Gastric disorders: modifications of gastric content, antacids and drugs influencing gastric secretions and motility

Abstract

Gastric disorders have significant relevance to the fields of both anaesthesia and intensive care medicine. Pneumonitis and development of pneumonia in the perioperative period are significant complications following aspiration of gastric acid and stomach contents. Anaesthetists play a key role in minimizing this risk through careful patient selection, pre-assessment and pharmacological management of gastric acid. Proton pump inhibitors are the most used drug class to reduce the risk of stress-related mucosal damage in intensive care and perioperatively. Histamine-2 receptor antagonists and sucralfate are also effective but not routinely used in clinical practice. Sodium citrate is still commonly used in obstetric anaesthesia. Ventilated patients in intensive care may also suffer from intestinal failure either subsequent to postoperative ileus, pharmacological treatments or as part of multi-organ dysfunction. Many strategies have been proposed for the management of intestinal failure in critical care; however, evidence is lacking in this area. Prokinetics including metoclopramide and erythromycin remain key drugs in the management of intestinal failure in current practice.