New Insights into Anesthesia-induced Postoperative Gastrointestinal Dysfunction: From Bench to Bedside

Postoperative Gastrointestinal Dysfunction (PGD), a common surgical complication closely linked to anaesthetic agents and techniques, has garnered increasing research attention under the framework of Enhanced Recovery After Surgery (ERAS), driving significant progress in both basic and clinical understanding. This review aims to summarise the latest advances in anaesthesia-induced PGD, with a focus on its mechanisms, anaesthetic drug effects, and clinical management strategies, to provide evidence-based references for optimising perioperative care.

A comprehensive narrative review of recent literature from PubMed was conducted. The search terms included "anaesthetic drugs," "postoperative gastrointestinal dysfunction," "ERAS," and "multimodal analgesia." Both preclinical and clinical studies were included to synthesize current evidence.

Anaesthetic drugs, especially opioids, significantly inhibit gastrointestinal motility and contribute to PGD. Inhalational anaesthetics such as sevoflurane may increase the risk of intestinal paralysis, while propofol demonstrates protective effects through anti-inflammatory and antioxidant mechanisms. Regional anaesthesia and multimodal analgesia reduce opioid exposure and improve gastrointestinal recovery. Emerging strategies, including novel opioid formulations, modulation of the gut microbiota, and non-pharmacological interventions (e.g., early enteral nutrition, electroacupuncture), show promising potential for mitigating PGD.

Preventing and managing PGD requires optimizing anesthetic protocols, reducing opioid reliance, and integrating multimodal interventions, while future research should prioritize personalized anesthesia, modulation of the gut-brain axis, and AI-enhanced perioperative care to improve outcomes.