Problems of the Gastrointestinal Tract in Anesthesia, the Perioperative Period, and Intensive Care: International Symposium in Würzburg, Germany, 1-3 October 1998

373 Pages·1999·22.82 MB·English

by  M. Schemann

M. K. Herbert· P. Holzer· N. Roewer (Eds.)
Problems of the Gastrointestinal Tract in Anesthesia,
the Perioperative Period, and Intensive Care
Springer
Berlin
Heidelberg
New York
Barcelona
Hong Kong
London
Milan
Paris
Singapore
Tokyo
M. K. Herbert . P. Holzer . N. Roewer
Editors
Problems of the
Gastrointestinal Tract in Anesthesia,
the Perioperative Period,
and Intensive Care
International Symposium in Wiirzburg, Germany,
1-3 October 1998
With 82 Figures and 39 Tables
Springer
Priv.-Doz. Dr. M. K. Herbert
UniversiUit Wurzburg
Klinik rur Anaesthesiologie
Josef-Schneider-StraBe 2
97080 Wurzburg, Germany
Professor Dr. P. Holzer
Universitat Graz
Abt. rur Exp. u. Klin. Pharmakologie
Universitatsplatz 4
8010 Graz, Austria
Professor Dr. N. Roewer
Universitat Wiirzburg
Klinik fur Anaesthesiologie
Josef-Schneider-StraBe 2
97080 Wurzburg, Germany
ISBN-13:978-3-642-64301-9 Springer-Verlag Berlin Heidelberg New York
Library of Congress Cataloging-in-Publication Data
Problems of the gastrointestinal tract in anaesthesia, the perioperative period, and intensive care :
International symposium in Wiirzburg, October 1 to 3, 19981 ed.: M.K. Herbert ... - Berlin; Heidel
berg; New York; Barcelona; HongKong ; London; Milan; Paris; Singapore; Tokyo: Springer, 1999
ISBN-13:978-3-642-64301-9 e-ISBN-13:978-3-642-60200-9
DOl: 10.1007/978-3-642-60200-9
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Preface
After a long period of neglect, the gastrointestinal tract is increasingly being recog
nized as an important target of anesthetics and anesthesia-related processes, as well
as of conditions and treatments related to peri- and postoperative period and inten
sive care. Drugs used in anesthesia and intensive care and physiological or pathologi
cal changes in the perioperative period affect the digestive system in its function from
the pharynx to the colon. Prolonged postoperative ileus or stasis of propulsive peri
stalsis in the critically ill or multiply injured patient may impair enteral nutrition and
give rise to complications such as sepsis or multiple organ failure.
In view of this new understanding of the clinical relevance of gut function, we felt
that a book on problems of the gastrointestinal tract in anesthesia, the perioperative
period, and intensive care was badly needed. The present volume is the product of an
international symposium which brought together physiologists, pharmacologists,
experimental and clinical anesthetists, gastroenterologists, surgeons, and intensive
care physicians to discuss all major contemporary aspects of bowel function in health
and under the influence of anesthesia, surgery, and intensive care.
The chapters of the book are designed to take account of the most important
developments in this emerging field of gastroenterology. The topics treated in depth
in the various articles cover the gamut of the physiology, pathophysiology, diagnosis,
and treatment of gut-associated problems in anesthesia, the perioperative period, and
intensive care. A number of chapters focus on the properties and functional aspects
of gastrointestinal motility, the impairment of intestinal motility in critically ill
patients and in the perioperative period, and on new therapeutic strategies to
improve gastrointestinal propulsion.
New insights into the mechanisms of gastrointestinal secretion, absorption, the
intestinal microflora, and the barrier function of the intestinal mucosa in health and
disease have led to rational approaches for the prevention and treatment of subse
quent complications by early enteral nutrition, new compositions of enteral formula
diets, and supplementation with additives. Disturbances of intestinal perfusion in the
perioperative period as well as under intensive care conditions promote the develop
ment of systemic inflammatory response syndrome, sepsis, and, in the worst case,
multiple organ dysfunction or failure. Another section of the book deals with post
operative nausea and vomiting, a condition that is increasingly better understood as
the predisposing risk factors and underlying mechanisms are revealed. The improve
ment of pharmacological prevention and therapy which results from these advances
is likely to reduce the incidence and severity of unpleasant episodes of nausea and
emesis in daily clinical practice.
