Randomized clinical trial on the influence of anaesthesia protocol on intestinal motility during laparoscopic surgery requiring small bowel anastomosis

Randomized clinical trial on the influence of anaesthesia protocol on intestinal motility during laparoscopic surgery requiring small bowel anastomosis

Background: Hyperperistalsis of the small bowel during laparoscopic surgery may cause mucosal prolapse and reduce exposure, making laparoscopic suturing or stapling more demanding for the surgeon. Although it is commonly accepted that both opioids and volatile anaesthetics induce intestinal paralysi...

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Bibliographic Details
Published in:British journal of surgery Vol. 99; no. 11; pp. 1524 - 1529
Main Authors: De Corte, W., Delrue, H., Vanfleteren, L. J. J., Dutré, P. E. M., Pottel, H., Devriendt, D. K. J. C., Van Rooy, F. H. E. C., D'Hondt, M., Carlier, S., Desmet, M. B.
Format: Journal Article
Language:English
Published: Chichester, UK John Wiley & Sons, Ltd 01-11-2012
Wiley
Subjects:
Adult
Anesthetics, Inhalation
Biological and medical sciences
Body Mass Index
Double-Blind Method
Female
Gastric Bypass - methods
Gastrointestinal Motility - drug effects
General aspects
Humans
Isoflurane - analogs & derivatives
Laparoscopy - methods
Male
Medical sciences
Methyl Ethers
Muscarinic Antagonists - pharmacology
Prospective Studies
Scopolamine Hydrobromide - pharmacology
Medicine
Endoscopic surgery
Randomization
Motility
Treatment
Digestive system
Anastomosis
Anesthesia
Laparoscopic surgery
Clinical trial
Small intestine
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Summary:Background: Hyperperistalsis of the small bowel during laparoscopic surgery may cause mucosal prolapse and reduce exposure, making laparoscopic suturing or stapling more demanding for the surgeon. Although it is commonly accepted that both opioids and volatile anaesthetics induce intestinal paralysis, intestinal hyperactivity during anaesthesia is not uncommon. This randomized trial investigated the effect of different volatile anaesthetics on intestinal motility and the impact on surgeon satisfaction. Methods: Patients scheduled for laparoscopic gastric bypass surgery were randomized to receive sevoflurane or desflurane in a balanced anaesthetic regimen. After surgical exposure peristaltic waves were counted over 1 min in a segment of the jejunum. Following evaluation of intestinal motility, N‐butylhyoscine, an antimuscarinic anticholinergic agent that relaxes bowel smooth muscle cells, could be administered if the surgeon judged the intestinal motility as disturbing. The endpoints were number of peristaltic waves and incidence of N‐butylhyoscine administration, a surrogate for surgeon satisfaction. Results: Twenty‐two patients were randomized to each group. The groups were similar in age, sex and body mass index. There was a statistically significant difference in intestinal motility between the desflurane and sevoflurane groups: median (range) 7 (0–12) versus 1 (0–10) waves counted over 1 min respectively (P < 0·001). A higher proportion of patients in the desflurane group received N‐butylhyoscine (10 of 22 versus 1 of 22 in the sevoflurane group; P = 0·004). Conclusion: Desflurane increased intestinal motility and decreased surgeon satisfaction compared with sevoflurane during laparoscopic gastric bypass surgery. A sevoflurane‐based anaesthetic protocol can help to avoid disturbing hyperperistalsis. Registration number: B39620097060 (http://www.clinicaltrials.be). Copyright © 2012 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd. Anaesthetic agents affect gut motility
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ArticleID:BJS8883
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ObjectType-News-1
ObjectType-Feature-3
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ISSN:0007-1323
1365-2168
DOI:10.1002/bjs.8883