resection and small intestine resection on the gastrointestinal system?
What is the difference between the effects of colon resection and small intestine resection on the gastrointestinal system?
What is the consequence of full colonic resection ?
What is the consequence of full colonic resection ?
What is the consequence of complete transection on the wave of activity in the intestine?
What is the consequence of complete transection on the wave of activity in the intestine?
What happens to the intestine distal to the transection after bowel anastomosis?
What happens to the intestine distal to the transection after bowel anastomosis?
What is the effect of bowel anastomoses on intestinal homeostasis and digestion?
What is the effect of bowel anastomoses on intestinal homeostasis and digestion?
What is the long-term effect on MMC activity after bowel anastomosis?
What is the long-term effect on MMC activity after bowel anastomosis?
What is the effect of close approximation of the muscle layers on the intestine distal to the transection?
What is the effect of close approximation of the muscle layers on the intestine distal to the transection?
Study Notes
• Preoperative anxiety leads to sympathetic stimulation, increasing norepinephrine levels, which inhibits GI tract activity, and benzodiazepines like midazolam are often used to enhance GABA's effect on GABA-A receptors, reducing anxiety.
• Midazolam's effect on small bowel motility includes increasing the duration of phase III of the migrating motor complex (MMC) in the proximal and distal parts of the duodenum, shortening the MMC by 27%.
• Volatile anesthetics affect bowel function by depressing spontaneous electrical, contractile, and propulsive activity in the stomach, small intestine, and colon, with the small intestine recovering first, followed by the stomach and then the colon.
• Rapid increases in desflurane concentration induce greater sympathetic activation, leading to increased BP and HR, but this effect is short-lived and unlikely to have a lasting impact on bowel function.
• Desflurane and isoflurane affect intestinal tissue oxygenation in a dose-dependent manner, which may influence bowel function postoperatively.
• Total intravenous anesthesia (TIVA) with propofol-remifentanil increases intestinal motility compared to sevoflurane-remifentanil, but may cause surgeon dissatisfaction.
• Nitrous oxide causes bowel distention due to its high solubility in blood, leading to gas accumulation in the bowels, and its use should be avoided in lengthy abdominal surgeries or when the bowel is already distended.
• Neuromuscular blocking drugs like succinylcholine do not affect GI motility, but can increase intragastric pressure, leading to reflux and aspiration.
• Reversal of paralysis with neostigmine increases parasympathetic activity and bowel peristalsis, but may be concerning in cases of fresh bowel anastomoses, and sugammadex may be a better alternative.
• Opioids exert their function on both central and peripheral receptors, with peripheral effects including reduced GI motility, constipation, and spasm.
• Activation of peripheral mu-receptors inhibits excitatory pathways, depresses peristaltic contraction, and increases resting muscle tone, leading to delayed gastric emptying and slow transit through the intestine.
• Combining opioids with enteral opioid receptor antagonists like methylnaltrexone or alvimopan may help alleviate opioid-induced constipation.
• The surgical procedure itself affects GI physiology and function, predisposing to postoperative ileus, which is defined as a transient cessation of coordinated bowel motility after surgical intervention.
• Manipulation of the intestines during surgery is the main factor that initiates postoperative ileus, with additional contributors including immobility, electrolyte imbalance, and intestinal wall swelling.
• Postoperative ileus has two phases: an early neurogenic phase lasting about 3-4 hours after surgery, and a late inflammatory phase.
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Description
Learn about the physiological effects of anxiety on the GI tract and how premedication with benzodiazepines can enhance the effect of neurotransmitters like GABA. Understand the importance of a good bedside manner and behavioral approaches in preoperative care.
