Freye E, Sundermann S, Wilder-Smith O H
Department of Vascular Surgery and Renal Transplantation, Heinrich-Heine-University Clinics, Düsseldorf, Germany.
Acta Anaesthesiol Scand. 1998 Jul;42(6):664-9. doi: 10.1111/j.1399-6576.1998.tb05299.x.
Gastrointestinal motility may be considerably reduced by anaesthesia and or surgery resulting in postoperative ileus. Inhibition of propulsive gut motility is especially marked after an opioid-based technique. Little, however, is known of the gastrointestinal effects of the hypnotic propofol when given continuously over a longer period of time, which is the case in total intravenous anaesthesia (TIVA) and in intensive care sedation. We therefore set out to study the effects of a propofol-based nitrous oxide/oxygen anaesthesia (group PO) on gastro-caecal transit time. The results were compared with a propofol-ketamine technique (group PK) and an isoflurane-based anaesthesia (group I; each group n = 20).
Gastro-caecal transit was determined by measurement of endexpiratory hydrogen concentration (ppm). Following gastral installation of lactulose at the end of the operation, the disaccharide was degraded by bacteria in the caecum, resulting in the liberation of hydrogen which was expired. A 100% increase in endexpiratory hydrogen concentration compared to the preinduction period was considered the end-point of gastro-caecal transit.
There was no significant difference with regard to gastro-caecal transit in the three groups of patients. In the propofol group mean gastro-caecal transit was 119 (+/- 50.6 SD) min, in the propofol-ketamine group it was 147 (+/- 57.4 SD) min, and in the isoflurane group transit time was 122 (+/- 48.6 SD) min.
The data suggest that propofol, even when given as a continuous infusion, does not alter gastrointestinal tract motility more than a standard isoflurane anaesthesia. The data may be particularly relevant to patients who are likely to develop postoperative ileus. They also suggest that in an ICU setting propofol does not alter gut motility more than a sedation technique with the analgesic ketamine.
麻醉和/或手术可能会显著降低胃肠动力，导致术后肠梗阻。基于阿片类药物的技术对肠道推进性蠕动的抑制尤为明显。然而，对于催眠药丙泊酚在较长时间持续给药时的胃肠道影响知之甚少，全静脉麻醉（TIVA）和重症监护镇静时就是这种情况。因此，我们着手研究丙泊酚复合氧化亚氮/氧气麻醉（PO组）对胃-盲肠转运时间的影响。将结果与丙泊酚-氯胺酮技术（PK组）和异氟烷麻醉（I组；每组n = 20）进行比较。
通过测量呼气末氢气浓度（ppm）来确定胃-盲肠转运。在手术结束时向胃内注入乳果糖后，二糖在盲肠中被细菌分解，导致氢气释放并呼出。与诱导前相比，呼气末氢气浓度增加100%被视为胃-盲肠转运的终点。
三组患者的胃-盲肠转运无显著差异。丙泊酚组的平均胃-盲肠转运时间为119（±50.6标准差）分钟，丙泊酚-氯胺酮组为147（±57.4标准差）分钟，异氟烷组的转运时间为122（±48.6标准差）分钟。
数据表明，即使持续输注丙泊酚，其对胃肠道动力的影响也不会比标准的异氟烷麻醉更大。这些数据可能与可能发生术后肠梗阻的患者特别相关。它们还表明，在重症监护病房环境中，丙泊酚对肠道动力的影响不会比使用镇痛氯胺酮的镇静技术更大。