VI Preface
Many chapters of the book have been written by leading authorities. Because of
particular relevance or topicality, several communications made by the participants
of the symposium have been included as short communications in order to expand
the range of the book. We trust that the book meets the need to integrate the state of
the knowledge on bowel function in health and under the influence of anesthesia, sur
gery, and intensive care. We also hope it will become the first in a series of volumes
continuously updating the growing information in this emerging field. With this ini
tial volume in print, we are very grateful to all contributors for providing so freely of
their time and expertise and to Marika Stauch, Lindrun Weber and David Roseveare
of Springer-Verlag for their invaluable help in guiding the book through the press.
M. K. Herbert, P. Holzer, N. Roewer
Contents
I Gastrointestinal Motility ............................................ .
Properties and Functional Aspects of the Enteric Nervous System ............ 3
M. Schemann, D. Reiche, M. Neunlist
Pharmacotherapy of Gastrointestinal Motor Disorders . . . . . . . . . . . . . . . . . . . . .. 12
J. A. J. Schuurkes
Effect ofInterleukin-1 ~ on Cholinergic Contractions
in the Gastrointestinal Tract of the Rat ................................... 23
T. G. Moreels, J. G. De Man, B. Y. De Winter, A. G. Herman,
P. A. Pelckmans
Impairment of Intestinal Motility in the Critically III Patient.
Clinical Implications and Contribution of Drugs and Mediators . . . . . . . . . . . . .. 28
M. K. Herbert
Potential of Motilides in the Treatment of Hypomotility Syndromes .......... 39
T. L. Peeters
The Pathogenesis of Postoperative Ileus in the Rat: Role of Nitric Oxide,
Vasoactive Intestinal Polypeptide and K-Opioid Receptors . . . . . . . . . . . . . . . . . .. 52
B. Y. De Winter, J. G. De Man, T. G. Moreels, G. E. Boeckxstaens,
P. Robberecht, A. G. Herman, P. A. Pelckmans
What Dose of Neostigmine is Effective for the Treatment of Postoperative
Colonic Ileus? Lessons from Colonic Motility Studies ....................... 70
M. E. Kreis, T. T. Zittel, M. Kasparek, G. Thiers, A. Huge, H. D. Becker,
E. C. Jehle
Small Bowel Transit Time in Intensive Care Unit Patients:
Effect of Cisapride and Erythromycin .................................... 74
J. Barnert, 1. Rockl-Wiedmann, C. Werner, G. Neeser, M. Wienbeck
Guided Placement of Nasojejunal Feeding Tubes Using Erythromycin
and Fluoroscopy in Intensive Care Unit Patients ........................... 79
J. Barnert, G. Neeser, M. Wienbeck
High-dose Catecholamines Diminish the Effect of Erythromycin
on Antral Motility and Gastric Emptying in Intensive Care Unit Patients ...... 83
J. Barnert, J. Goebel, G. Neeser, M. Wienbeck
VIII Contents
II Dysfunction of the Gastrointestinal Tract in Shock, Sepsis
and Critical Illness. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 89
Gastrointestinal Secretion, Absorption and Barrier Function ................ 91
M. Fromm, A. H. Gitter, J.-D. Schulzke
The Human Intestinal Microflora: Physiology and Pathophysiology ........... 108
1. B. Autenrieth
Clinical Strategies for Prevention of Bacterial Translocation ................. 118
W. Druml
Reduction of Perioperative Endotoxin Leakage from the Gastrointestinal Tract
by Enteral Application ofImmunoglobulin-Enriched Colostral
Milk Preparation ...................................................... 127
E. Beilke, D. Berger, K. Buttenschon, R. Lissner, A. Arnold, F. Hausmann,
M. Seidelmann, H. G. Beger
Bacterial Translocation and Endotoxemia During Aseptic Surgery . . . . . . . . . . .. 131
E. BoIke, D. Berger, N. Hiki, B. Poch, A. Beier, M. Graf, M. Seidelmann,
H. G. Beger
Antiendotoxin Antibody Production of Mononuclear Cells
in Multiply Injured Patients . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 135
