Guha A, Scawn N D A, Rogers S A, Pennefather S H, Russell G N
University Hospital Aintree, Department of Anaesthesia, Liverpool, UK.
Eur J Anaesthesiol. 2002 Sep;19(9):652-7. doi: 10.1017/s0265021502001072.
The effect of anaesthesia and surgery on gastric emptying is not constant, and this has not been previously studied in patients undergoing thoracotomy for lung resection with a bupivacaine-fentanyl epidural infusion for analgesia. There are important implications in this group of patients with regards to the recommencement of important oral medication as well as the risks of aspiration of gastric contents. The study examined gastric emptying in these patients until the second postoperative day.
In a prospective repeated measures study, the effect of fentanyl-bupivacaine epidural analgesia at the mid-thoracic level on gastric emptying was assessed in 11 patients undergoing thoracotomy for lung resection. Gastric emptying was measured using a paracetamol absorption technique. Patients acted as their preoperative controls and were assessed 4 h postoperatively and on the second postoperative day.
The mean (SEM) maximum plasma paracetamol concentration was 204.6 (20.4) micromol L(-1) before operation, 61 (9.5) micromol L(-1) 4 h postoperatively and 114.3 (22.6) micromol L(-1) on the second postoperative day. Mean (SEM) paracetamol absorption at 120 min was 15,638 (1441) micromol min L(-1) preoperatively, 5731 (821) micromol min L(-1) 4 h postoperatively and 9325 (1759) micromol min L(-1) on the second postoperative day. Postoperative values were significantly (P < 0.005) less than the preoperative values.
After thoracotomy, gastric emptying was delayed until at least the second postoperative day in patients receiving mid-thoracic fentanyl-bupivacaine epidural analgesia.
麻醉和手术对胃排空的影响并不恒定，此前尚未在接受开胸肺切除术且采用布比卡因 - 芬太尼硬膜外输注镇痛的患者中进行过研究。对于这组患者而言，重新开始服用重要口服药物以及胃内容物误吸的风险具有重要意义。本研究对这些患者的胃排空情况进行了直至术后第二天的检查。
在一项前瞻性重复测量研究中，对11例接受开胸肺切除术的患者评估了胸段硬膜外给予芬太尼 - 布比卡因镇痛对胃排空的影响。采用对乙酰氨基酚吸收技术测量胃排空。患者以术前自身作为对照，并在术后4小时和术后第二天进行评估。
术前对乙酰氨基酚的平均（标准误）最大血浆浓度为204.6（20.4）微摩尔/升，术后4小时为61（9.5）微摩尔/升，术后第二天为114.3（22.6）微摩尔/升。对乙酰氨基酚在120分钟时的平均（标准误）吸收量术前为15,638（1441）微摩尔·分钟/升，术后4小时为5731（821）微摩尔·分钟/升，术后第二天为9325（1759）微摩尔·分钟/升。术后值显著低于术前值（P < 0.005）。
开胸术后，接受胸段芬太尼 - 布比卡因硬膜外镇痛的患者胃排空延迟至少至术后第二天。
