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Abstracts of Posters Presented at the International Anesthesia Research Society; 72nd Clinical and Scientific Congress; Orlando, FL; March 7-11, 1998: Critical Care Anesthesia

GASTRO-INTESTINAL MOTILITY AND EARLY DUODENAL FEEDING AFTER MAJOR ABDOMINAL SURGERY

Tournadre, JP; Barclay, ML; Fraser, R; Young, R; Jury, P; Ferguson, L; Berce, M; Dent, J

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doi: 10.1097/00000539-199802001-00156
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Abstract S157

Major surgery or trauma often leads to a deterioration in nutritional status, associated with impairment of immune function, and serious infections. Enteral feeding leads to a better clinical outcome than when parenteral nutrition is used, but is associated with complications such as pulmonary aspiration, diarrhea, and abdominal cramps. In health, fasting small intestinal motility undergoes cyclical activity with a frequency of approximately 0.5/h and consists of 3 phases: I (quiescence), II (irregular contractions) and III (bursts of pressure waves with a frequency >10/min which migrate aborally and propel intraluminal contents distally). Fasting motility is normally interrupted by meal ingestion or enteral nutrition. Limited data suggest that fasting small intestinal motility is abnormal in critically ill patients, but there are no data about the motor responses to enteral feeding. The aim of the present study was to assess fasted and fed motor activity in critically ill patients after elective abdominal aortic aneurysm repair.

METHODS: In 12 patients (63-75 yrs), a manometric assembly (diameter 3.5 mm), positioned by the surgeon intraoperatively was used to record pressures from 12 sites between the antrum and 100 cm beyond the pylorus.

An additional lumen allowed duodenal feeding (Osmolite, 1 kcal/mL, 40-80 mL/h) beginning 30 +/- 6 h post operatively. All patients received mid thoracic epidural analgesia (T7-T8) with bupivacaine, which was continued for 72 hours.

Post operative ventilation lasted 4.6 h [0-19]. Manometric recordings commenced immediately postoperatively and continued for up to 3 days (11 patients). Recordings were analyzed for the return of pressure waves, and the frequency and propagation of phase III activity. Data are mean +/- SEM.

RESULTS: Small intestinal pressure waves were seen in all patients within 2 h of surgery. The first antral pressure waves were seen 16 +/- 4 h post operatively. Phase III frequency was higher on day 1 compared to day 3 (2.00/h vs 1.47/h, p<0.05). Normal aboral migration occurred in nonventilated patients whereas during ventilation the organization of phase III was frequently abnormal (simultaneous onset in multiple channels (46%), retrograde propagation (20%), multiple (8%) or distal origins (8%)). Enteral feeding did not interrupt phase III activity. Phase II activity was virtually absent.

CONCLUSIONS: Continuous phase III activity propagating to the distal small intestine, which is not interrupted by intestinal nutrient administration, may contribute to diarrhea and pain during post operative enteral feeding.

© 1998 International Anesthesia Research Society