K. Buttenschon, D. Berger, K. Stenzel, T. Piper, H. G. Beger
Multivariate Analysis of Parameters Predicting Lethal Outcome
in a Porcine Model of Abdominal Sepsis .... . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 139
T. Strate, C. G. Schneider, M. Wolf, J. R. Izbicki, C. Bloechle
Gastric Mucosal Tonometry ............................................. 143
M. V. Chapman, M. G. My then
Continuous Mucosal PC0 Monitoring of the Gastrointestinal Tract .......... 158
2
G. Knichwitz, T. Briissel
The Potential of Tissue Lightguide Spectrophotometry
for Monitoring Gastric Mucosal Oxygenation During Mechanical Ventilation .. 173
A. Fournell, 1. A. Schwarte, T. W. 1. Scheeren
III Nutritional Aspects ................................................ 179
The Colon as a Metabolically Active Organ: Implications
for the Composition of Enteral Formula Diets ............................. 181
W. M. Scheppach
Early Enteral Nutrition Influences Immunological Response of Lymphocyte
Subsets After Poly trauma ............................................... 191
J. M. Engel, T. Menges, G. Hempelmann
Glutamine-supplemented Parenteral Nutrition ............................. 195
R. D. Griffiths, C. Esanu-Varnav
Contents IX
IV Perioperative Dysfunction of the Gastrointestinal Tract ............... 213
Perioperative Motility of the Foregut ..................................... 215
K. H. Fuchs, J. Maroske, H. Tigges, J. Heimbucher, S. M. Freys,
A. Thiede
Electrogastrography During the Early Postoperative Period. . . . . . . . . . . . . . . . .. 223
J. Maroske, J. Heimbucher, K. H. Fuchs, S. M. Freys, A. Thiede
Therapeutic Interventions for Improvement of Impaired Intestinal
Blood Flow ........................................................... 227
G. F. E. Noldge-Schomburg, D. A. Vagts
Influence of Dopexamine on Splanchnic Perfusion
During Cardiac Surgery ................................................ 245
F. Bach, M. Silomon, T. Graeter, R. Larsen, U. Grundmann
Postoperative Intestinal Ischemia in Cardiac Surgical Patients . . . . . . . . . . . . . . .. 251
J. Neumann, H.-D. Unrein
Gastrointestinal Complications After Cardiopulmonary Bypass .............. 257
J. Rotker, M. Erren, G. Knichwitz, R. Tandler, N. Roeder, M. C. Deng,
D. Hammel, H. H. ScheId
The "Laparoscopic Window": A New Laparoscopic Bedside Technique
for Second Look Intervention ........................................... 261
A. van Ophoven, B. Patel, H. G. Schindler
V Postoperative Nausea and Vomiting .................................. 265
Postoperative Nausea and Vomiting ...................................... 267
P. 1. R. Andrews
Prediction of Postoperative Nausea and Vomiting Using Clinical Risk Factors .. 289
C. C. Apfel, N. Roewer
Logistical Regression Analysis of Factors Causing Postoperative Nausea
or Vomiting During Different Postoperative Time Periods . . . . . . . . . . . . . . . . . .. 302
T. Schroder, Ch. v. Heymann, R. Scherer, W. J. Kox
Postoperative Nausea and Vomiting After Laparoscopy in Gynecology ........ 307
S. Kriiper, O.-E. Mohr
Prophylaxis and Therapy of Postoperative Nausea and Vomiting ............. 313
J. Scholz, M. Steinfath
x Contents
VI Update - Gastric, Duodenal, and Stress Ulcer,
Etiology, Pathophysiology, Treatment. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 327
Gastric Acid Backdiffusion and Neuronal Emergency System ................ 329
P. Holzer, 1. T. Lippe, M. Jocie, A. Heinemann
Intensive Care Pharmacotherapy: Stress Ulcer Prophylaxis
and Mucosecretolysis .................................................. 341
B. M. W. Schmidt, M. Wehling
Pneumonia Prophylaxis Under Ulcer Therapy ............................. 353
G. Stohr, M. Kunze, C. Ohmann, H. D. Roher, J. Piek, W. Sandmann,
H. Becker
Subject Index ........................................................ 363