INTESTINAL OBSTRUCTION

Speaker: Dr Bhagirath.S.N

Moderator: Dr Sarika

Intestinal Obstruction

• Vomiting soon after the feeds-Most common

symptom

• presentation after first week of life

• rare causes include congenital webs

• Main electrolyte imbalance-Na+ & K+ loss

• fluid loss secondary to vomiting Pylorus

Upper Gastro Intestinal obstruction

• Imperforate anus• Anal atresia• Duodenal atresia • Jejunoileal atresia• Intussusception• Malrotation•Volvulus• Choledochal cyst• Meconium Ileus

Lower Gastro Intestinal obstruction

•Abdominal distension•Very little or no stool•Hematochezia•Pain•Vomiting

causes

Intestinal Obstruction

Diagnosis

• Barium meal-X ray

• CT scan

• MRI

• Ultrasonography

• Clinical features as listed

before

Duodenal atresia-double bubble appearance

Jejunal Obstruction

Intestinal Obstruction-after diagnoses

• Correct the sodium loss and maintain at 130 mEq/L

• Correct the fluid loss-target urine volume of 1-2 mL/Kg/hr

• Adequate oxygenation and ventilation

• delayed diagnoses-increased risk of aspiration pneumonitis & sepsis-secondary to prolonged pressure on the diaphragm

• Look for associated congenital anomalies:

Duodenal atresia (seen in Down’s syndrome, cystic fibrosis, imperforate anus, renal abnormalities)

Intestinal Obstruction-Anesthetic Management in Upper GI obstruction1. Obtain I.V. access if not already present

2. Intubate the trachea.

3. Adequate relaxation for abdominal exploration, repair of congenital

defect and closure of abdomen.

4. N2O is seldom contraindicated as there is minimal gas in the upper GI

tract.

5. Depending on the ability to ventilate towards the end of procedure,

opoids may be administered.

6. But the most preferred technique is to administer general anaesthesia

with caudal epidural anaesthesia so as to allow the use of minimal

levels of volatile anaesthetics and minimal relaxant use.

7. Extubation is done if incision is small and the neonate is generally

well disposed. If the baby is debilitated or the surgical incision

extensive, then it will be prudent to avoid extubation and instead

postoperative ventilation is chosen.

Intestinal Obstruction-Anesthetic Management in lower GI obstruction1. Decide on Invasive Arterial line and central venous monitoring.

2. fluid and electrolyte resuscitation.

3. If associated with vomiting and abdominal distension (choose awake

intubation or Rapid sequence intubation-preferably after pre-

oxygenation)

4. If there is associated cardiovascular instability, Ketamine or Etomidate

is chosen as an induction agent.

5. N2O is not used for the obvious reason of avoiding gaseous

distension of intestine.

6. Provide adequate muscle relaxation.

7. remifentanil can be used for its shorter duration of action-thereby

increasing chances of extubation at the end of surgery

8. On similar lines as upper GI obstruction, decide on when to extubate.