Prevention and Treatment of Gastrointestinal Morbidity

The prevention and treatment of perioperative gastrointestinal morbidity is an area where much attention has been paid in recent years. This chapter aims to review the more common adverse gastrointestinal outcomes including aspiration of gastric contents, postoperative nausea and vomiting, and postoperative ileus. Particular focus is spent on the different modalities of providing anesthetic care and how they affect patient outcomes. For each of these morbidities, the literature supporting risk stratification was reviewed in an effort to identify those populations in whom there was an increased risk. Once those patients for whom there is an increased risk area identified, the different modalities used to mitigate the incidence are discussed. The areas covered include: (1) Those tasks performed before the patient is ever administered an anesthetic including preoperative fluid ingestion; (2) What anesthesia providers can do during cases that will have a discernable benefit including medications given, types of anesthetic regimens, and timing of certain pharmacologic interventions; and (3) Patient management postoperatively that impacts return to appropriate bowel homeostasis.