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Surgical Procedures- Gastrointestinal

QuestionAnswer
What is the fluid of choice for bowel obstruction? Why? Fluid supplemented w K+ is appropriate bc these pt's usually have hemoconcentration, a decreased circulating blood volume & a decreased total body K+.
How much fluid should be given initially to the pt undergoing bowel surgery? An initial rate of 5-6 ml/kg/hr would be appropriate for very extensive intra-abdominal procedures.
How should nitrous oxide (NO) be used in the patient w a bowel obstruction? Best to avoid NO when bowel contains much gas.It is prob safe to use NO limiting its concentration to 50% for a brief period of time (10-15 minutes) @ the start of an operation to facilitate induction. NO should be d/c & O2 & volatile agent then be used.
If NO is used for a bowel obstruction, what is the purpose for using this particular technique? NO for 10-15 min at the begining of the case and then d/c NO and switch to O2 and volatile agent thereafter? This technique leads to little or no increase in size of the gas-containing cavity.
What prophylactic treatments (preventative measures) should be given in an emergency appendectomy? 1)raise the pH of gastric contents (non-particulate antacids)2)reduce acid secretion w H2 blockers;ranitidine & pepcid drugs of choice w fewer SE, but cimetidine is also effective. 3)reduce gastric content volume w motility stimulating drugs;reglan.
What is a major consideration in anesthesia for GI surgery? Prevention of inadvertent airway soiling by aspiration of GI contents during induction and maintenance of anesthesia.
LIGHTING BOLT- The patient is undergoing a surgical pocedure on the lower abdomen; the surgeon complains about an "active bowel." What might you administer and why? Peristaltic & propulsive mvts of the bowel are due to smooth muscle activity, regulated by myenteric plexus & the PSNS. Increased PSNS activity increases bowel motility; so, an antimuscarinic such as atropine or glycopyrrolate may reduce GI motility.
Created by: ngawlik
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