Influencing factors and interventions of decreased gastrointestinal blood flow during bariatric surgery

doi:10.3877/cma.j.issn.2095-9605.2023.03.006

Abstract

Abstract:

Post operative nausea and vomiting (PONV) is one of the most common postoperative adverse effects of bariatric surgery, reducing patient comfort and satisfaction and slowing down the recovery process. There are many predisposing factors of PONV, among which the decrease in gastrointestinal blood flow during the perioperative period of bariatric surgery, resulting in gastrointestinal mucosal ischemia and hypoxia and postoperative gastrointestinal dysfunction, are one of the risk factors for the occurrence of PONV. In this regard, this article analyzes anesthetic drugs, surgical factors and preoperative fasting of bariatric surgery, discusses the reasons for the decline of gastrointestinal blood flow in the perioperative period, and summarizes the interventions to improve gastrointestinal tissue ischemia and hypoxia, hoping to alleviate the occurrence of PONV in bariatric surgery by improving gastrointestinal blood flow.

Key words: Bariatric surgery, Gastrointestinal blood flow, Ischemia and hypoxia, Postoperative nausea and vomiting, Perioperative, Gastrointestinal disorders

Yingying Xiao, Yinqi Tian, Xuemei Peng. Influencing factors and interventions of decreased gastrointestinal blood flow during bariatric surgery[J]. Chinese Journal of Obesity and Metabolic Diseases(Electronic Edition), 2023, 09(03): 179-185.

/ / Recommend

Add to citation manager EndNote|Ris|BibTeX

URL: https://zhfpydxbdzzz.cma-cmc.com.cn/EN/10.3877/cma.j.issn.2095-9605.2023.03.006

