[Anesthesia in the patient with stomach dilatation-volvulus]

Before a decision on the anesthetic protocol and the various patient support measures can be taken, the pathophysiological changes that occur during a gastric dilatation-volvulus need to be evaluated. The most important changes are of a circulatory and/or respiratory nature, inducing hypotension, hypovolaemia, cardiac dysrhythmias, a decreased respiratory minute volume, and subsequently resulting in changes in the acid-base balance and plasma electrolyte concentration. In view of these changes and the increased anaesthetic risk for the patient with gastric dilatation-volvulus, the use of barbiturates or ketamine cannot be recommended for anaesthetising these patients. With the use of neurolept-analgesic combinations, such as methadone-droperidol or sufentanil-midazolam, an increased cardiovascular stability and an ample analgesic effect can be obtained. Especially with the potent sufentanil in combination with midazolam, an excellent anaesthesia for patients with gastric dilatation-volvulus can be achieved.