Longnecker's Anesthesiology > Part 4. Managing Anesthesia Care > Section E. Specialty Areas of Anesthetic Practice > Chapter 55. Anesthesia for Gastrointestinal Surgery Martin Slodzinski, MD, PhD, and William T. Merritt, MD, MBA

Key Points

"1. Diseases of the gastrointestinal system frequently result in abnormal gastric function, with potentially increased anesthetic risk caused by increased intragastric pressure, delayed gastric emptying, gastric dilation, and increased gastric secretion.

2. The volume, pH, and amount of particulate matter in the aspirate appear to be the three most important factors determining the severity of the pulmonary insult.

3. Extensive bowel, pancreatic, or esophageal resections entail considerable morbidity, with potential serious postoperative complications such as hemorrhage, coagulopathy, and hepatic, renal, pulmonary, or cardiovascular failure.

4. Laparoscopy entails the installation of gas (usually CO₂) into the peritoneal cavity with physiologic changes resulting from this gas under pressure and subsequent surgical positioning. Hemodynamic compromise can occur, which, although rare, can be catastrophic.

5. The systemic inflammatory response syndrome/multiorgan dysfunction syndrome continuum is often accompanied by GI mucosal ischemia and the release of mediators that further compromise both splanchnic and systemic perfusion. Anesthetic care of these patients is especially challenging.

6. If the lower esophageal sphincter is not functioning properly, or if a hiatal hernia exists, stomach contents may reflux into the esophagus and pharynx..."