https://zhfpydxbdzzz.cma-cmc.com.cn/EN/Y2023/V09/I03/179

Figures/Tables 2

References 59

[1]	Halliday TA, Sundqvist J, Hultin M, et al. Post-operative nausea and vomiting in bariatric surgery patients: an observational study [J]. Acta anaesthesiologica Scandinavica, 2017, 61(5): 471-479.
[2]	Apfel CC, Läärä E, Koivuranta M, et al. A simplified risk score for predicting postoperative nausea and vomiting: conclusions from cross-validations between two centers [J]. Anesthesiology, 1999, 91(3): 693-700.
[3]	Gan TJ, Mythen MG. Does peroperative gut-mucosa hypoperfusion cause postoperative nausea and vomiting? [J]. Lancet, 1995, 345(8957): 1123-1124.
[4]	Pusch F, Berger A, Wildling E, et al. The effects of systolic arterial blood pressure variations on postoperative nausea and vomiting [J]. Anesthesia and analgesia, 2002, 94(6): 1652-1655.
[5]	Heidari SM, Saghaei M, Shafiee Z. Effect of preoperative volume loading on the intraoperative variability of blood pressure and postoperative nausea and vomiting [J]. Medicinski arhiv, 2012, 66(2): 94-96.
[6]	Apfel CC, Heidrich FM, Jukar-Rao S, et al. Evidence-based analysis of risk factors for postoperative nausea and vomiting [J]. British journal of anaesthesia, 2012, 109(5): 742-753.
[7]	Paris S, Ekeanyanwu R, Jiang Y, et al. Obesity and its effects on the esophageal mucosal barrier [J]. American journal of physiology: Gastrointestinal and liver physiology, 2021, 321(3): G335-G343.
[8]	Kwon YS, Choi JW, Lee HS, et al. Effect of a Preoperative Proton Pump Inhibitor and Gastroesophageal Reflux Disease on Postoperative Nausea and Vomiting [J]. Journal of clinical medicine, 2020, 9(3): 825.
[9]	Gan TJ, Belani KG, Bergese S, et al. Fourth Consensus Guidelines for the Management of Postoperative Nausea and Vomiting [J]. Anesth Analg, 2020, 131(2): 411-448.
[10]	Chantler S, Griffiths A, Matu J, et al. The Effects of Exercise on Indirect Markers of Gut Damage and Permeability: A Systematic Review and Meta-analysis [J]. Sports medicine, 2021, 51(1): 113-124.
[11]	Ter steege RW, Van der Palen J, Kolkman JJ. Prevalence of gastrointestinal complaints in runners competing in a long-distance run: an internet-based observational study in 1281 subjects [J]. Scandinavian journal of gastroenterology, 2008, 43(12): 1477-1482.
[12]	Schuster R, Alami RS, Curet MJ, et al. Intra-operative fluid volume influences postoperative nausea and vomiting after laparoscopic gastric bypass surgery [J]. Obesity surgery, 2006, 16(7): 848-851.
[13]	Mensink PB, Moons LM, Kuipers EJ. Chronic gastrointestinal ischaemia: shifting paradigms [J]. Gut, 2011, 60(5): 722-737.
[14]	Marston A. Responses of the splanchnic circulation to ischaemia [J]. Journal of clinical pathology, 1977, s3-11(1): 59-67.
[15]	Zheng L, Kelly CJ, Colgan SP. Physiologic hypoxia and oxygen homeostasis in the healthy intestine. A Review in the Theme: Cellular Responses to Hypoxia [J]. American journal of physiology: Cell physiology, 2015, 309(6): C350-360.
[16]	Denholm L, Gallagher G. Physiology and pharmacology of nausea and vomiting [J]. Anaesthesia & Intensive Care Medicine, 2021, 22(10): 663-666.
[17]	郭苗苗, 朱慧杰, 薄晗, 等. 老年患者胃肠道手术术后恶心呕吐的危险因素分析 [J]. 国际麻醉学与复苏杂志, 2019, 40(1): 25-29.
[18]	Herman JA, Urits I, Kaye AD, et al. Perioperative crystalloid versus colloid fluids: Impact on postoperative nausea and vomiting reduction [J]. Journal of clinical anesthesia, 2022, 79: 110025.
[19]	Qu Mengdi, Zhang Mengyuan, Wang Gongming, et al. Intraoperative systemic vascular resistance is associated with postoperative nausea and vomiting after laparoscopic hysterectomy [J]. World journal of clinical cases, 2020, 8(20): 4816-4825.
