DOI: http://dx.doi.org/10.18203/2349-3933.ijam20185093

Anaesthetic management of acute abdomen: a clinical study

Sanjay Saksena, Namrata Jain

Abstract


Background: Patients of acute abdomen present anaesthetic problems like fluid and electrolyte loss, intraoperative vomiting, regurgitation and aspiration, postoperative sickness, electrolyte imbalance, prolonged total parenteral alimentation etc. This study focused on intraoperative and postoperative complications with reference to anaesthetic management.

Methods: Around 300 patients, suffering from acute abdomen, operated during routine or emergency were randomly distributed in three groups, Group I General anaesthesia with narcotic analgesics and relaxants; Group II General anaesthesia with inhalational agents; Group III Spinal subarachnoid analgesia. No modification of pre and post-operative hospital care and treatment was done.

Results: There was a preponderance of younger age group patients (15 to 34years), more often in male patients. The mean duration in Group I was highest. Intraoperative Hypotension was the commonest (86 patients) followed by regurgitation and aspiration. Post-operative pyrexia was the commonest complication (120 patients) followed by postoperative nausea. ASA Grade III had a mortality of 22 patients (11.6%), ASA Grade IV having mortality of 46 patients (60.52%). About 221 patients had long duration of operations and the mortality was 28.95% as compared to 79 patients operated for short duration having mortality of 13.92%.

Conclusions: Outcome and the survival of the patients depend on the surgical disease, duration of surgery, preoperative ASA grading, degree of dehydration, and the anaesthetic technique.


Keywords


Acute Abdomen, General anaesthesia

Full Text:

PDF

References


Chhetri RK, Shrestha ML. A comparative study of pre-operative with operative diagnosis in acute abdomen. Kathmanolu University Med. J. 2005;3(2):107-10.

Smith GCS, Paterson-Brown S. The acute abdomen and intestinal obstruction. In: Garden OJ, Bradbury AW, Forsythe J, eds. Principles and practice of surgery. London; Churchill Livingstone;2002:198-220.

Augustin G, Majerovic M. Non-obstetrical acute abdomen during pregnancy. Euro J Obs Gynecol Repro Biol. 2007;131(1):4-12.

Elhardello OA, MacFie J. Digital rectal examination in patients with acute abdominal pain. Emerg Med J. 2018;35(9):579-80.

Verki MM, Motamed H. Rectus muscle hematoma as a rare differential diagnosis of acute abdomen; a case report. Emerg. 2018;6(1):e28.

Kaushal-Deep SM, Anees A, Khan S, Khan MA, Lodhi M. Primary cecal pathologies presenting as acute abdomen and critical appraisal of their current management strategies in emergency settings with review of literature. Int J Crit Illness Injury Sci. 2018;8(2):90.

Bojarska A. Fluid management for emergency laparotomy in rural hospitals. Update in Anaes. 2005;20:7-11.

Morton H. Intestinal obstruction and anaesthesia. Brit Med J. 1957;2:224.

Wylie WD. The use of muscle relaxants at the induction of anaesthesia of patients with a full stomach. BJA: Brit J Anaes. 1963;35(3):168-73.

Jones, P, Turkstra, T. Gastrointestinal surgery. In: I. McConachie, Eds. Anesthesia for the High-Risk Patient. Cambridge: Cambridge University Press; 2009:278-292.

Sellick BA. Cricoid pressure to control regurgitation of stomach contents during induction of anaesthesia. The Lancet. 1961;278(7199):404-6.

Thwaites AJ, Rice CP, Smith I. Rapid sequence induction: a questionnaire survey of its routine conduct and continued management during a failed intubation. Anaes. 1999;54(4):376-81.

Salem MR, Wong AY, Mani M, Sellick BA. Efficacy of cricoid pressure in preventing gastric inflation during bag-mask ventilation in pediatric patients. Anesthesiol: J Am Society of Anesthesiol. 1974;40(1):96-8.

Lawes EG, Campbell I, Mercer D. Inflation pressure, gastric insufflation and rapid sequence induction. BJA: Brit J Anaes. 1987;59(3):315-8.

Asai T, Barclay K, McBeth C, Vaughan RS. Cricoid pressure applied after placement of the laryngeal mask prevents gastric insufflation but inhibits ventilation. Brit J Anaes. 1996;76(6):772-6.

Clark MM. Aspiration of stomach content in a conscious patient: a case report. BJA: Brit J Anaes. 1963;35(2):133-4.

Coller FA, Maddock WG. Dehydration attendant on surgical operations. JAMA.1932;99(11):875-80.

Stephens FO. Syndrome of Intestinal Pseudo-obstruction. Brit Med J. 1962;1(5287):1248-38.

Morton HJ, Wylie WD. Anaesthetic deaths due to regurgitation or vomiting. Anaesthesia. 1951;6(4):190-201.

Berry RE. Diagnosis and treatment of acute intestinal obstruction. J Am Med Associa. 1952;148(5):347-55.