title: Randomized clinical trial on the influence of anaesthesia protocol on intestinal motility during laparoscopic surgery requiring small bowel anastomosis.
abstract: BACKGROUND
  Hyperperistalsis of the small bowel during laparoscopic surgery may cause mucosal prolapse and reduce exposure, making laparoscopic suturing or stapling more demanding for the surgeon. Although it is commonly accepted that both opioids and volatile anaesthetics induce intestinal paralysis, intestinal hyperactivity during anaesthesia is not uncommon. This randomized trial investigated the effect of different volatile anaesthetics on intestinal motility and the impact on surgeon satisfaction.
  
  
  METHODS
  Patients scheduled for laparoscopic gastric bypass surgery were randomized to receive sevoflurane or desflurane in a balanced anaesthetic regimen. After surgical exposure peristaltic waves were counted over 1 min in a segment of the jejunum. Following evaluation of intestinal motility, N-butylhyoscine, an antimuscarinic anticholinergic agent that relaxes bowel smooth muscle cells, could be administered if the surgeon judged the intestinal motility as disturbing. The endpoints were number of peristaltic waves and incidence of N-butylhyoscine administration, a surrogate for surgeon satisfaction.
  
  
  RESULTS
  Twenty-two patients were randomized to each group. The groups were similar in age, sex and body mass index. There was a statistically significant difference in intestinal motility between the desflurane and sevoflurane groups: median (range) 7 (0-12) versus 1 (0-10) waves counted over 1 min respectively (P < 0·001). A higher proportion of patients in the desflurane group received N-butylhyoscine (10 of 22 versus 1 of 22 in the sevoflurane group; P = 0·004).
  
  
  CONCLUSIONS
  Desflurane increased intestinal motility and decreased surgeon satisfaction compared with sevoflurane during laparoscopic gastric bypass surgery. A sevoflurane-based anaesthetic protocol can help to avoid disturbing hyperperistalsis.
  
  
  BACKGROUND
  B39620097060 (http://www.clinicaltrials.be).
authors.affiliation: Department of Anaesthesia, Groeninge Hospital, Kortrijk, Belgium. wouter.decorte@azgroeninge.be
authors.forename: W
authors.initials: W
authors.lastname: De Corte
authors.forename: H
authors.initials: H
authors.lastname: Delrue
authors.forename: L J J
authors.initials: LJ
authors.lastname: Vanfleteren
authors.forename: P E M
authors.initials: PE
authors.lastname: Dutré
authors.forename: H
authors.initials: H
authors.lastname: Pottel
authors.forename: D K J C
authors.initials: DK
authors.lastname: Devriendt
authors.forename: F H E C
authors.initials: FH
authors.lastname: Van Rooy
authors.forename: M
authors.initials: M
authors.lastname: D'Hondt
authors.forename: S
authors.initials: S
authors.lastname: Carlier
authors.forename: M B
authors.initials: MB
authors.lastname: Desmet
mesh_terms: D000328:Adult; D018685:Anesthetics, Inhalation; D015992:Body Mass Index; D000077335:Desflurane; D004311:Double-Blind Method; D005260:Female; D015390:Gastric Bypass / Q000379:methods*; D005769:Gastrointestinal Motility / Q000187:drug effects*; D006801:Humans; D007530:Isoflurane / Q000031:analogs & derivatives*; D010535:Laparoscopy / Q000379:methods*; D008297:Male; D008738:Methyl Ethers; D018727:Muscarinic Antagonists / Q000494:pharmacology; D011446:Prospective Studies; D012601:Scopolamine / Q000494:pharmacology; D000077149:Sevoflurane
chemical_list: D018685:Anesthetics, Inhalation; D008738:Methyl Ethers; D018727:Muscarinic Antagonists; D000077149:Sevoflurane; D000077335:Desflurane; D007530:Isoflurane; D012601:Scopolamine