[20]	Párraga Ros E, Correa-Martín L, Sánchez-Margallo FM, et al. Intestinal histopathological changes in a porcine model of pneumoperitoneum-induced intra-abdominal hypertension [J]. Surgical endoscopy, 2018, 32(9): 3989-4002.
[21]	Schilling MK, Redaelli C, Krähenbühl L, et al. Splanchnic microcirculatory changes during CO₂ laparoscopy [J]. Journal of the American College of Surgeons, 1997, 184(4): 378-382.
[22]	Adelsdorfer C, Taura P, Ibarzabal A, et al. Effect of transgastric natural orifice transluminal endoscopic surgery peritoneoscopy on abdominal organ microcirculation: an experimental controlled study [J]. Gastrointestinal endoscopy, 2016, 83(2): 427-433.
[23]	彭峰. 肥胖症与心血管疾病(续一) [J]. 中华高血压杂志, 2007, 15(08): 689-690.
[24]	高山, 高博文. 胃肠道手术患者术后恶心呕吐的发生情况及影响因素分析 [J]. 实用医技杂志, 2020, 27(12): 1643-1645.
[25]	中国医师协会外科医师分会肥胖和糖尿病外科医师委员会, 中国肥胖代谢外科研究协作组. 中国肥胖代谢外科数据库：2022年度报告 [J/CD]. 中华肥胖与代谢病电子杂志, 2023, 9(2): 83-91.
[26]	Brown W. 7th IFSO Global Registry Report [R]. 2022.
[27]	Kushner BS, Freeman D, Sparkman J, et al. Assessment of postoperative nausea and vomiting after bariatric surgery using a validated questionnaire [J]. Surgery for obesity and related diseases, 2020, 16(10): 1505-1513.
[28]	Mion F, Tolone S, Garros A, et al. High-resolution Impedance Manometry after Sleeve Gastrectomy: Increased Intragastric Pressure and Reflux are Frequent Events [J]. Obesity surgery, 2016, 26(10): 2449-2456.
[29]	Li YW, Liu YF, Liu SW, et al. Diabetic vascular diseases: molecular mechanisms and therapeutic strategies [J]. Signal transduction and targeted therapy, 2023, 8(1): 152.
[30]	葛海燕, 沈明勤, 李娟. 中医益气健脾与养阴和胃法对糖尿病胃轻瘫大鼠胃动力和胃血流的作用比较 [J]. 中国实验方剂学杂志, 2012, 18(12): 238-241.
[31]	Addison ML, Ranasinghe P, Webb DJ. Novel Pharmacological Approaches in the Treatment of Hypertension: A Focus on RNA-Based Therapeutics [J]. Hypertension, 2023, 80(11): 2243-2254.
[32]	Pawlik MW, Kwiecien S, Ptak-Belowska A, et al. The renin-angiotensin system and its vasoactive metabolite angiotensin-(1-7) in the mechanism of the healing of preexisting gastric ulcers. The involvement of Mas receptors, nitric oxide, prostaglandins and proinflammatory cytokines [J]. Journal of physiology and pharmacology, 2016, 67(1): 75-91.
[33]	Akça O, Sessler DI. Supplemental oxygen reduces the incidence of postoperative nausea and vomiting [J]. Minerva anestesiologica, 2002, 68(4): 166-170.
[34]	Markwei MT, Babatunde IO, Kutlu-Yalcin E, et al. Perioperative Supplemental Oxygen and Postoperative Nausea and Vomiting: Subanalysis of a Trial, Systematic Review, and Meta-analysis [J]. Anesthesiology, 2023, 138(1): 56-70.
[35]	Staehr-Rye AK, Meyhoff CS, Scheffenbichler FT, et al. High intraoperative inspiratory oxygen fraction and risk of major respiratory complications [J]. British journal of anaesthesia, 2017, 119(1): 140-149.
[36]	朱莹, 陈小萍, 高巨. 围手术期吸入高浓度氧的争议与思考 [J]. 国际麻醉学与复苏杂志, 2021, 42(12): 1308-1313.
[37]	Young CC, Harris EM, Vacchiano C, et al. Lung-protective ventilation for the surgical patient: international expert panel-based consensus recommendations [J]. British journal of anaesthesia, 2019, 123(6): 898-913.
[38]	王天龙, 黄宇光. 推动麻醉学向围手术期医学转变:《加速康复外科中国专家共识及路径管理指南(2018版)》麻醉部分解读 [J]. 协和医学杂志, 2018, 9(06): 481-484.
[39]	Stuart PC. The evidence base behind modern fasting guidelines [J]. Best practice & research clinical anaesthesiology, 2006, 20(3): 457-469.
[40]	Van de Putte P, Perlas A. Gastric sonography in the severely obese surgical patient: a feasibility study [J]. Anesthesia and analgesia, 2014, 119(5): 1105-1110.
[41]	赵秀秀, 陈利海, 曹媛媛, 等. 术前饮用高能碳水化合物者胃残余量的超声评估 [J]. 实用医学杂志, 2022, 38(08): 1042-1044.
