Anesthetic management of intestinal obstruction: A postgraduate educational review

Abstract

Intestinal obstruction is associated with significant morbidity and mortality. Scientific assessment of the cause, site of obstruction, appropriate correction of the fluid deficit and electrolyte imbalance with preoperative stabilization of blood gases is ideal as a preoperative workup. Placement of a preoperative epidural catheter especially in the thoracic interspace takes care of perioperative pain and stress reduction. Intraoperative management by controlled general anesthesia administering a relative high inspired fraction of oxygen with invasive monitoring in selected sick cases is mandatory. Preoperative monitoring and stabilizing raised intra-abdominal pressure reduces morbidity. Caution should be exercised during opening and closure of abdomen to avoid cardiorespiratory ill effects. There should be an emphasis on avoiding hypothermia. The use of nonsteroidal anti-inflammatory drugs may worsen sick, fragile patients. The use of sugammadex rather than neostigmine will obscure certain controversies in the healing of intestinal anastomotic site. Replacement of blood loss continued correction of fluids and electrolytes with possible postoperative mechanical ventilation in sick cases may improve outcomes in these patients.

Keywords: Anesthesia; intestinal obstruction; outcome.

Figure 1

Plain X-ray abdomen erect posterior-anterior view shows multiple air-fluid levels with features of small bowel obstruction. No free air under the diaphragm. Fat plane psoas shadow are normal

Figure 2

Bedside supine X-ray chest anterior-posterior view shows multiple inhomogeneous airspace opacities in the right lung mid zone and both side lower zones - likely aspiration pneumonitis. Cardiac silhouette, pleural spaces, and soft tissues are normal