Anesthesia in GI Patients

Question 1

anticholinergic drugs

Answer 1

atropine
glycopyrrolate

Question 2

indications for anticholinergics

Answer 2

• sinus bradycardia
• vagally mediated 1st and 2nd degree AV block

Question 3

GI side effects of anticholinergics

Answer 3

reduced secretions
decreased GI motility
decreased LES tone
increased gastric pH

Question 4

H2 blocker drugs

Answer 4

famotidine

Question 5

indications for H2 blockers

Answer 5

used with H1 blockers in patients with MCTs

Question 6

GI side effects of H2 blockers

Answer 6

decrease gastric acid secretion
increase gastric pH

Question 7

proton pump inhibitor drugs

Answer 7

pantoprazole
omeprazole

Question 8

indications for PPI

Answer 8

prevent esophagitis in patients at risk of GER or regurgitation

decrease severity of aspiration pneumonia

Question 9

GI side effects of PPIs

Answer 9

decrease gastric acid secretion
increase gastric pH

Question 10

what antiemetic drug is used most commonly with anesthesia

Answer 10

maropitant

reduces opioid induced emesis

Question 11

indications for opioids

Answer 11

sedation - premed
analgesia

Question 12

GI effects of opioids

Answer 12

decreased GI motility
initial vomiting followed by antiemetic properties
decreased LES tone
increased risk of regurg

Question 13

GI effects of acepromazine

Answer 13

antiemetic
delays gastric emptying
decreased GI motility
decreased LES tone
increased risk of regurg

Question 14

GI effects of dexmedetomidine

Answer 14

vomiting (cats)
decreased LES tone
increased risk of regurg
decreased GI motility

Question 15

GI effects of benzodiazepines

Answer 15

MINIMAL GI EFFECTS

decrease LES tone
increased risk of regurg

Question 16

GI effects of propofol

Answer 16

antiemetic
decreased gastric empting/GI motility

Question 17

GI effects of alfaxalone

Answer 17

decreased LES tone

Question 18

GI effects of ketamine

Answer 18

MINIMAL GI EFFECTS

decreases GI motility

Question 19

GI effects of inhalants

Answer 19

decreased LES tone
increased risk of regurg
decreased GI motility

Question 20

3 anesthetic considerations for vomiting patients

Answer 20

1. head position down
2. suction mouth prior to intubation
3. rapid induction

Question 21

3 anesthetic considerations for regurgitating patients

Answer 21

1. head position upward
2. suction mouth prior to intubation and extubation
3. rapid induction

Question 22

where do refluxed contents go in patients with gastroesophageal reflux

Answer 22

nose

esp. brachycephalics

Question 23

what are risk factors for GER during surgery

Answer 23

1. age (older > younger)
2. abdominal procedures
3. long pre-op fasting period
4. drugs - phenothiazines, atropine, morphine

Question 24

do position and type of inhalant used affect GER

Answer 24

NO

Question 25

what medications can be used to reduce the risk of GER

Answer 25

high dose metoclopramide CRI OR cisapride

Question 26

what drugs should not be used for induction when a rapid induction is required

Answer 26

inhalants or opioids

Question 27

what complications can occur from vomiting, regurgitation, or reflux under anesthesia

Answer 27

esophagitis aspiration pneumonia

Question 28

how to prevent esophagitis under anesthesia

Answer 28

suction frequently lavage esophagus with high volume saline can add bicarbonate to lavage fluid

Question 29

what factors increase risk of developing aspiration pneumonia

Answer 29

1. hydromorphone 2. history of regurgitation 3. surgery type 4. megaesophagus 5. history of neuro or respiratory disease

Question 30

what is the goal in order to prevent postoperative ileus

Answer 30

maintain intestinal oxygenation and blood flow

Question 31

steps of ileus prevention

Answer 31

1. perioperative analgesia - limit opioid use while still providing good analgesia 2. surgical technique - minimize handling of intestines 3. postoperative care - get patient eating and walking quickly, use laxatives, peripheral opioid antagonists, prokinetics

Question 32

components of an anesthesia anticipated problem list

Answer 32

1. anesthesia related problems 2. procedure related problems 3. disease related problems

Question 33

anesthesia related problems

Answer 33

hypotension hypoventilation hypothermia +/- bradycardia

Question 34

procedure related problems

Answer 34

pain bleeding stomach distention esophagitis

Question 35

disease related problems

Answer 35

vomiting regurgitation electrolyte imbalances esophageal perforation