[Effect of anesthetics on the function of the gastrointestinal tract]

In spite of numerous interactions between the gut and the entire organism, today's knowledge in this field is still limited. In intensive care patients, reduced gastrointestinal perfusion and motility result in sequestration of fluids and translocation of bacteria and endotoxins, and the immunological function of the gut is depressed. To prevent gastrointestinal organ failure, early restitution of enteral nutrition is a main goal in intensive care medicine. Thus, the influence of anaesthetics on gut function is of special importance in analgosedation of intensive care patients. Pharmacological data of common anaesthetics allow judgement of their global effects on the gut. Interactions with opioid receptors of the enteral nerve system and systemic effects on the vegetative nerve system are of special interest. The results of in vitro and clinical studies show profound negative effects of opiods on gastrointestinal motility. Piritramide seems to be excluded from this judgement, but further studies with equipotent analgetic doses, when compared with fentanyl, are necessary. Ketamine is an analgetic alternative without relevant negative effects on gastrointestinal motility. Among the sedative components of analgosedation, midazolam, gamma-hydroxy butyric acid and probably propofol are useful, whereas barbiturates seem to have negative effects. Epidural anaesthesia with local anaesthetics is of additional benefit.