[42]	Lobo DN, Hendry PO, Rodrigues G, et al. Gastric emptying of three liquid oral preoperative metabolic preconditioning regimens measured by magnetic resonance imaging in healthy adult volunteers: a randomised double-blind, crossover study [J]. Clinical nutrition, 2009, 28(6): 636-641.
[43]	Suh S, Hetzel E, Alter-Troilo K, et al. The influence of preoperative carbohydrate loading on postoperative outcomes in bariatric surgery patients: a randomized, controlled trial [J]. Surgery for obesity and related diseases, 2021, 17(8): 1480-1488.
[44]	Sánchez CA, Papapietro VK. Perioperative nutrition in ERAS Protocols [J]. Revista medica de Chile, 2017, 145(11): 1447-1453.
[45]	Jewer JK, Wong MJ, Bird SJ, et al. Supplemental perioperative intravenous crystalloids for postoperative nausea and vomiting [J]. The Cochrane database of systematic reviews, 2019, 3(3): CD012212.
[46]	Lee MJ, Lee C, Kang H, et al. The impact of crystalloid versus colloid fluids on postoperative nausea and vomiting: A systematic review and meta-analysis of randomized controlled trials [J]. Journal of clinical anesthesia, 2020, 62: 109695.
[47]	Holte K, Sharrock NE, Kehlet H. Pathophysiology and clinical implications of perioperative fluid excess [J]. British journal of anaesthesia, 2002, 89(4): 622-632.
[48]	代文杰, 朱化强. 液体管理与术后肠道屏障功能恢复 [J]. 中国实用外科杂志, 2007, (12): 1015-1017+1033.
[49]	郭高锋, 孟星, 阮孝国, 等. 不同导向液体治疗对乳腺癌改良根治患者术后恶心呕吐的影响 [J]. 广东医学, 2020, 41(17): 1758-1762.
[50]	Zheng XZ, Wei K, Liu L, et al. The Impact of Goal-Directed Fluid Therapy on Postoperative Nausea and Vomiting in High-Risk Patients Undergoing Laparoscopic Sleeve Gastrectomy [J]. Obesity surgery, 2022, 32(11): 3533-3540.
[51]	Mühlbacher J, Luf F, Zotti O, et al. Effect of Intraoperative Goal-Directed Fluid Management on Tissue Oxygen Tension in Obese Patients: a Randomized Controlled Trial [J]. Obesity surgery, 2021, 31(3): 1129-1138.
[52]	He HB, Li XQ, Li XM, Li Xiaomei, et al. Therapeutic effect of total triterpenoids of Chaenomeles speciosa combined with omeprazole on gastric ulcer induced by indomethacin in rats [J]. Zhongguo Zhong Yao Za Zhi, 2019, 44(11): 2338-2347.
[53]	Takeuchi K. Gastric cytoprotection by prostaglandin E₂ and prostacyclin: relationship to EP1 and IP receptors [J]. Journal of physiology and pharmacology, 2014, 65(1): 3-14.
[54]	Głowacka U, Magierowski M, Śliwowski Z, et al. Hydrogen Sulfide-Releasing Indomethacin-Derivative (ATB-344) Prevents the Development of Oxidative Gastric Mucosal Injuries [J]. Antioxidants, 2023, 12(8): 1545.
[55]	张宏伟, 张志广. 谷氨酰胺对非甾体抗炎药损伤胃黏膜的保护作用 [J]. 医学综述, 2010, 16(1): 103-104.
[56]	Kwon J, Choi YI, Jo HJ, et al. The Role of Prostaglandin E1 as a Pain Mediator through Facilitation of Hyperpolarization-Activated Cyclic Nucleotide-Gated Channel 2 via the EP2 Receptor in Trigeminal Ganglion Neurons of Mice [J]. International journal of molecular sciences, 2021, 22(24): 13534.
[57]	Dancker C, Hopster K, Rohn K, et al. Effects of dobutamine, dopamine, phenylephrine and noradrenaline on systemic haemodynamics and intestinal perfusion in isoflurane anaesthetised horses [J]. Equine veterinary journal, 2018, 50(1): 104-110.
[58]	白璐, 朱林, 唐文富, 等. 电针"足三里"调控急性坏死性胰腺炎大鼠胃肠道血流量的机理研究 [J]. 四川大学学报:医学版, 2013, 44(06): 982-986.
[59]	Xiong QJ, Min S, Wei K, et al. Correction to: Transcutaneous Electrical Acupoint Stimulation Combined with Dexamethasone and Tropisetron Prevents Postoperative Nausea and Vomiting in Female Patients Undergoing Laparoscopic Sleeve Gastrectomy: a Prospective, Randomized Controlled Trial [J]. Obesity surgery, 2021, 31(10): 4669.

类别	影响因素
麻醉因素	麻醉药物
	术中低血压
	麻醉前禁饮禁食
手术因素	气腹的建立
	手术直接刺激（胃肠道手术PONV发生率更高）
	术中体位（反屈式体位）
患者因素	糖尿病
	高血压

类别	影响因素
麻醉因素	麻醉药物
	术中低血压
	麻醉前禁饮禁食
手术因素	气腹的建立
	手术直接刺激（胃肠道手术PONV发生率更高）
	术中体位（反屈式体位）
患者因素	糖尿病
	高血压

Please choose a citation manager

Content to export